bluuebunny/crossref_metadata_2025 huggingface dataset:
Abdominal Flap-based Breast Reconstruction versus Abdominoplasty: The Impact of Surgical Procedure on Scar Location
Authors: Li Alexander Y. , Momeni Arash
Published: February 2021

Background:

Autologous breast reconstruction has been demonstrated to be associated with superior patient-reported outcomes, and hence is regarded as the gold standard reconstructive modality. A common drawback of this procedure, however, is related to a high abdominal scar. Recently, hybrid breast reconstruction (ie, the combination of autologous and implant-based reconstruction) was presented as an approach that would combine the benefits of both reconstructive modalities. In this study, we sought to assess abdominal aesthetic outcomes associated with this approach.

Methods:

Thirty-two blinded reviewers evaluated standardized pre- and postoperative abdominal images of patients following autologous reconstruction with free abdominal flap (Group 1; N = 10), hybrid reconstruction (Group 2; N = 5), and abdominoplasty (Group 3; N = 10). Aesthetic abdominal appearance, including overall result, scar position, skin redundancy, and lateral abdominal contour, was rated on a 5-point Likert scale and a comparative analysis was performed.

Results:

Hybrid reconstruction was associated with significantly lower abdominal scars compared with Group 1 (P = 0.01), nearing results of patients in Group 3 (P = 0.39). Significantly higher aesthetic ratings were ascribed to Groups 2 and 3 when compared with Group 1 (P < 0.001) with regard to scar positioning (P < 0.001), skin redundancy (P < 0.001), and lateral abdominal contour (P < 0.001). No significant difference in aesthetic ratings was noted between Groups 2 and 3.

Conclusions:

When applied to the appropriate patient population, hybrid breast reconstruction is a powerful method to achieve reconstructive goals while optimizing abdominal aesthetics. A significantly lower scar position was noted and higher abdominal aesthetic ratings were given following abdominoplasty and hybrid reconstruction compared with conventional abdominal flap-based reconstruction.
Factors Affecting the Outcome of Frontalis Sling Surgery in Patients with Severe Blepharoptosis
Authors: Al Mansory Amer S.
Published: February 2021

Background:

Several factors play a role in the outcome of severe blepharoptosis correction by frontalis sling surgery, including the age of a patient, sex, causes of ptosis, and its severity, among others. Identifying the factors that most severely affect surgical outcomes could reduce the complication rate and improve patients’ satisfaction.

Methods:

This was a retrospective analytical study using logistic regression statistics to evaluate the effects of the following 6 factors on frontalis sling surgical outcomes: age, sex, cause of ptosis, type of anesthesia used, eye side (right or left), degree of ptosis, and levator function. These factors were compared with 10 types of surgical outcomes. The study included 120 eyelids in 95 patients, of which 70 eyelids were unilateral and 50 eyelids were bilateral. Patient ages ranged between 2 and 75; patient sex distribution was 47.5% females and 52.5% males.

Results:

The study yielded 60 comparison tables. Only statistically significant and clinically relevant data are presented and discussed. Overall, male patients showed better eye symmetry (P < 0.026) and better satisfaction (P < 0.004) than did females. Causes other than the congenital ptosis are characterized by better eye closure during sleep (P = 0), in comparison with congenital ptosis cases.

Conclusion:

The use of silk suture as a sling material is recommended for male patients, as its use produces better results, including eye symmetry and patient satisfaction, with a lower complication rate compared with that in female patients.
Abnormal Cranial Shape Preceding Radiographic Evidence of Craniosynostosis
Authors: Fazzino Josie Z. , Mantilla-Rivas Esperanza , Talbet Joseph H. , Kapoor Elina , Manrique Monica , McGrath Jennifer L. , Magge Suresh N. , Oh Albert K. , Rogers Gary F.
Published: February 2021

Premature fusion of a cranial suture is known to result in characteristic changes in the head shape, even when the synostosis involves only part of the suture. We report an unusual case of a patient seen at the age of 2 months for an abnormal head shape that was present at birth. The phenotype was consistent with an isolated fusion of the frontosphenoidal suture, but the suture was open on a high-resolution computed tomography scan finding. There was no improvement in cranial form after 6 months of helmet therapy, and a follow-up computed tomography scan image taken at age 10 months showed the development of bilateral isolated frontosphenoidal synostosis. This case highlights that an abnormal head shape may, in some patients, predate radiographic evidence of craniosynostosis.
Transitioning Multidisciplinary Craniofacial Care to Telehealth during the COVID-19 Pandemic: A Single Center Experience
Authors: Badiee Ryan K. , Willsher Heidi , Rorison Eve , Langham Margaret , Donnelly Andrea , Rosenbluth Glenn , Pomerantz Jason H.
Published: February 2021

Craniofacial clinics are composed of multidisciplinary teams of providers to deliver coordinated and comprehensive patient care. The coronavirus disease of 2019 (COVID-19) pandemic has disrupted this model, as social distancing guidelines have precluded in-person patient appointments and forced clinics to reconsider their method of care delivery. The University of California, San Francisco, Craniofacial Center has continued to serve patients during this acute period, adopting a hybrid model in which the vast majority of patients are seen through telehealth and a limited number of patients are evaluated in-person. Surveyed patients and families reported high rates of satisfaction, with time savings cited as a particular benefit. Furthermore, most felt comfortable using the video technology required for their appointment. This experience has demonstrated to us that multidisciplinary craniofacial evaluations can be effectively delivered in a telehealth format and has informed our conception of idealized clinic structure. Moving forward, we intend to utilize telehealth visits for selected components of craniofacial evaluations in an effort to maximize efficiency and minimize burden, including addressing barriers to accessing care. Benefits of a hybrid model will include decongestion of clinics and waiting areas, allowing social distancing, addressing clinic space limits, and increased efficiency by eliminating the need for patient and family movement. Demonstration of the safety and efficacy of telehealth visits, combined with regulatory reform that improves reimbursement and allows for appointments across state lines, will be critical for this model to persist beyond the pandemic.
Algorithm for Management of Mandibular Condylar Base Fractures
Authors: Peterson Erin C. , Nguyen Dennis C. , Baughman Ethan J. , Skolnick Gary B. , Chi John J. , Patel Kamlesh B.
Published: February 2021

Background:

Increasing evidence suggests that open reduction and internal fixation of condylar base fractures in adults results in improved outcomes in regard to interincisal opening, jaw movement, pain, and malocclusion. However, most of the condylar fractures are managed by maxillomandibular fixation alone due to the need for specialized training and equipment. Our aim was to present an algorithm for condylar base fractures to simplify surgical management.

Methods:

A retrospective review was performed of patients (n = 22) with condylar base fractures treated from 2016 to 2020. Patients who presented with operative fractures that require open treatment underwent 1 of 2 different techniques depending on the fracture type: a preauricular approach with a transoral approach if the condyle was dislocated (n = 2) or a transoral only approach (n = 20) in nondislocated cases. Operative time, occlusion, range of motion, and postoperative complications were assessed.

Results:

Condylar base fractures were combined with other mandibular fractures in 16 of 22 patients. Patients with condylar dislocation were managed with a preauricular approach with a secondary transoral incision (n = 2, median 147 minutes). Those without dislocation were treated with a transoral approach (n = 20, median 159 minutes). Most patients were restored to their preoperative occlusion without long-term complications.

Conclusions:

We present a simplified algorithm for treating condylar base fractures. Our case series suggests that reduction in operative time and clinical success can be achieved with open reduction and internal fixation using a transoral approach alone or in combination with a preauricular approach for dislocated fractures.
Biopsy Results Are Not Sufficient to Exclude Breast Implant–associated Anaplastic Large Cell Lymphoma: A Case Mistaken for Disseminated Silicosis
Authors: Freedman Jonathan , Peredo Andrew , Rosser Julie , Christian Nicole , Kaoutzanis Christodoulos
Published: February 2021

We present a case report of breast implant–associated anaplastic large cell lymphoma (BIA-ALCL) that was mistaken as disseminated silicosis after multiple percutaneous biopsies. The correct diagnosis of BIA-ALCL was confirmed only after a pathologic examination of the capsulectomy specimens. A review of the literature of percutaneous biopsies of ALCL showed a diagnostic yield of only 63%. Although percutaneous biopsies may be facile to obtain and may be diagnostic, in our case, biopsies were not sufficient to exclude the diagnosis of BIA-ALCL.
The Public’s Awareness and Willingness to Undergo Plastic Surgery Procedures during the COVID-19 Pandemic
Authors: Gelidan Adnan G. , Mrad Mohamed A. , Kattan Abdullah E. , Kattan Wid E. , AlEnazi Thamer H. , Bakraa Reem M. , Barry Mazen A.
Published: February 2021

Background:

In March 2020, the Saudi Ministry of Health implemented mitigation measures to control the Coronavirus Disease 2019 (COVID-19) pandemic, including media campaigns, a nationwide lockdown, and closures of plastic surgery clinics. The aim of this study was to explore the public’s knowledge of COVID-19, their willingness to undergo cosmetic surgery during the pandemic, and the factors influencing their decisions.

Methods:

An internet-based cross-sectional survey was conducted. We collected data on demographic information, knowledge about COVID-19, and willingness to undergo cosmetic procedures. Participants also completed the cosmetic procedure screening questionnaire to assess body dysmorphic disorder.

Results:

The sample included a total of 1643 participants (women, n = 1002; 61%). A total of 613 (37.3%) participants were aged between 30 and 40 years. The majority (n = 1472; 89.6%) referred to official government accounts for information regarding COVID-19. Most participants (n = 1451; 88.3%) felt that the pandemic was serious, and 1387 (85%) said they would not leave home to undergo cosmetic procedures during the outbreak. Being women, the presence of body-image concerns, and higher cosmetic procedure screening questionnaire scores were associated with an increased willingness to undergo cosmetic procedures.

Conclusions:

This is the first study to explore the public’s willingness to undergo cosmetic procedures during the COVID-19 pandemic. The public was well educated about the pandemic, via government actions. This was reflected in participants who wished to undergo a cosmetic plastic procedure; we identified factors associated with an increased willingness to undergo procedures, which may help design awareness initiatives.
Recommendations to Safeguard Reconstructive Microsurgeons Performing High-risk Operations during the COVID-19 Pandemic
Authors: AL Deek Nidal F. , Wei Fu-Chan
Published: February 2021

An unprecedented number of health care providers have been infected and many have died during the COVID-19 pandemic. Reconstructive microsurgeons from different surgical backgrounds often are involved in the care of known COVID-19 and high-risk patients. The need for a magnification loupe/microscope makes it difficult for them to wear recommended personal protection equipment, increasing the risk of exposure. Although advanced technologies are available, they have not been exploited effectively. To date, no safety guidelines are available for safe reconstructive microsurgical procedures in high-risk operations/known COVID-19 patients—particularly, to address operations risk and COVID-19 status of the patients, who would operate, how many should be involved, how to equip the surgeons for the procedure, when to operate as the procedure unfolds, how to adapt surgical techniques to reduce exposure risk, and can advanced technology be used to minimize exposure. A set of safety recommendations were thus developed based on literature review and firsthand knowledge of safety procedures during the COVID-19 pandemic. Current understanding of COVID-19 virology can optimize surgical team buildup and dynamics. Operating smaller teams (in a sequential style), minimizing the use of aerosols-generating devices, and modifying surgical plan and flap selection could aid in diminishing the risk of exposure and in conserving resources. Modifications in loupes design, and the combined wear of surgical mask and N95 respirators, and efficient use of “buddy system” could aid in protecting surgeons during donning and doffing. “Remote operating” is a novel concept of using a surgical robot to maximize surgeons’ safety during COVID-19 pandemic.
Open Abdomen Negative Pressure Device Applied for Two-stage Closure of Enterocutaneous Fistula
Authors: Fujisawa Kou , Kitatsuji Maki , Yamamoto Yusuke
Published: February 2021

Enterocutaneous fistula (ECF), which is an abnormal connection between the gastrointestinal tract and skin, is a serious complication of abdominal surgery, and a multidisciplinary approach is required for its treatment. Here, we report the case of a 46-year-old woman who had a large ECF measuring 6 × 12 cm that was successfully treated with a 2-stage surgery. After the first surgery of intestinal wall reconstruction, an abdominal negative pressure wound therapy (NPWT) device was administered to facilitate the reexploration of the abdominal cavity. On postoperative day 5, intestinal perforation and abdominal cavity infection were found during dressing change and were immediately repaired. Subsequently, after 10 days of abdominal NPWT, the second surgery comprising abdominal wall reconstruction was performed using a pedicled anterolateral thigh flap (8 × 19 cm) combined with the fascia lata (12 × 20 cm). The defective rectus sheath and skin were uneventfully closed with the fascia lata and flap skin paddle, respectively. In the follow-up after 7 months, ECF had not recurred. The abdominal NPWT device enabled easy reentry of the abdominal cavity and reduced the size of the flap needed to cover the defect. Moreover, open abdominal management can be performed consistently, independent of the surgeon’s expertise. Therefore, this report suggests that 2-stage surgery with abdominal NPWT management is a useful strategy for ECF treatment.
Uterine septum: a case report and a recommendation to change the current guidelines
Authors: Timmons Douglas , Rivera Mudafort Estefania , DeCherney Alan
Published: February 2021

Müllerian anomalies are the result of an embryological error in normal anatomic development and can result in malformations of the fallopian tubes, uterus, cervix, or within the upper two-thirds of the vagina. Uterine malformations, specifically a septate uterus, is a common type of Müllerian anomaly and have been associated with decreased fertility, increased rates of miscarriage and preterm birth, along with other adverse fetal outcomes. At this time, septum resection is recommended only for patients with a septate uterus and a history of recurrent pregnancy loss, and is not universally recommended for patients with unexplained infertility or brfore in vitro fertilization. This recommendation should be revisited as we now have sufficient evidence to support septum resection in those with unexplained infertility and in those who are attempting in vitro fertilization.
Septal curvature as a robust and reproducible marker for basal septal hypertrophy
Authors: Marciniak Maciej , Gilbert Andrew , Loncaric Filip , Fernandes Joao Filipe , Bijnens Bart , Sitges Marta , King Andrew , Crispi Fatima , Lamata Pablo
Published: February 2021

Background:

Basal septal hypertrophy (BSH) is an asymmetric, localized thickening of the upper interventricular septum and constitutes a marker of an early remodelling in patients with hypertension. This morphological trait has been extensively researched because of its prevalence in hypertension, yet its clinical and prognostic value for individual patients remains undetermined. One of the reasons is the lack of a reliable and reproducible metric to quantify the presence and the extent of BSH. This article proposes the use of the curvature of the left ventricular endocardium as a robust feature for BSH characterization, and as an objective criterion to quantify current subjective ‘visual assessment’ of the presence of sigmoidal septum. The proposed marker, called average septal curvature, is defined as the inverse of the radius adjacent to each point of the endocardial contour along the basal and mid inferoseptal segments of the left ventricle.

Method:

Robustness and reproducibility were assessed on a cohort of 220 patients, including 161 hypertensive patients (32 with BSH) and 59 healthy controls.

Results:

The results show that compared with the conventionally used wall thickness metrics, the new marker is more reproducible (relative standard deviation of errors of 7 vs. 13%, and 8 vs. 38% for intra-observer and inter-observer variability, respectively) and better correlates to the functional parameters related to BSH, with main difference (absolute rank correlation 0.417 vs. 0.341) in local deformation changes assessed by longitudinal strain.

Conclusion:

Average septal curvature is a more precisely defined and reproducible metric than thickness ratios, it can be fully automated, and better infers the functional remodelling related to hypertension.
Modified Contact Lens Sandwich Technique of Glue for Management of Medium to Large Corneal Perforations in the COVID Era
Authors: Bafna Rahul K. , Lata Suman , Asif Mohamed I. , Kalra Nidhi , Agarwal Rinky , Sharma Namrata
Published: February 2021

The aim of this article is to describe a novel technique of gluing as an interim measure to provide tectonic support in cases of medium-sized to large-sized (3–6 mm) corneal perforations. Five eyes of five patients in which conventional cyanoacrylate glue application was not feasible, and therapeutic keratoplasty could not be performed in view of the unavailability of corneal tissues were included. Surgery to maintain integrity of the globe was performed, and a therapeutic keratoplasty was performed on tissue availability (mean interval of 7.4 days). On follow-up, all patients had a well-formed anterior chamber, and none of them had progression. The contact lens sandwich technique of glue was a feasible, reproducible, and economical technique during times of tissue unavailability such as the present COVID pandemic, in patients with medium to large perforated corneal ulcers.
Companies That Promote a Culture of Health, Safety, and Wellbeing Outperform in the Marketplace
Authors: Fabius Raymond , Phares Sharon
Published: February 2021

Objective:

The objective of this research is to test the hypothesis that companies distinguished by their commitment to their workforce's health, safety, and well-being outperform in the marketplace.

Methods:

To test this, we analyzed the real-world stock market performance of an investment fund of publicly traded companies selected on evidence demonstrating their pursuit of a culture of health, safety, and well-being.

Results:

This fund outperformed the market by 2% per year, with a weighted return on equity of 264% compared with the S&P 500 return of 243% over a 10-year period.

Conclusions:

Employers, fund managers, and fund investors would be well served by including strategies that assess a company's commitment to the health, safety, and well-being of their workforce when evaluating investments in their enterprise and portfolios.
Profiles of US Law Enforcement Officers’ Diagnosed Health Conditions
Authors: Mumford Elizabeth A. , Liu Weiwei , Taylor Bruce G. , Ramey Sandra
Published: February 2021

Objective:

To assess comorbidity across five common health conditions.

Methods:

Surveys were collected from a probability-based sample of US law enforcement officers, and latent class models estimated for hypertension (HTN), high blood cholesterol (LDL), diabetes (DM), a gastrointestinal disorder (GI), and sleep apnea (SA).

Results:

The majority of officers (69.4%) were classified in a Healthy profile. One in four officers (23.7%) were classified in a LDL-HTN-DM profile. About 7% of officers were classified in a GI-SA-HTN profile. Age, sex, body mass index (BMI), exercise, and working a rotating shift assignment distinguished class membership.

Conclusion:

Most officers reported good health. Law enforcement administrative or clinical assessments using readily accessible measures might be informative in identifying risk categories of need for more targeted prevention and treatment support.
A Primer on DNA Methylation and Its Potential to Impact Maternal Depression Risk and Assessment During Pregnancy and the Postpartum
Authors: Lapato Dana M. , Wolf Hope M. , Lancaster Eva E. , Roberson-Nay Roxann , York Timothy P.
Published: February 2021

Depression onset during and after pregnancy is prevalent and associated with significant implications for maternal, child, and family health. Although environmental risk factors important to the expression of pregnancy-related depression are well known, knowledge of the genetic underpinning is limited. Given the joint contribution of environmental and genetic factors to depression risk liability, DNA methylation presents itself as an ideal biomarker to investigate basic mechanisms and opportunities for translational research to care for pregnancy-related depression health outcomes. This article is an introduction to DNA methylation and its potential to serve as a marker of depression risk during pregnancy and the postpartum. This commentary discusses current clinical uses of DNA methylation–based testing and how it may be applied to perinatal depression clinical care and management.
The perils of not knowing the history of the nurse practitioner role
Authors: Berg Judith A.
Published: February 2021

Historians tell us there are perils to not knowing history and that studying history allows us to understand our past as well as our present. The how and why of our nurse practitioner (NP) role today lies in our history. The NP role was created in the 1960s by Dr. Loretta Ford and Dr. Henry Silver in Colorado out of need to increase patients' access to pediatric care. Today, Dr. Ford believes NPs providing high-quality primary care can solve what ails the country: access to care. To better understand how the NP role developed, what pushback was met from health care professionals and patients that hindered practice and how this was resolved, how NP practice has changed, and pearls of wisdom for contemporary NPs were questions asked of six pioneer NPs (female, n = 5; male, n = 1). Their collated responses illuminate myriad ways the role was established and how each one overcame restrictions and barriers to practice. These pioneer NP participants highlighted ways NP practice has changed since those early days. They imparted a variety of pearls of wisdom that can guide contemporary NPs to address scope of practice barriers and overcome patient's and other health professionals' objections to NP practice. Loretta Ford cautions us to remember the most important word in NP is “Nurse” and we need to be mindful of our professional roots. Many of these pioneer respondents noted the importance of collective voices when dealing with professional and practice issues; they urge all NPs to join and be active in professional organizations that are invested in promoting and protecting the NP role.
Business documents of the advanced practice registered nurse: Curriculum vitae, resume, and biosketches
Authors: Hicks Rodney W. , Berg Judith A. , Roberts Mary Ellen E.
Published: February 2021

Advanced practice nurses (APNs) now have great opportunities to serve in leadership positions for organizations, institutions of higher education, community and public agencies, and more. The need exists for APNs to have a full set of professional business documents readily available. Such common documents would extend beyond the professional business card and professional photograph to include the curriculum vitae, the resume, and the National Institutes of Health Biographical Sketch (biosketch) and a professional biosketch. Advanced practice nurses should understand the differences between the documents as each document helps to share the professional identity.
Relative value units in health care: Friend, foe, or necessary evil?
Authors: Sheppard Kate G. , Duncan Cameron G.
Published: February 2021

The purpose of this article is to describe this use of relative value units (RVUs) among nurse practitioners (NP), including the challenges NPs may experience. Relative value units were developed as a means to determine reimbursement for health care based on time spent with the patient and skills required to complete the interaction, while addressing any disparities of reimbursement based on geography or insurance. Increasingly, providers such as NPs are being evaluated based in large part on how many RVUs they generate, which seems to prioritize productivity and may overlook many nonbillable aspects of the NP role such as emotional support or patient education. Nurse practitioners working in settings that require more invasive procedures may seem to be more productive on paper, regardless of the number of patients seen. Relative value units may not adequately reflect the skill and time taken to care for patients with chronic illness. Gender differences have been noted, both in terms of the number of RVUs generated for care of male or female patients, and those generated by male or female providers. If NPs are evaluated primarily based on productivity as measured by RVUs, we must consider how this might minimize or even invalidate the therapeutic relationship and holistic approach to patient care. Relative value units may negatively affect the willingness of NPs to serve as preceptors. Finally, as NPs experience less face-to-face time with patients and more demands for productivity, there may be a loss of quality care and professional integrity, which raises the risk of burnout among NPs.
Improving breastfeeding duration through creation of a breastfeeding-friendly pediatric practice
Authors: Imboden Annie , Lawson Robin
Published: February 2021

Background:

Breastfeeding is the gold standard for infant feeding. In the United States, 83.2% of women initiate breastfeeding on their infant's birth. When the infant reaches 6 months of age, however, only 57.6% of mothers are still breastfeeding, and a mere 24.9% are breastfeeding exclusively.

Local problem:

Breastfeeding rates in rural areas are below the national averages. The greatest disparities exist in minorities and individuals with lower educational and socioeconomic status.

Methods:

A preintervention/postintervention design was used for this quality improvement project. The Model for Improvement's Plan, Do, Study, Act cycle guided the project processes. Breastfeeding rates were obtained at each well-child visit from newborn through 4 months of age. On completion, mean preimplementation and postimplementation breastfeeding rates were compared to determine effectiveness.

Interventions:

A breastfeeding support initiative was implemented at a multisite rural Illinois pediatric practice. An evidence-based breastfeeding policy was developed, staff education sessions were conducted, private lactation rooms were created, and breastfeeding photographs/posters were displayed throughout the offices. Lactation support services were publicized via signs and social media postings.

Results:

Overall breastfeeding rates were higher at each time point after implementation. Statistically significant increases occurred at the newborn and 1-month visits, with a modest improvement at 2 and 4 months.

Conclusions:

This project demonstrated an improvement in breastfeeding duration rates. It is anticipated that this practice-wide standard of care change will promote breastfeeding throughout the first 12 months of life.
Implementation of the standardized, evidence-based three-stage suicide risk screening: Experience of a large Veterans Affairs medical center
Authors: Nwangwu Helen , de Peralta Shelly S. , Birman Sharon , Hicks Rodney W.
Published: February 2021

Suicide is a global public health concern and may be preventable with early identification. The suicide rate among US veterans is increasing. In response to the increase, Veterans Health Administration recommended a new standardized three-step, evidence-based suicide risk screening process across all Veterans Health Administration sites. The purpose of this project was to implement the new three-step suicide screening method and evaluate the rate of provider adherence. The implementation occurred in seven clinical sites in the Veterans Affairs Greater Los Angeles Health care System. Following initial implementation, two Plan-Do-Study-Act (PDSA) evaluated provider adherence to the screening processes. Staff members at each site received suicide prevention education. Staff members had the option of using an embedded template in the course of normal patient care workflow. Plan-Do-Study-Act 1 measured the early results. Staff members achieved a performance adherence rate of 18%, indicating that staff were less likely to proactively screen for risk of suicide. In PDSA-2, the mandatory use of screening replaced the optional use. Staff members achieved a 95% adherence rate after 3 months. Changing the workflow within the electronic health record from optional to mandatory utilization brought forth improvements in suicide prevention screening.
The impact of nurse practitioner and physician assistant workforce supply on Medicaid-related emergency department visits and hospitalizations
Authors: Norful Allison A. , de Jacq Krystyna , Liu Jianfang , Ye Siqin , Khadka Simran , Poghosyan Lusine
Published: February 2021

Background:

New York State (NYS) has approximately 4.7 million Medicaid beneficiaries with 75% having at least one or more chronic conditions. An estimated 10% of Medicaid beneficiaries seek emergency department (ED) services for nonurgent matters. It is unclear if an increased supply of nurse practitioners (NPs) and physician assistants (PAs) impact utilization of ED and subsequent hospitalizations for chronic conditions.

Purpose:

To investigate the relationship between NYS workforce supply (physicians, NPs, and PAs) and 1) ED use and 2) in-patient hospitalizations for chronically ill Medicaid beneficiaries.

Methods:

A cross-sectional study design was employed by calculating total workforce supply per NYS county and the proportion of physicians, NPs, and PAs per total number of Medicaid beneficiaries. We extracted the frequencies of all NYS Medicaid beneficiary chronic condition–related ED visits and in-patient admissions. Medicaid beneficiaries were considered to have a chronic condition if there was a claim indicating that the beneficiary received a service or treatment for this specific condition. We calculated the proportion of ED visits/beneficiary for each chronic disease category and the proportion of category-specific in-patient hospitalizations per the number of beneficiaries with that diagnosis.

Results:

As the NP/beneficiary proportion increased, ED visits for dual and nondual eligible beneficiaries decreased (p = .007; β = −2.218; 95% confidence interval [CI]: −3.79 to −0.644 and p = .04; β = −2.698; 95% CI: −5.268 to −0.127, respectively).

Implications for practice:

Counties with a higher proportion of NPs and PAs had significantly lower numbers of ED visits and hospitalizations for Medicaid beneficiaries.
Predictors of serious adverse drug events from opioids: Results from the Food and Drug Administration Adverse Events Reporting System
Authors: McDonald Deborah Dillon , Srisopa Pornpan
Published: February 2021

Background:

Opioids pose significant increased risk for serious adverse drug events (ADEs).

Purpose:

The purpose was to identify significant predictors and their associated magnitude of risk for serious life-threatening opioid ADEs.

Methods:

A post hoc design was used to examine predictors of opioid analgesics ADEs with Food and Drug Administration Adverse Events Reporting System (FAERS) data. The sample consisted of all eligible cases from the second quarter of the 2019 FAERS where an opioid analgesic was identified as the primary suspect for an ADE. Logistic regression was used to predict serious life-threatening ADEs. Final predictors included age, gender, misuse/substance use disorder, number of concurrent opioids; use of benzodiazepines, other sedatives, and antidepressants; and use of morphine, fentanyl, and oxycodone.

Results:

Life-threatening ADEs, excluding suicide and suicide attempts, comprised 19.9% of the cases. Protective factors that reduced risk included female gender, use of antidepressants, and use of morphine. Harmful factors that increased risk of a serious ADE included misuse/substance use disorder, use of benzodiazepines, and use of other sedatives. Persons taking an opioid with both a benzodiazepine and another sedative increased risk of a serious ADE by 18.78 times.

Implications for practice:

Results provide risk data helpful to share with people who use prescribed opioids for self-management of pain. Combination of opioids and clinically indicated antidepressants that do not both promote serotonin uptake inhibition may reduce risk for serious opioid ADEs. Practitioners should continue to avoid prescribing benzodiazepines and other sedatives when opioids are used.
Knowledge and clinical dialogues about complementary health approaches among nurse practitioners specialized in geriatrics
Authors: Geisler Carol , Cheung Corjena , Johnson Steinhagen Stasia , Brueggemann Alvina
Published: February 2021

Background:

In the United States, people over the age of 65 years will account for 20% of the population by 2030, and these elders are more likely to have chronic comorbid complex health problems. Sixty-three percent use complementary health approaches (CHAs) but less than half disclose their use to their health care providers. Nurse practitioners (NPs) are the fastest growing population of primary care health providers.

Purpose:

This study identifies to what degree NPs with specialized training in geriatrics understand CHAs, use them themselves, encourage their patients to access them, and engage in CHA clinical dialogue.

Methods:

Cross-sectional online survey collecting quantitative and narrative data; US NPs with specialized training in geriatrics (n = 170, mean age 52 years, SD: 9.0, range: 29–73).

Results:

Although NPs are knowledgeable about some CHA and believe they are beneficial for older adults to use, they want more education to help understand the effects of a variety of CHA, be more aware of possible treatment interactions, and to integrate CHA into the current health care system. Patient factors (impaired cognitive function, acute health problems, and not open to CHA), provider factors (inadequate CHA knowledge, limited referral paths and resources), and system factors (limited accessibility and availability of CHA in in-patient setting, CHA not covered by insurance, and limited clinical time) disrupt NPs from assessing and discussing CHA with their patients.

Implications for practice:

There is a need to develop and implement NP practice guidelines for CHA clinical management for older adults and provide educational opportunities to incorporate CHA into clinical practice.
Defining the urology nurse practitioner role in the United States: A Delphi study
Authors: Quallich Susanne , Lajiness Michelle J.
Published: February 2021

Background:

Nurse practitioners (NPs) achieve expertise in urology environments due to on-the-job training and independent study, coupled with mentoring. This creates a wide variety of preparation and role descriptions, and despite the availability of sought NP certification in urology, there is not a current definition for a “urology NP.”

Purpose:

This project sough to develop a contemporary definition of the urology NP role, based on expert opinion.

Methods:

Study design was the Delphi method, which evaluates consensus and opinion when there is incomplete knowledge or lack of evidence. Participants were a nonrandom panel of experts on the urology NP role with at least 2 years as a full-time urology NP. This exempted study collected data via an online platform that ensured anonymity, and was completed in two rounds.

Results:

The following definition is proposed after the study results: “The Urology NP provides acute and chronic care to individuals experiencing urological health care needs across the lifespan, engages in office-based urology procedures in accordance with the state Board of Nursing, maintains membership in professional organizations and acts as preceptor to all health care disciplines.” Certification in the specialty role was deemed important.

Implications for practice:

Results demonstrated the very patient-care centered nature of this specialty NP role, as professional roles of the NP were given less weight. The project offers a definition of the urology NP role that can be offered to educators and other stakeholders.
The fiscal impact of repeat imaging in a pediatric orthopedic clinic
Authors: Thompson Cynthia T. , Bartolomei Olivia , Vuillermin Carley
Published: February 2021

Background:

Many patients present to an initial pediatric orthopedic clinic visit without bringing previously obtained x-rays (XRs), leading to repeat imaging, unnecessary radiation exposure, and increased health care costs. Importing images to the picture archiving and communication system and the use of cloud-based medical image-sharing software systems result in the reduction of reimaging rates and health care costs.

Local problem:

Unnecessary duplicative XR imaging was recognized in our pediatric orthopedic clinic as an area for quality improvement. Our purpose was to determine the magnitude of the problem and the feasibility of decreasing total visit charges through electronic retrieval of previous XRs.

Method:

Data collection occurred from May 22, 2019, through June 22, 2019, in the orthopedic trauma clinics at the main campus of a quaternary care pediatric hospital in the northeast United States and its three satellite locations.

Intervention:

The number of patients who did not bring XRs to their initial orthopedic visit and the type of XR ordered were recorded by clinicians. A retrospective chart audit was also completed for comparison.

Results:

Of 699 new patient visits, 77 (11%) did not bring previous XRs. This resulted in total reimaging charges of $33,326, representing 30%–50% of total visit charges. Retrospective chart audit identified 60% more new patients than the clinicians.

Conclusions:

Electronic retrieval of XRs in pediatric orthopedic clinics can decrease duplicative charges, radiation exposure, and health care waste. It can also contribute to successful care of patients via virtual visits in times of restricted access such as a pandemic.
A practical approach to obesity prevention: Healthy home habits
Authors: Fruh Sharon , Williams Susan , Hayes Katey , Hauff Caitlyn , Hudson Geoffrey M. , Sittig Scott , Graves Rebecca J. , Hall Heather , Barinas Jennifer
Published: February 2021

Families have the potential to foster a healthy home environment aimed at reducing the risk of overweight and obesity. Establishing habits associated with reduced risk of obesity and overweight early in childhood can have lasting effects into adulthood. Nurse practitioners can encourage families to participate in healthy habits by addressing areas of growth for obesity prevention within the home. A review of the most recent literature, approximately over the past decade, was used to provide a consolidated source of reference for healthy home habits for the nurse practitioner. The search included terms such as “obesity,” “overweight,” “healthy habits,” “physical activity,” “obesogenic behaviors,” “family meals,” “screen time,” “depression,” “sugary beverages,” and “portion sizes.” The information was synthesized into three content areas: nutrition and consumption, patterns of activity, and stress within the home. Establishing healthy habits early in life can protect against the development of overweight and obesity. Nurse practitioners can serve a vital role in the prevention of pediatric, adolescent, and adult obesity. Equipped with the unique role of assisting those from a diverse patient base, nurse practitioners can inform patients how to improve healthy habits to decrease the likelihood of obesity or overweight. Encouraging behavior change related to the healthy habits associated with the prevention of overweight and obesity can have a long-term impact on the health of an entire family.
Inflammation at the Tissue-Electrode Interface in a Case of Rapid Deterioration in Hearing Performance Leading to Explant After Cochlear Implantation
Authors: Hough Kate , Sanderson Alan , Grasmeder Mary , Mitchell Tim , Verschuur Carl A. , Newman Tracey A.
Published: February 2021

Objective:

The reasons for soft failure after cochlear implantation require investigation. This study proposes a method to study and characterize the tissue response to the array in a case of soft failure in a person undergoing reimplantation.

Case:

The woman in her 50s, with an underlying autoimmune condition, received a cochlear implant using hearing preservation technique after developing profound hearing loss more than 2 kHz with a moderate loss of less than 500 Hz over a 10-year period. The case was identified as a soft failure due to deteriorating performance, discomfort, and migration over the 10 months after implantation. Impedance telemetry, speech perception measures, and audiometric thresholds are described. At explantation there was evidence of fibrosis.

Intervention(s):

To use histology and immunohistochemistry to determine the cellular response of the tissue associated with the electrode array at time of explantation.

Main Outcome Measure(s):

Identification of the cell types, regional variations, and inflammatory marker expression in the fibrotic tissue associated with the array.

Results:

Neutrophils and eosinophils were identified, along with a variable pattern of collagen deposition. CD68 and CD163-positive macrophages and T cells were variably distributed through the tissue and interleukin-1 beta and vascular endothelial growth factor receptor-2 expression was identified.

Conclusions:

The expression profile is evidence of active inflammation in the tissue despite the time since implantation. This study is the first to characterize the tissue response to the array in a person undergoing reimplantation, and who can be followed to determine the individual response to arrays. It establishes that the investigation of explanted devices after soft-failure is feasible.
Ultrasound-Controlled Manual Magnet Repositioning in Magnet Dislocation of Cochlear Implants
Authors: Rupp Robin , Hornung Joachim , Balk Matthias , Traxdorf Maximilian , Sievert Matti , Hoppe Ulrich , Iro Heinrich , Gostian Antoniu-Oreste
Published: February 2021

Objective:

To investigate whether ultrasound is a helpful and reliable diagnostic tool to survey the status of the magnet previous and after manual repositioning in patients with partially dislocated cochlear implant (CI) magnets and to assess the success rate of a manual repositioning maneuver.

Design:

A prospective cohort study.

Setting:

A tertiary referral medical center.

Patients:

Patients with a cochlear implant who presented with magnet dislocation after magnetic resonance imaging (MRI) between June 1, 2019 and July 15, 2020.

Interventions:

Manual repositioning of the partially dislocated CI magnet surveyed by pre- and post-interventional ultrasound.

Main Outcome Measures:

Rate of successfully diagnosed and manually repositioned magnets; complication rate and recurrence rate after initial manual repositioning maneuver.

Results:

Nine patients presented with a partial magnet dislocation diagnosed by pre-interventional ultrasound following MRI (n = 9 magnets; three ♀; eight right-sided implants; 65.4 ± 21.7 yr). All magnets were repositioned manually. The magnets were successfully repositioned at the first attempt in six out of eight patients. Two patients required a second and one patient a third attempt of manual repositioning. Post-interventional ultrasound confirmed the entirely restored magnet position in all cases. During the mean follow-up period of 7.3 months (±5.4 mo) no patient experienced any complication or recurrent dislocation of the respective magnet.

Conclusion:

Manual magnet repositioning is a feasible and reliable method with a high success rate for partially dislocated CI magnets. The pre-interventional diagnosis as well as the post-interventional confirmation of the magnet status can be effectively determined by ultrasound. Thus, manual magnet repositioning and ultrasound investigation can be advocated as first-line therapeutic and diagnostic instruments when dealing with partial magnet dislocation.
Tobacco Use and Skin Reactivity in Patients With Percutaneous Auditory Osseointegrated Implants
Authors: Gardiner Lauren , Lavallee Martin , Sima Adam , Coelho Daniel H.
Published: February 2021

Objectives:

To determine if there is an association between tobacco use and the development of postoperative skin reactions in patients undergoing percutaneous osseointegrated auditory implant (pOAI) surgery.

Study Design:

Single surgeon retrospective cohort study.

Setting:

Academic medical center.

Subjects and Methods:

Retrospective chart review was performed on all patients who underwent pOAI. Smoking status (current and former users versus never-users) was recorded as were numerous demographic and surgical variables. The primary outcome measure was skin reactivity as measured by Holgers score. Secondary outcomes studied included total number of problem visits, minor interventions, and major interventions.

Results:

126 patients, 73 with no tobacco history (NT) and 53 with a positive smoking tobacco history (T) underwent pOAI surgery in this study. The T group was found to have higher rates of first postoperative visit soft tissue reactions compared with the NT group (24.5% versus 6.8%, p 1/4 0.011, odds ratio [OR] 4.42, 95% confidence interval [CI]: 1.5, 13.3), but not at long-term follow-up. When former smokers were eliminated from analysis, differences were also found at long- term follow-up (40.9% versus 19.2%, p 1/4 0.037, OR 2.92, 95% CI [1.0 – 8.1]). There were no differences in total number of problem visits or total number of minor or major interventions.

Conclusions:

Patients with a history of tobacco use have a significantly higher rates of skin reactivity compared with patients without, though smoking cessation may partially mitigate long-term risks. Surgeons should be aware of the risks of early skin reactivity and should counsel patients accordingly.