bluuebunny/crossref_metadata_2025 huggingface dataset:
Morphometric Outcomes of Non-Syndromic Sagittal Synostosis following Open Middle and Posterior Cranial Vault Expansion
Authors: Massenburg Benjamin B. , Mercan Ezgi , Shepard Elizabeth , Birgfeld Craig B. , Susarla Srinivas M. , Lee Amy , Ellenbogen Richard G. , Hopper Richard A.
Published: February 2023

PURPOSE:

This study aims to quantify the change in three-dimensional skull morphometrics for patients with sagittal synostosis (SS) at presentation, after surgery, and at two-year follow-up.

METHODS:

CT scans from 91 patients with isolated SS were age, gender, and race-matched to 273 controls. We performed vector analysis with linear regressions to model the impact of open middle and posterior cranial vault remodeling on cranial shape and growth.

RESULTS:

Anterior cranial volume, bossing angle and frontal shape were not changed by surgery but normalized without surgical intervention by 2 years. Biparietal narrowing and middle cranial volume were corrected after surgery and maintained at 2 years. Occipital protuberance was improved after surgery and normalized at 2 years. Posterior cranial volume was decreased by the occipital remodeling and remained slightly lower than control volumes at 2 years whereas middle vault volume was larger than controls. Residual deformities that persisted at 2 years were decreased superolateral width at the level of opisthion, and increased anterosuperior height (vertex bulge). Linear models suggested older age at surgery resulted in more scaphocephaly and enlarged posterior cranial vault volumes at two years but did not impact other volume outcomes. Preoperative severity was the variable most predictive of 2-year morphometrics.

CONCLUSION:

Initial severity of SS deformity was the best predictor of 2-year morphometric outcomes. Upper posterior cranial width decreases with time after surgery and an anterior vertex bulge can persist after open surgery, but frontal dysmorphology self-corrects without surgical intervention.

LEVEL OF EVIDENCE: III
Assessing the Validity and Reliability of the Zwisch Scale in Plastic Surgery Residency
Authors: Almufarrej Faisal , Shahait Awni , Nava Guillermina
Published: February 2023

Background:

The Zwisch scale is a recognized model for assessing surgical skills competency and autonomy, with paucity of its application in plastic surgery field. We look to assess the validity of utilizing this model for plastic surgery residency programs.

Methods:

This 6-month pilot study was a prospective study with attending surgeons from 3 different teaching hospitals. Two samples were obtained. The first sample contained all procedures performed by a participating faculty member and resident during a specified time period. The second sample was a subset of the first consisting of 15 procedures. The procedures were observed in person by 2 additional surgeons who rated the resident’s performance leveraging the Zwisch scores. A third surgeon utilized the operative skill assessment tool- Ottawa Surgical Competency OR Evaluation (O-SCORE) to provide ratings. All ratings were confidential.

Results:

Six residents and 5 attendings participated with a total number of 126 encounters for 184 procedures. The association between the Q1 (complexity of procedure- easiest, average, hardest) and Q2 (Zwisch level) was estimated with Spearman’s correlation and tested using Chi-square test. ICC and Spearman’s rank correlation coefficient demonstrated validity of the Zwisch scores in plastic surgery procedures with good reliability amongst attending surgeons with resident self-rating decreased score reliability (ICC Without self-rating 0.817, with self-rating 0.752).

Conclusion:

Plastic surgery cases are often more complex and have longer operative times making it difficult to evaluate residents. This research substantiates developing a specifically modified Zwisch scoring system for plastic surgery.
Effective Strategies to Patent Plastic Surgery Ideas and Intellectual Property
Authors: Xu Hong Hao , Kazan Roy , Zammit Dino , Reece Edward , Jowett Nate , Gilardino Mirko S. , Vorstenbosch Joshua
Published: February 2023

Patents are of great importance to plastic surgery, a field fueled by constant innovation. Familiarity with the patent process, in turn, could promote further innovation by plastic surgeons. By granting proprietary rights to inventors in exchange for publication of their inventions, patents incentivize creativity and innovation while simultaneously promoting diffusion and transfer of technology. The task of securing patent protection, however, is complex, and begins well before the patent application. Inventors must familiarize themselves with regulations to ensure that their inventions satisfy the criteria for patentability, which can differ between countries. Patents regarding surgical methods should undergo additional ethical deliberation given their potential interference with medical altruism. The patent application must be thoroughly devised and written as it needs to withstand meticulous examination by patent offices and potential third-party opposition—professional assistance in doing so should thus be sought. Filing of the application calls for intricate procedural and timing requirements that bear major benefits if well understood and respected by applicants. Given that patent rights only cover the issuing country’s territorial scope, further endeavors must be pursued when seeking patent protection in additional countries. In this regard, two options exist, and the ultimate decision should be tailored to each inventor’s personal needs. At every step of the patenting process, financial readiness is key as costs can be unpredictable and quickly escalate. In this manuscript, we propose effective strategies directed at plastic surgeons to facilitate patenting of their ideas and protection of their intellectual property.
Contemporary Lower Body Lift
Authors: Colwell Amy S.
Published: February 2023

Circumferential body contouring addresses abdominal, mons, lateral thigh, and buttock laxity. The goals of contouring are to optimize abdominal aesthetics while also addressing lateral thigh and buttock skin excess with an easily concealed scar. Key concepts in contemporary lower lift include a low anterior scar that gently slopes superior to help with waist accentuation but also address lateral thigh contour. The posterior scar lies at the top of the gluteal crease to preserve buttock aesthetic units, allow for autoaugmentation, and minimize wound healing complications. Patient safety considerations include thromboembolism prevention, minimizing blood loss, and keeping the patient warm. With proper planning, the lower body lift effectively and aesthetically removes circumferential skin laxity.
Lateral Thoracic Vessel as a Recipient Vessel in Immediate Breast Reconstruction after Nipple/Skin-Sparing Mastectomy: Clinical Experience of 270 Perforator Flaps
Authors: Muto Mayu , Satake Toshihiko , Tsunoda Yui , Koike Tomoyuki , Narui Kazutaka , Ishikawa Takashi , Maegawa Jiro
Published: February 2023

Background:

The selection of recipient vessels for free-flap breast reconstruction is important for the success of the surgery and the esthetics of the breast mound. The thoracodorsal artery and vein (TDA/V) allow reconstruction without noticeable scars from the anterior view, but TDA/V exposure is an invasive and time-consuming process on sentinel node biopsy. This study aimed to determine the effectiveness of the lateral thoracic artery and vein (LTA/V) as recipient vessels by comparing them with the TDA/V.

Methods:

This study included 270 flaps that underwent immediate free-flap breast reconstruction after nipple/skin-sparing mastectomy by lateral incision. The patients were categorized into two groups (LTA and TDA) based on the recipient vessel selected.

Results:

The LTA and TDA groups comprised 78 and 192 flaps, respectively. Among the 131 short and small pedicle flaps, such as gluteal artery perforator flap and profunda artery perforator flap, 65 (50%) used LTA as the recipient vessel. The external diameters of the LTA/LTV (median, 1.2 mm/1.5 mm) were significantly lower than those of the TDA/TDV (median, 1.65 mm/2.0 mm). LTV was present in 94% and the second vein was present in 49% of cases with anastomosis. No significant differences in flap-related complications were observed between the two groups.

Conclusions:

LTA/V can be used as recipient vessels for immediate free-flap reconstruction. Because of their superficial location and small caliber, they are easily accessible and suitable for short and small pedicle flaps.
“Gender Considerations in Rhinoplasty”
Authors: Rodriguez Abigail M. , Savetsky Ira L. , Cohen Joshua M. , Avashia Yash J. , Rohrich Rod J. , Rodriguez Eduardo D.
Published: February 2023

Precise nasofacial analysis ahead of rhinoplasty surgery is imperative. Features common to the Caucasian masculine nose are reviewed in a stepwise fashion and contrasted to the Caucasian feminine nose. A solid understanding of the cis-male, masculine nose enables the plastic surgeon to determine the changes required for a successful facial feminizing rhinoplasty, as a part of facial gender confirmation.
Body contouring surgery improves long-term satisfaction with appearance and health-related quality of life after bariatric surgery: BODY-Q results from a Danish cohort study
Authors: Poulsen Lotte , Rae Charlene , Simonsen Nina , Klassen Anne F , Lorenzen Mike , Rose Michael , Juhl Claus B. , Støving René Klinkby , Cano Stefan J , Andries Alin , Pusic Andrea L , Sorensen Jens Ahm
Published: February 2023

Background:

Patient-reported outcomes are crucial in bariatric surgery (BaS) and body contouring surgery (BC) since patients’ goals include improvement in appearance and health-related quality of life (HR-QOL). The BODY-Q is a patient-reported outcome measure developed to measure change in satisfaction with appearance and HR-QOL in BaS and BC patients.

Objectives:

The aim of this study was to examine BODY-Q scores over the entire weight loss journey, and to investigate the impact of BC after BaS.

Methods:

Patients completed the BODY-Q pre/post-BaS and BC at four hospital departments in Denmark between 2015 and 2019. Cross-sectional scores were analyzed by phase of weight loss journey using one-way ANOVA. Scores for patients who provided longitudinal assessments were analyzed using repeat measures ANOVA and paired T-test. The impact of BC was examined over time after BaS, using an Independent T-test from pre BaS through >7 years post BaS.

Results:

The study included 1527 patients who provided 2285 BODY-Q assessments. The cross-sectional analysis by phase of weight loss journey showed higher scores post-BaS, lower scores pre-BC and highest level scores post-BC. The longitudinal analysis showed higher post-surgery mean scores compared to pre-surgery scores for both BaS and BC. The analysis over time after BaS revealed lower mean scores in patients who did not receive BC.

Conclusion:

Our results provide evidence of the positive impact of BaS and BC on patients’ lives and underline the importance of considering BC to finalize the weight loss journey as it helps to maintain improvements in appearance and HR-QOL.
Racial Disparities in the Cost of Unplanned Hospitalizations After Breast Reconstruction
Authors: Nasser Jacob S. , Billig Jessica I. , Wang Chang , Wang Lu , Chung Kevin C.
Published: February 2023

Background:

Given the national attention to disparities in healthcare, understanding variation provided to minorities becomes increasingly important. This study will examine the effect of race on the rate and cost of unplanned hospitalizations after breast reconstruction procedures.

Methods:

We performed an analysis comparing patients undergoing implant-based and autologous breast reconstruction in the Healthcare Cost and Utilization Project (HCUP). We evaluated the rate of unplanned hospitalizations and associated expenditures among patients of different races. Multivariable analyses were performed to determine the association among race and readmissions and healthcare expenditures.

Results:

The cohort included 17,042 patients. The rate of an unplanned visit was five percent. The rates of readmissions among Black patients (6%) and Hispanic patients (7%) in this study are higher compared to White patients (5%). However, after controlling for patient-level characteristics, race was not an independent predictor of an unplanned visit. In our expenditure model, Black patients (adjusted cost ratio, 1.35 [95% CI, 1.11-1.66]) and Hispanic patients (adjusted cost ratio, 1.34 [95% CI, 1.08-1.65]) experienced greater cost for their readmission compared to White patients.

Conclusion:

Although race is not an independent predictor of an unplanned hospital visit after surgery, racial minorities bear a higher cost burden after controlling for insurance status, further stimulating healthcare disparities. Adjusted payment models may be a strategy to reduce disparities in surgical care. Additionally, direct and indirect measures of disparities should be used when examining healthcare disparities to identify consequences of inequities more robustly.
“A Technique for Severe Lower Eyelid Retraction – The Fascia Lata Sling with Lateral Burr Hole”
Authors: Culver Abby J. , Gilliland Connor , Pulikkottil Benson , Gilliland Grant
Published: February 2023

Background:

Lower eyelid retraction is a common and feared complication of both disease processes and aesthetic and cosmetic surgical procedures. A 4 finger approach has been previously described to determine adequate treatment of lid retraction.1 In our experience we have found even the most aggressive treatment of the approach, subperiosteal cheek lift with with canthopexy and interpositional graft, is inadequate to address severe lower lid retraction.

Methods:

We propose a technique of a lower lid fascial sling with a lateral burr hole for support to be used when all 5 fingers are needed to correct the lower lid retraction. Review of 134 patients who underwent the fascia lata sling with lateral burr hole for severe lower lid retraction was performed.

Results:

The fascia lata sling with lateral burr hole adequately corrected the lid retraction in all but 1 patient in one procedure. This patient had persistent lateral ectropion and underwent revision canthoplasty resulting in resolution the lateral ectropion.

Conclusion:

The fascia lata sling with lateral burr hole is a reliable procedure to correct lid retraction from a wide variety of etiologies.

Level of Evidence:

IV
Improving Breast Implant Safety through International Collaboration of National Registries – A Review of over 85000 Patients and 200000 Implants from Four Countries.
Authors: Becherer Babette E. , Hopper Ingrid , Cooter Rodney D. , Couturaud Benoît , von Fritschen Uwe , Mullen Erin , Perks A. Graeme B. , Pusic Andrea L. , Stark Birgit , Mureau Marc A.M. , Rakhorst Hinne A.
Published: February 2023

Background

. Growing awareness about breast implant-related adverse events has stimulated the demand for large, independent data resources. For this, data from breast implant registries could be combined. However, that has never been achieved yet.

Methods

. Real-world data from four currently active national breast implant registries were used. All permanent breast implants from the Australian, Dutch, Swedish and American registries were included. A sub-population present across all registries between 2015-2018 was subsequently selected, including only permanent breast implants inserted during primary surgery for breast reconstruction or augmentation in patients without previous breast device surgery. Nationwide coverage, patient and implant characteristics, infection control measures, and revision incidences were analyzed.

Results

. A total of 207189 breast implants were registered. Nationwide coverage varied between 3-98 percent. The sub-population included 111590 implants (7 percent reconstruction, 93 percent augmentation). Across the registries, mean patient age varied between 41-49 years (P <0.001) for reconstruction and 31-36 years (P <0.001) for augmentation. Variation was observed in implant preferences across the countries and over the years. Infection control measures were most frequently registered in Australia. Cumulative revision incidence at two years ranged from 6-16 percent after reconstruction and 1-4 percent after augmentation.

Conclusion

. For the first time, independent, national, registry-based data from four breast implant registries were combined. This is a powerful step forward in optimizing international breast implant monitoring, evidence-based decision-making, and patient safety.
Examining Between-Group Differences in Social Network Density and High-Sensitivity C-Reactive Protein in Older Adults: Implications for the Hispanic Mortality Paradox
Authors: Flores Melissa , O’Neill Riley M. , Boyd Savannah M. , Uchino Bert N. , Ruiz John M.
Published: February 2023

Objective

Hispanic/Latino(x) and African American/Black older adults experience disproportionate cardiometabolic disease burdens when compared with their non-Hispanic White counterparts. Sources of resilience such as social networks have been found to mitigate the risk of this disease and its end points like high-sensitivity C-reactive protein (hs-CRP). However, little is known about the social network infrastructure among these groups. Moreover, existing work has largely ignored the degree to which members of one’s network are connected to one another (network density), which may be important for navigating structural barriers within interdependent groups. The objective of this study was to understand the association between network density and 5-year hs-CRP (blood spot) and whether this association was moderated by race-ethnicity.

Methods

A subsample of Hispanic/Latino(x), African American/Black, and non-Hispanic White older adults (N = 1431) from the National Social Life Health and Aging Project was used. Multivariable regression was used to estimate the association between network density and its interaction with race-ethnicity, with hs-CRP 5 years later.

Results

Although no main effect of network density on 5-year hs-CRP was found, results revealed a significant network density by race-ethnicity interaction (Wald χ
2(2, 1242) = 3.31, p = .037). Simple slopes analyses revealed that Hispanic/Latino(x) older adults with high network density had significantly lower hs-CRP levels when compared with their same-ethnic counterparts with low network density (b = −0.73, standard error = 0.31, 95% confidence interval = −1.33 to −0.13, p = .018).

Conclusions

Results demonstrate population-level differences in social network structure and differential associations of this infrastructure with health. Implications for the Hispanic Mortality Paradox are discussed.
The Government as Plaintiff: An Analysis of Medical Litigation Against Healthcare Providers in the Eastern Province of the Kingdom of Saudi Arabia
Authors: AlMubarak Sama’a Hamed , Alshatti Fatimah Ali
Published: February 2023

Objectives

The Saudi healthcare and medicolegal systems have seen several developments to improve quality of services and ensure patient safety. However, violation claims have seen an upward trend in the past few years. Several studies have analyzed medical litigation to better understand violations within healthcare sectors and address them accordingly. Such studies have focused extensively on medical litigations filed by patients against healthcare providers, overlooking other plaintiffs, such as governments. In this study, we examined violation claims filed by governmental entities against healthcare providers in the Eastern Province of the Kingdom of Saudi Arabia.

Methods

From 2016 to 2019, 718 healthcare providers were involved in violation claims that were referred to the Medical Offenses Committee. Two logistic regression analyses were performed to identify significant predictors of receiving a guilty verdict and the verdict type (for guilty verdicts), given defendant-related factors.

Results

Eighty-two percent of healthcare providers received a guilty verdict. Guilty verdicts were prevalent among non-Saudis and healthcare providers in the private sector. Healthcare providers working in the private sector were significantly more likely to receive a guilty verdict than healthcare providers working in the public sector. Nurses were significantly less likely to receive a guilty verdict than physicians. Being involved in violation claims with 5 or more codefendants decreased the likelihood of receiving a guilty verdict. In addition, non-Saudis being involved in violation claims with multiple defendants, working in the private sector, and working in pharmacies and medical complexes were significant predictors of the verdict type.

Conclusions

Results of the study extend the extant literature by analyzing medical litigation including plaintiffs other than patients. In addition, the study introduces implications for the government and policymakers as well as areas for future research The study’s findings emphasized the importance of employment sector and number of defendants as significant predictors of violation claims’ verdicts. Policymakers should take into consideration significant predictors to ensure healthcare providers’ compliance with respective rules and regulations. Tailored attention toward these predictors could minimize the prevalence of medical violation claims, ensure patient safety, and avoid associated negative consequences.
Linking Patient Safety Climate With Missed Nursing Care in Labor and Delivery Units: Findings From the LaborRNs Survey
Authors: Zhong Jie , Simpson Kathleen Rice , Spetz Joanne , Gay Caryl L. , Fletcher Jason , Landstrom Gay L. , Lyndon Audrey
Published: February 2023

Objective

This study aimed to explore the association of nurses’ perceptions of patient safety climate with missed nursing care in labor and delivery (L&D) units.

Methods

We recruited nurse respondents via email distribution of an electronic survey between February 2018 and July 2019. Hospitals with L&D units were recruited from states with projected availability of 2018 state inpatient data in the United States. Measures included the Safety Attitudes Questionnaire Safety Climate Subscale and the Perinatal Missed Care Survey. We estimated the relationship between safety climate and missed care using Kruskal-Wallis tests and mixed-effects linear regression.

Results

The analytic sample included 3429 L&D registered nurses from 253 hospitals (response rate, 35%). A majority of respondents (65.7%) reported a perception of good safety climate in their units, with a mean score of 4.12 (±0.73) out of 5. The mean number of aspects of care occasionally, frequently, or always missed on respondents’ units was 11.04 (±6.99) out of 25. χ
2 Tests showed that six mostly commonly missed aspects of care (e.g., timely documentation) and three reasons for missed care (communications, material resources, and labor resources) were associated with safety climate groups (P < 0.001). The adjusted mixed-effects model identified a significant association between better nurse-perceived safety climate and less missed care (β = −2.65; 95% confidence interval, −2.97 to −2.34; P < 0.001) after controlling for years of experience and highest nursing education.

Conclusions

Our findings suggest that improving safety climate—for example, through better teamwork and communication—may improve nursing care quality during labor and birth through decreasing missed nursing care. Conversely, it is also possible that strategies to reduce missed care—such as staffing improvements—may improve safety climate.
Chronic obstructive pulmonary disease and the risk for myocardial infarction by type in people with HIV
Authors: Crothers Kristina , Nance Robin M. , Whitney Bridget M. , Harding Barbara N. , Heckbert Susan R. , Budoff Matthew J. , Mathews William C. , Bamford Laura , Cachay Edward R. , Eron Joseph J. , Napravnik Sonia , Moore Richard D. , Keruly Jeanne C. , Willig Amanda , Burkholder Greer , Feinstein Matthew J. , Saag Michael S. , Kitahata Mari M. , Crane Heidi M. , Delaney Joseph A.C.
Published: February 2023

Objectives:

The relationship between chronic obstructive pulmonary disease (COPD) and cardiovascular disease in people with HIV (PWH) is incompletely understood. We determined whether COPD is associated with risk of myocardial infarction (MI) among PWH, and if this differs for type 1 (T1MI) and type 2 (T2MI).

Design:

We utilized data from five sites in the Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) cohort, a multisite observational study.

Methods:

Our primary outcome was an adjudicated MI, classified as T1MI or T2MI. We defined COPD based on a validated algorithm requiring COPD diagnosis codes and at least 90-day continuous supply of inhalers. We conducted time-to-event analyses to first MI and used multivariable Cox proportional hazards models to measure associations between COPD and MI.

Results:

Among 12 046 PWH, 945 had COPD. Overall, 309 PWH had an MI: 58% had T1MI (N = 178) and 42% T2MI (N = 131). In adjusted models, COPD was associated with a significantly increased risk of all MI [adjusted hazard ratio (aHR) 2.68 (95% confidence interval (CI) 1.99–3.60)] even after including self-reported smoking [aHR 2.40 (95% CI 1.76–3.26)]. COPD was also associated with significantly increased risk of T1MI and T2MI individually, and with sepsis and non-sepsis causes of T2MI. Associations were generally minimally changed adjusting for substance use.

Conclusion:

COPD is associated with a substantially increased risk for MI, including both T1MI and T2MI, among PWH. Given the association with both T1MI and T2MI, diverse mechanistic pathways are involved. Future strategies to decrease risk of T1MI and T2MI in PWH who have COPD are needed.
Participation of HIV-1 infected treatment-naive females in clinical trials and sex differences in efficacy and safety outcomes
Authors: Zhou Shuang , Qi Karen , Nugent Bridget M. , Bersoff-Matcha Susan J. , Struble Kimberly
Published: February 2023

Objectives:

To examine female participation and the observed efficacy and safety by sex from phase 3 HIV-1 trials submitted to the United States Food and Drug Administration (FDA) to support approval or a major labeling change.

Design:

Our analyses were based on phase 3 trials in HIV-1 infected treatment-naive adults submitted to FDA since 2010.

Methods:

We evaluated enrollment of treatment-naive females in 18 clinical trials for HIV-1. Participation to prevalence ratio (PPR) was calculated as the percentage of females among trial participants divided by the percentage of females in the disease population. PPR between 0.8 and 1.2 reflects similar representation of females in the trial and the disease population. Sex differences in efficacy (virologic response rates) and selected safety events were evaluated.

Results:

United States (US) females, particularly US Black females were not adequately represented in clinical trials. The PPR for US females overall was 0.59 and for US Black females was 0.63. Statistically significant sex differences favoring males were observed for efficacy outcomes in both the global population and US participants. Statistically significant sex differences were observed for some safety outcomes.

Conclusions:

US females are underrepresented in phase 3 HIV-1 clinical trials. Underrepresentation was not likely due to enrollment criteria. Statistically significant sex differences were noted for efficacy and selected safety outcomes; however, some differences were not clinically relevant. The ability to detect sex differences was hindered by low numbers of female participants overall and within subgroups. Additional research into innovative approaches to recruit and retain females in clinical trials should continue.
Real world use of dolutegravir two drug regimens
Authors: Bowman Conor , Ambrose Alissa , Kanitkar Tanmay , Flores Katia , Simoes Pedro , Hart Jennifer , Hunter Alan , Akodu Jane , Barber Tristan J.
Published: February 2023

Background:

Since 2015, we prescribed dolutegravir (DTG)-based two drug regimens (DTG-2DR) for 620 people [total cohort 3133 (19.8%)].

Method:

Clinic database search 1 January 15 to 31 October 21. Demographic, tolerability and HIV related data analysed.

Results:

In total, 620 people identified; 561 had complete data. 446 male (79.5%); median age 54 years (interquartile range 46, 59). 343 (61.1%) MSM. Nine people who initiated naïvely achieved viral suppression (100%). 546/552 (99.0%) switched or continued and were suppressed at data censor. 460/552 (83.3%) received DTG-lamivudine (DTG/3TC), 74/552 (13.4%) received DTG-rilpivirine (DTG/RPV) and 18/552 (3.3%) received DTG-emtricitabine (DTG/FTC). 70 (12.5%) switched off DTG-2DR (55 DTG/3TC, 13 DTG/RPV, two DTG/FTC) due to side-effects. 41 episodes of blip (1 off >50 copies/ml) occurred in 30 people (5.3%). 11/41 on DTG-RPV [n = 7 multi-tablet regimen (MTR), n = 4 single tablet regimen (STR)]. 27/41 DTG-3TC, 3/41 DTG/FTC (n = 26 MTR, n = 4 STR). Six people (1.1%) failed (confirmed viral load >200 copies/ml or persistent low level viraemia) (n = 4 DTG-3TC STR, n = 1 DTG-3TC MTR, n = 1 DTG-RPV MTR). Four failures due to low level viraemia, one due to non-adherence and one due to high viral load. Resistance tests performed for 5/6 – mutations detected only in latter person with high viral load failure (on DTG-3TC MTR) who developed triple class resistance.

Conclusion:

Majority of experience is in DTG/3TC stable switch. Minority of patients developed side-effects. Low number of virological failures, one developed integrase inhibitor resistance. Viral failure associated with MTR, commensurate with trial data showing no failure with resistance if DTG/3TC STR used. Overall DTG-2DR demonstrates high efficacy in real-world setting.
Auditory Function in the Pediatric HIV/AIDS Cohort Study Adolescent Master Protocol Up Young Adults: A Pilot Study
Authors: Torre Peter , Zhang Zhongli J. , Hoffman Howard J. , Frederick Toni , Purswani Murli , Williams Paige L. , Yao Tzy-Jyun ,   for the Pediatric HIV/AIDS Cohort Study (PHACS)
Published: February 2023

Background:

To collect and compare selected hearing measures in a pilot study of young adults with perinatally acquired HIV (YAPHIV) and those with perinatal HIV exposure who are uninfected young adults with PHEU (YAPHEU).

Setting:

Cross-sectional hearing measures in YAPHIV and YAPHEU enrolled in the Pediatric HIV/AIDS Cohort Study Adolescent Master Protocol (AMP) for Participants 18 Years of Age and Older (AMP Up).

Methods:

Pure-tone air conduction audiometry and distortion product otoacoustic emission (DPOAE) data were collected in 1 visit. A low-frequency pure-tone average (PTA) (LFPTA, at 0.25, 0.5, 1, and 2 kHz), a speech-frequency PTA (SFPTA, at 0.5, 1, 2, and 4 kHz), and a high-frequency PTA (HFPTA, at 3, 4, 6, and 8 kHz) were calculated. Hearing loss was defined as worse ear SFPTA of ≥20 dB HL. Separate linear regression models were fit for worse ear LFPTA, SFPTA, and HFPTA to assess associations with PHIV status. DPOAE signal-to-noise ratios (SNRs) were obtained at 3 frequencies in each ear.

Results:

Forty-seven YAPHIV and 9 YAPHEU completed hearing testing. All adjusted mean PTAs were similar between YAPHIV and YAPHEU. Hearing loss occurred more in YAPHIV (7/47, 15.2%; 95% CI: 6.3%–28.9%), compared with YAPHEU (0/9, 0%). No associations were detected between HIV disease severity measures and worse ear SFPTA. DPOAE SNRs were similar between YAPHIV and YAPHEU.

Conclusions:

In this pilot study, peripheral hearing (ie, PTAs) and cochlear function (ie, DPOAEs) were similar between YAPHIV and YAPHEU. A larger study is warranted to confirm these findings.
Impact of COVID-19 Response on the HIV Epidemic in Men Who Have Sex With Men in San Francisco County: The Importance of Rapid Return to Normalcy
Authors: Liang Citina , Suen Sze-chuan , Nguyen Anthony , Moucheraud Corrina , Hsu Ling , Holloway Ian W. , Charlebois Edwin D. , Steward Wayne T.
Published: February 2023

Background:

In response to the COVID-19 pandemic, San Francisco County (SFC) had to shift many nonemergency health care resources to COVID-19, reducing HIV control resources. We sought to quantify COVID-19 effects on HIV burden among men who have sex with men (MSM) as SFC returns to pre-COVID service levels and progresses toward the Ending the HIV Epidemic (EHE) goals.

Setting:

Microsimulation model of MSM in SFC tracking HIV progression and treatment.

Methods:

Scenario analysis where services affected by COVID-19 [testing, care engagement, pre-exposure prophylaxis (PrEP) uptake, and retention] return to pre-COVID levels by the end of 2022 or 2025, compared against a counterfactual where COVID-19 changes never occurred. We also examined scenarios where resources are prioritized to reach new patients or retain of existing patients from 2023 to 2025 before all services return to pre-COVID levels.

Results:

The annual number of MSM prescribed PrEP, newly acquired HIV, newly diagnosed, and achieving viral load suppression (VLS) rebound quickly after HIV care returns to pre-COVID levels. However, COVID-19 service disruptions result in measurable reductions in cumulative PrEP use, VLS person-years, incidence, and an increase in deaths over the 2020–2035 period. The burden is statistically significantly larger if these effects end in 2025 instead of 2022. Prioritizing HIV care/prevention initiation over retention results in more person-years of PrEP but less VLS person-years and more deaths, influencing EHE PrEP outcomes.

Conclusions:

Earlier HIV care return to pre-COVID levels results in lower cumulative HIV burdens. Resource prioritization decisions may differentially affect different EHE goals.
Dedicated Research Seed Funding to Support High-Priority Clinician-Led Research: A Survey of Clinician-Researchers
Authors: Morassaei Sara , Kahumba Levina B. , Liszewski Brian , Di Prospero Lisa
Published: February 2023

Background and Objectives:

Developing research capacity and supporting research engagement among health professionals are essential parts of bridging the evidence-to-practice gap. The objective of this study was to describe and assess the impact of research seed funding in promoting the engagement of nursing and allied health professionals in leading practice-based research studies within a health care organization.

Methods:

An impact assessment survey was administered to health professional grant recipients (n = 30) to collect self-reported observations of changes related to clinical practice, patient care, and organizational priorities as a result of the funded research projects. The electronic survey was developed in collaboration with an interprofessional advisory committee and contained 23 closed- and open-ended questions. Survey data were analyzed descriptively, and responses to open-ended survey questions were used to characterize the funded research activities and the perceived successes and challenges experienced by the research teams.

Results:

A large proportion of health professional grant recipients reported observing impact from their research studies on clinical practice, organizational priorities, and external networks. The grant funds were used to carry out knowledge dissemination activities such as conference presentations, publications, and sharing findings at professional meetings and networks. The majority of grant expenditures were used for research personnel, and the most common challenge to conducting research was related to the need for protected research time. Most grant recipients were interested in participating in another grant-funded research project in the future.

Conclusion:

Organizational funding and support for research led by health professionals have potential impact on clinical practice, patient care, and organizational priorities. This study provides evidence to support the value of investing in continued and expanded research funding programs for health professionals.
Reducing Unnecessary Complete Blood Count Ordering Through Education and Standardization: A Quality Improvement Initiative
Authors: Gujju Veena R. , Khattab Mahmood , Kastens Valerie , Saeed Ghayur , Chen Sixia , Khattab Mohamad
Published: February 2023

Background and Objectives:

The American Board of Internal Medicine's Choosing Wisely campaign recommends against ordering repetitive complete blood counts (CBC) in the face of clinical and laboratory stability.

Methods:

Consecutive patients admitted to a teaching team were included. Intervention 1 was an educational lecture outlining costs of and indications for CBC ordering. Intervention 2 added a simplified algorithm to help providers determine the need for a daily CBC. The primary outcome measure was the number of CBCs ordered per number of patients per day. The secondary outcome measure was net cost saved. The process measures were lecture/poster and algorithm utilization rates. The balancing measure was emergency department visits/readmissions within 7 days of discharge. A statistical process control chart was generated to assess special cause variation. Using R software version 3.5.2, a 2-sample t test and Fisher exact test differences between groups in the outcome and balancing measures.

Results:

One hundred ten patients were included over a 62-day period. The difference between the pre-intervention group and both interventions combined was significant (P = .000317). Special cause variation was observed after institution of both interventions in conjunction. Net costs saved totaled $43 482. Emergency department visits/readmissions within 7 days were similar between the groups (P = .1403).

Conclusions:

Complete blood count ordering patterns and costs were improved through education and providing a decision support tool in the form of a simplified algorithm, without increasing 7-day emergency department visits/readmissions. The algorithm, far less detailed than that previously published, still resulted in significant improvement without unintended consequences, making for a safe and potentially sustainable intervention.
Comparison Between Amide Proton Transfer Magnetic Resonance Imaging Using 3-Dimensional Acquisition and Diffusion-Weighted Imaging for Characterization of Prostate Cancer: A Preliminary Study
Authors: Kido Ayumu , Tamada Tsutomu , Ueda Yu , Takeuchi Mitsuru , Kanki Akihiko , Yamamoto Akira
Published: February 2023

Objective

This study aimed to compare diagnostic performance for tumor detection and for assessment of tumor aggressiveness in prostate cancer (PC) between amide proton transfer magnetic resonance imaging (MRI) with 3-dimensional acquisition (3DAPT) and diffusion-weighted imaging.

Methods

The subjects were 23 patients with 27 pathologically proven PCs who underwent 3T multiparametric MRI. With reference to the pathology findings, 2 readers in consensus identified the location of PC on multiparametric MRI and measured APT signal intensity (APT SI [%]) and mean apparent diffusion coefficient (ADC) of the benign region and each PC lesion.

Results

The mean ADC showed a significant difference between benign regions and PC lesions (0.74 ± 0.15 vs 1.37 ± 0.21, P < 0.001), whereas APT SI did not (P = 0.091). Lesion APT SI was significantly higher and lesion ADC was significantly lower in PCs with Gleason group (GG) ≥3 than in PCs with GG ≤2 (3.37 ± 1.30 vs 1.78 ± 0.67, P < 0.001, and 0.71 ± 0.18 vs 0.79 ± 0.10, P = 0.038, respectively). The APT SI was significantly higher in GG3 than in GG1, in GG3 than in GG2, and in GG4 than in GG2 (P = 0.009, P = 0.001, and P = 0.006, respectively). The area under the curve for separating tumor lesions and benign regions was 0.601 for 3DAPT and 0.983 for ADC (P < 0.001). The area under the curve for separating tumors with GG ≤2 from tumors with GG ≥3 was 0.912 for 3DAPT and 0.734 for ADC (P = 0.172).

Conclusions

In patients with PC, it might be preferable to use ADC to discriminate benign from malignant tissue and use APT SI for assessment of tumor aggressiveness.
Growth Rates of Pulmonary Carcinoid Tumors and Hamartomas
Authors: Ryan James W. , Hammer Mark M.
Published: February 2023

Background

Pulmonary nodule growth is often measured by volume doubling time (VDT), which may guide management. Most malignant nodules have a VDT of 20 to 400 days, with longer VDTs typically observed in indolent nodules. We assessed the utility of VDT in differentiating pulmonary carcinoids and hamartomas.

Methods

A review was performed from January 2012 to October 2021 to identify patients with pathologic diagnoses and at least 2 chest computed tomography scans obtained 6 or more months apart. Visualization software was used to segment nodules and calculate diameter and volume. Volume doubling time was calculated for scans with 1-mm slices. For the remainder, estimated nodule volume doubling time (eVDT) was calculated using nodule diameter. Volume doubling times/eVDTs were placed into growth categories: less than 400 days; 400–600 days; and more than 600 days.

Results

Sixty nodules were identified, 35 carcinoids and 25 hamartomas. Carcinoids were larger than hamartomas (median diameter, 13.5 vs 11.5 mm; P = 0.05). For carcinoid tumors, median VDT (n = 15) was 1485 days, and median eVDT (n = 32) was 1309 days; for hamartomas, median VDT (n = 8) was 2040 days and median eVDT (n = 25) was 2253 days. Carcinoid tumor eVDT was significantly shorter than hamartomas (P = 0.03). By growth category, 1 of 25 hamartomas and 5 of 35 carcinoids had eVDT less than 400 days and 24 of 25 hamartomas and 27 of 35 carcinoids had eVDT more than 600 days. Of 4 carcinoid tumors with metastases, 2 had eVDT less than 400 days and 2 had eVDT more than 600 days.

Conclusions

Growth rate was not a reliable differentiator of pulmonary hamartomas and carcinoids. Slow growing carcinoids can metastasize. Radiologists should be cautious when discontinuing computed tomography follow-up based on growth rates alone.
Extramedullary Hematopoiesis: A Forgotten Diagnosis and a Great Mimicker of Malignancy
Authors: Fouladi Daniel Fadaei , Fishman Elliot K. , Kawamoto Satomi
Published: February 2023

Radiology errors have been reported in up to 30% of cases when patients have abnormal imaging findings. Although more than half of errors are failures to detect critical findings, over 40% of errors are when findings are recognized but the correct diagnosis or interpretation is not made. One common source of error is when imaging findings from one process simulate imaging findings from another process but the correct diagnosis is not made. This can result in additional imaging studies, unnecessary biopsies, or surgery. Extramedullary hematopoiesis is one of those uncommon disease processes that can produce many imaging findings that may lead to misdiagnosis. The objective of this article is to review the common and uncommon imaging features of extramedullary hematopoiesis while presenting a series of interesting relevant illustrative cases with emphasis on CT.
Cognitive Dysfunction Biomarkers in Patients With Rheumatoid Arthritis
Authors: Sousa Daniela Cabral de , de Almeida Samuel Brito , Roriz Filho Jarbas de Sá , Freitas Thiago Holanda , Braga-Neto Pedro
Published: February 2023

Background/Objectives

During the last years, a growing number of studies have investigated the link between cognitive dysfunction and rheumatoid arthritis (RA), highlighting the potential pathogenic role of several clinical, psychological, and biological factors. We aimed to investigate serological and cerebrospinal fluid biomarkers in humans and its association with cognitive dysfunction in patients with RA.

Methods

We performed a systematic review using PRISMA (Preferred Reported Items for Systematic Reviews and Meta-analysis) protocol. A systematic search was conducted in the PubMed/MEDLINE, EMBASE, LILACS, Scopus, and Google Scholar databases from inception up to November 2021. The inclusion criteria for studies were defined based on the participants involved, type of exposure, type of comparison group, outcome of interest, and study design.

Results

Five original studies were included, which provided data from 428 participants. Among plasma proteins, SHH was increased and TTR was reduced in patients with mild cognitive impairment; anti–myelin basic protein and anti–myelin oligodendrocyte glycoprotein negatively correlated with memory, executive function, and attention. S100β negatively correlated with memory and executive functions; some lymphocyte subpopulations positively correlated with attention, memory, and executive functions. Interleukin 2 [IL-2], IL-4, IL-6, and tumor necrosis factor α negatively correlated with memory and positively correlated with executive functions. Interleukin 1β negatively correlated with global cognitive dysfunction and positively correlated with logical thinking. Interleukin 10 and brain-derived neurotrophic factor negatively correlated with memory.

Conclusion

Despite the relative scarcity of studies on this subject and the heterogeneity of results, we identified possible biomarkers for cognitive deficits in the RA population. Further longitudinal studies are warranted to clarify these associations and the establishment of possible biomarkers for cognitive deficits in RA.
Hospital Admissions and Mortality in Patients With Anti–Neutrophil Cytoplasmic Antibody–Associated Vasculitis
Authors: Sims Catherine , Golenbiewski Jon , Eudy Amanda M. , Allen Nancy B. , Clowse Megan E. B.
Published: February 2023

Background/Objectives

Anti–neutrophil cytoplasmic antibody–associated vasculitis has reported hospital mortality rates ranging between 10% and 20% with inadequate information regarding causes and outcomes of these hospitalizations. Characterization of outcomes in anti–neutrophil cytoplasmic antibody–associated vasculitis can improve patient care and prognostication following hospitalization.

Methods

A medical records review of all hospitalizations between October 1, 2015, and December 31, 2018, of adults with granulomatosis with polyangiitis or microscopic polyangiitis at a single academic medical center was performed. Chart review confirmed diagnoses in patients identified by International Classification of Diseases, Tenth Revision code. Vasculitis activity was determined based on clinical data and treatment during the hospitalization. Differences in outcome measures were analyzed using Fisher exact test, t test, and Wilcoxon signed-rank test.

Results

Of the 127 hospitalizations among 54 patients, active vasculitis was identified in 43 hospitalizations (33.9%). A total of 15 patients with active disease, including 10 patients with a new diagnosis, required intensive care unit (ICU)–level care. Of 84 hospitalizations when vasculitis was inactive, infection was diagnosed in 31 admissions (36.9%), with inactive disease representing 44% of all ICU admissions. Overall mortality was 7% for hospitalized patients and 15% for those admitted to the ICU. An additional 5 patients died within 28 days of discharge, for an overall mortality rate of 17%. All 4 hospital deaths and 3 of 5 postdischarge deaths were in the setting of known infection.

Conclusion

Most hospitalizations and patient deaths were in the context of inactive vasculitis, with infection being the most common cause. Infection and ICU admission were associated with patient death.