bluuebunny/crossref_metadata_2025 huggingface dataset:
A “Smart” Biosensor-Enabled Intravascular Catheter and Platform for Dynamic Delivery of Propofol to “Close the Loop” for Total Intravenous Anesthesia
Authors: Chaum Edward , Lindner Ernő
Published: January 2021

Background

Target-controlled infusion anesthesia is used worldwide to provide user-defined, stable, blood concentrations of propofol for sedation and anesthesia. The drug infusion is controlled by a microprocessor that uses population-based pharmacokinetic data and patient biometrics to estimate the required infusion rate to replace losses from the blood compartment due to drug distribution and metabolism. The objective of the research was to develop and validate a method to detect and quantify propofol levels in the blood, to improve the safety of propofol use, and to demonstrate a pathway for regulatory approval for its use in the USA.

Methods

We conceptualized and prototyped a novel “smart” biosensor-enabled intravenous catheter capable of quantifying propofol at physiologic levels in the blood, in real time. The clinical embodiment of the platform is comprised of a “smart” biosensor-enabled catheter prototype, a signal generation/detection readout display, and a driving electronics software. The biosensor was validated in vitro using a variety of electrochemical methods in both static and flow systems with biofluids, including blood.

Results

We present data demonstrating the experimental detection and quantification of propofol at sub-micromolar concentrations using this biosensor and method. Detection of the drug is rapid and stable with negligible biofouling due to the sensor coating. It shows a linear correlation with mass spectroscopy methods. An intuitive graphical user interface was developed to: (1) detect and quantify the propofol sensor signal, (2) determine the difference between targeted and actual propofol concentration, (3) communicate the variance in real time, and (4) use the output of the controller to drive drug delivery from an in-line syringe pump. The automated delivery and maintenance of propofol levels was demonstrated in a modeled benchtop “patient” applying the known pharmacokinetics of the drug using published algorithms.

Conclusions

We present a proof-of-concept and in vitro validation of accurate electrochemical quantification of propofol directly from the blood and the design and prototyping of a “smart,” indwelling, biosensor-enabled catheter and demonstrate feedback hardware and software architecture permitting accurate measurement of propofol in blood in real time. The controller platform is shown to permit autonomous, “closed-loop” delivery of the drug and maintenance of user-defined propofol levels in a dynamic flow model.
An Analysis of Prolonged, Continuous Ketamine Infusions
Authors: Schauer Steven G , Naylor Jason F , Davis William T , Borgman Matthew A , April Michael D
Published: January 2021

Introduction

Opioids carry high risk of dependence, and patients can rapidly build tolerance after repetitive dosing. Low-dose ketamine is an analgesic agent alternative that provides more hemodynamic stability. We sought to describe the effects of prolonged ketamine use in non-burn patients.

Materials and Methods

We queried the electronic health system at the Brooke Army Medical Center for patient encounters with ketamine infusions lasting >72 hours. We abstracted data describing demographics, vital signs, ketamine infusion dose and duration, and discharge diagnoses potentially relevant to ketamine side effects.

Results

We identified 194 subjects who met the study inclusion criteria. The median age was 39 years, most were male (67.0%), and most were primarily admitted for a non-trauma reason (59.2%). The mean ketamine drip strength was 43.9 mg/h (95% CI, 36.7-51.1; range 0.1-341.6) and the mean drip length was 130.8 hours (95% CI, 120.3-141.2; range 71-493). Most subjects underwent mechanical ventilation (56.1%) at some point during the infusion and most survived to hospital discharge (83.5%). On a per-day basis, the average heart rate was 93 beats per minute, systolic blood pressure was 128 mmHg, diastolic blood pressure was 71 mmHg, oxygen saturation was 96%, and respiratory rate was 22 respirations per minute.

Conclusions

We demonstrate that continuous ketamine infusions provide a useful adjunct for analgesia and/or sedation. Further development of this adjunct modality may serve as an alternative agent to opioids.
Technological innovation in a police organization: Lessons learned from the National Police of the Netherlands
Authors: Ernst Sander , ter Veen Hanneke , Kop Nicolien
Published: January 2021

Police organizations internationally explore and experiment with new technologies to improve their performance and in response to new forms of crime. The police in the Netherlands experiment with various forms of innovative technology. Previous research has shown that social, organizational, and technological factors are important for effective use and deployment of technology by the police. However, the precise factors and mechanisms underlying the promotion or inhibition of technological innovations within the police are not clear. This study aims to provide empirical knowledge about these mechanisms by providing insight into the processes through which technological innovation develops within the police in the Netherlands. From January 2017 to February 2018, 13 technological innovation projects were subjected to a longitudinal process study. The results show that innovation processes within the police organization are often inhibited by organizational factors, whereas social factors can stimulate and promote these processes.
A 10-item Fugl-Meyer Motor Scale Based on Machine Learning
Authors: Lin Gong-Hong , Huang Chien-Yu , Lee Shih-Chieh , Chen Kuan-Lin , Lien Jenn-Jier James , Chen Mei-Hsiang , Huang Yu-Hui , Hsieh Ching-Lin
Published: January 2021

Objective

The Fugl-Meyer motor scale (FM) is a well-validated measure for assessing upper extremity and lower extremity motor functions in people with stroke. The FM contains numerous items (50), which reduces its clinical usability. The purpose of this study was to develop a short form of the FM for people with stroke using a machine-learning methodology (FM-ML) and compare the efficiency (ie, number of items) and psychometric properties of the FM-ML with those of other FM versions, including the original FM, the 37-item FM, and the 12-item FM.

Methods

This observational study with follow-up used secondary data analysis. For developing the FM-ML, the random lasso method of ML was used to select the 10 most informative items (in terms of index of importance). Next, the scores of the FM-ML were calculated using an artificial neural network. Finally, the concurrent validity, predictive validity, responsiveness, and test–retest reliability of all FM versions were examined.

Results

The FM-ML used fewer items (80% fewer than the FM, 73% fewer than the 37-item FM, and 17% fewer than the 12-item FM) to achieve psychometric properties comparable with those of the other FM versions (concurrent validity: Pearson r = 0.95–0.99 vs 0.91–0.97; responsiveness: Pearson r = 0.78–0.91 vs 0.33–0.72; and test–retest reliability: intraclass correlation coefficient = 0.88–0.92 vs 0.93–0.98).

Conclusion

The findings preliminarily support the efficiency and psychometric properties of the 10-item FM-ML.

Impact

The FM-ML has potential to substantially improve the efficiency of motor function assessments in patients with stroke.
Predictive Factors for Patients’ Failure to Show for Initial Outpatient Physical Therapist Evaluation
Authors: Briggs Matthew S , Ulses Christine , VanEtten Lucas , Mansfield Cody , Ganim Anthony , Hand Brittany N , Quatman-Yates Catherine C
Published: January 2021

Objective

The objective of this study was to examine primary factors that may predict patients’ failure to show at initial physical therapist evaluation in an orthopedic and sports outpatient setting.

Methods

A retrospective analysis of patients’ demographic data for physical therapist evaluations between January 2013 and April 2015 was performed. A binary logistic regression model was used to evaluate the odds of a no-show at evaluation. Demographic variables of age, employment status, days waited for the appointment, payer source, and distance traveled to the clinic were analyzed. Independent variables were considered significant if the 95% CIs of the odds ratios (ORs) did not include 1.0.

Results

A total of 6971 patients were included in the final analysis, with 10% (n = 698) of the scheduled patients having a no-show event for their initial evaluation. The following factors increased the odds of patients having a no-show event: days to appointment (OR = 1.058; 95% CI = 1.042–1.074), unemployment status (OR = 1.96; 95% CI = 1.41–2.73), unknown employment status (OR = 3.22; 95% CI = 1.12–8.69), Medicaid insurance (OR = 4.87; 95% CI = 3.43–6.93), Medicare insurance (OR = 2.22; 95% CI = 1.10–4.49), unknown payer source (OR = 262.84; 95% CI = 188.72–366.08), and distance traveled 8 or more kilometers (OR = 1.31; 95% CI = 1.01–1.70). Female sex (OR = 0.73; 95% CI = 0.57–0.95) and age 40 years or older (OR = 0.44; 95% CI = 0.33–0.60) decreased the odds of a no-show event.

Conclusions

Results from this study indicate there may be some demographic factors that are predictive of patients failing to attend their first physical therapist visit.

Impact

Understanding the predictive factors and identifying potential opportunities for improvements in scheduling processes might help decrease the number of patients failing to show for their initial physical therapy appointment, with the ultimate goal of positively influencing patient outcomes.
Why were there 231 707 more deaths than expected in England between 2010 and 2018? An ecological analysis of mortality records
Authors: Darlington-Pollock Frances , Green Mark A , Simpson Ludi
Published: January 2021

Background

Policy responses to the Global Financial Crisis emphasized wide-ranging fiscal austerity measures, many of which have been found to negatively impact health outcomes. This paper investigates change in patterns of mortality at local authority level in England (2010–11 to 2017–18) and the relation with fiscal austerity measures.

Methods

Data from official local authority administrative records are used to quantify the gap between observed deaths and what was anticipated in the 2010-based subnational population projections. Regression analyses are used to explore the relation between excess deaths, austerity and wider process of population change at local authority level.

Results

We estimate 231 707 total excess deaths, the majority of which occurred since 2014–15 (89%) across the majority of local authorities (91%). Austerity is positively associated with excess deaths. For working age adults, there is a clear gradient to the impact of austerity, whereas for older adults, the impact is more uniform.

Conclusions

Fiscal austerity policies contributed to an excess of deaths for older people and widened social inequalities for younger populations. These results call for an end to all austerity measures and require further research into areas with the highest total excess deaths as a priority following the COVID-19 pandemic.
Zero-Coupon Yields and the Cross-Section of Bond Prices
Authors: Aaron Pancost N
Published: January 2021

I estimate a dynamic term structure model on an unbalanced panel of Treasury coupon bonds, without relying on an interpolated zero-coupon yield curve. A linearity-generating model, which separates the parameters that govern the cross-sectional and time-series moments of the model, takes about 8 min to estimate on a sample of over 1 million bond prices. The traditional exponential affine model takes about 2 hr, because of a convexity term in coupon-bond prices that cannot be concentrated out of the cross-sectional likelihood. I quantify the on-the-run premium and a “notes versus bonds” premium from 1990 to 2017 in a single, easy-to-estimate no-arbitrage model. (JEL G12, G14, C33)

Received: April 30, 2018; editorial decision November 3, 2020 by Editor Nikolai Roussanov
COVID-19 Prevalence and Mortality Among Schizophrenia Patients: A Large-Scale Retrospective Cohort Study
Authors: Tzur Bitan Dana , Krieger Israel , Kridin Khalaf , Komantscher Doron , Scheinman Yochai , Weinstein Orly , Cohen Arnon Dov , Cicurel Assi Albert , Feingold Daniel
Published: January 2021

Objective

Individuals with schizophrenia may be at an increased risk for COVID-19 morbidity due to the disease characteristics. In this study, we aimed to explore the odds of significant COVID-19 morbidity and mortality among schizophrenia patients while controlling for potential sociodemographic and medical confounders.

Methods

Schizophrenia patients and age-and-sex matched controls (total n = 51 078) were assessed for frequency of COVID-19 positivity, hospitalizations, and mortality. The odds for COVID-19-associated hospitalization and mortality were calculated using logistic regression models, while controlling for age, sex, marital status, sector, socioeconomic status, diabetes, ischemic heart disease, hypertension, hyperlipidemia, obesity, smoking, and chronic obstructive pulmonary disease.

Results

Individuals with schizophrenia were less likely to test positive for COVID-19; however, they were twice as likely to be hospitalized for COVID-19 (OR 2.15 95% CI 1.63–2.82, P < .0001), even after controlling for sociodemographic and clinical risk factors (OR 1.88 95% CI 1.39–2.55, P < .0001). Furthermore, they were 3 times more likely to experience COVID-19 mortality (OR 3.27 95% CI 1.39–7.68, P < .0001), compared to controls.

Conclusions

We found evidence of associations between schizophrenia and increased COVID-19 morbidity and mortality compared to controls regardless of sociodemographic and medical factors. As these patients present with a combination of potential risk factors for mortality, efforts should be made to minimize the effects of the pandemic on this vulnerable population.
A LoRa sensor network for monitoring pastured livestock location and activity1
Authors: dos Reis B R , Easton Z , White R R , Fuka D
Published: January 2021

Precision technologies for confinement animal agricultural systems have increased rapidly over the past decade, though precision technology solutions for pastured livestock remain limited. There are a number of reasons for this limited expansion of technologies for pastured animals, including networking availability and reliability, power requirements, and expense, among others. The objective of this work was to demonstrate a rapidly deployable long-range radio (LoRa) based, low-cost sensor suite that can be used to track location and activity of pastured livestock. The sensor is comprised of an inexpensive Arduino-compatible microprocessor, a generic MPU-9250 motion sensor which contains a 3-axis accelerometer, 3-axis magnetometer, and a 3-axis gyroscope, a generic GPS receiver, and a RFM95W generic LoRa radio. The microprocessor can be programmed flexibly using the open source Arduino IDE software to adjust the frequency of sampling, the data packet to send, and what conditions are needed to operate. The LoRa radio transmits to a Dragino LoRa gateway which can also be flexibly programmed through the Arduino IDE software to send data to local storage or, in cases where a web or cellular connection is available, to cloud storage. The sensor was powered using a USB cord connected to a 3,350 mAh lithium-ion battery pack. The Dragino gateway was programmed to upload data to the ThingSpeak IoT application programming interface for data storage, handling, and visualization. Evaluations showed minimal benefit associated with reducing sampling frequency as a strategy to preserve battery life. Packet loss ranged from 40% to 60%. In a 3 d evaluation on pastured sheep, the sensor suite was able to report GPS locations, inertial sensor readings, and temperature. Preliminary demonstrations of our system are satisfactory to detect animal location based on GPS data in real-time. This system has clear utility as a lower-cost strategy to deploy flexible, useful precision technologies for pasture-based livestock species.
The Politics of Health Care
Authors: Myers Carole R.
Published: January 2021

What can we expect from the Biden administration?
Use of Pneumococcal Conjugate Vaccines to Prevent Acute Otitis Media in Children
Authors: Christie Janice
Published: January 2021

Editor's note: The mission of Cochrane Nursing is to provide an international evidence base for nurses involved in delivering, leading, or researching nursing care. Cochrane Corner provides summaries of recent systematic reviews from the Cochrane Library. For more information, see https://nursing.cochrane.org.
New Drugs for Rare Disorders
Authors: Aschenbrenner Diane S.
Published: January 2021

Several new drugs have been approved to treat rare genetic disorders: setmelanotide for certain conditions causing obesity; lumasiran for primary hyperoxaluria type 1, a kidney disorder; and lonafarnib for two diseases that cause premature aging.
The ‘Grueling Process’ of Emancipation
Authors: Brown Theresa
Published: January 2021

Black Americans' fight for health care remains highly relevant.
Dietary Supplements, Strength Training Offer no Significant Effects in Older Adults
Authors: Rosenberg Karen
Published: January 2021

According to this study:

A study of adults age 70 or older without major comorbidities showed that treatment with vitamin D3, omega-3 fatty acids, or a strength training exercise program didn't result in clinically significant changes in blood pressure, nonvertebral fractures, physical performance, infection rates, or cognitive function.
Development of a Scale to Measure Synergy: A Tool to Evaluate Team-Based Learning in Nursing
Authors: Keister Kathy J. , Farra Sharon L. , Smith Sherrill J. , Bottomley Michael
Published: January 2021

AIM

The purpose of this study was to develop and pilot an instrument to assess group synergy and team-based learning among nursing students.

BACKGROUND

Little is known on how to evaluate soft nursing skills such as synergy.

METHOD

Nurse faculty were recruited through purposive and snowball sampling to serve on an expert panel. Using the DeVillis framework, three rounds of data were collected using semistructured online surveys. The resulting scale of 34 items was piloted with teams of undergraduate nursing students taking part in a simulation experience.

RESULTS

Item-content validity index ranged from .8 to 1.0 for each item. Scale-content validity index average was .93; scale-content validity index universal was .62. Exploratory factor analysis identified three factors.

CONCLUSION

This study suggests that synergy is multifactorial and can be assessed by faculty. However, further testing of the scale is needed.
Physician Mental Health: My Personal Journey and Professional Plea
Authors: Kirch Darrell G.
Published: January 2021

Longitudinal surveys of adults in the United States have shown that approximately 1 in 5 individuals experienced a mental illness in the prior year, with an increase in the observed prevalence over the last decade. Studies of physicians, including medical students, residents, and fellows, have shown that they also experience mental disorders, with some research (e.g., on depression) showing prevalence rates higher than those in the general population. Tragically, physicians also have higher suicide rates than the general population.

In this commentary, the author discusses his own challenges with mental disorders beginning in early childhood. He shares how earlier trauma led to the emergence of symptoms that nearly caused him to withdraw from medical school during his first year, and he describes how support from a faculty member helped him receive psychiatric treatment that allowed him to successfully negotiate that serious crisis and experience a long, productive career. The author underscores how the idealized image of the physician as care giver rather than care receiver that many bring to their medical career, as well as the stigma associated with mental disorders, may prevent physicians from seeking care. He uses the narrative of his personal journey to make a plea to colleagues to share their own stories of mental illness and successful treatment, arguing that this is key to ultimately destigmatizing these issues for the profession of medicine.
Developmental Coordination Disorder Plus: A Diagnosis by Exclusion?
Authors: Santosuosso Jodi , Strand Kristin , Surran Brooke B. , Rosman N. Paul , Augustyn Marilyn
Published: January 2021

CASE:

Cayden is a 6.3-year-old boy who you have been following in our practice since birth. He was born at 35.5 weeks at 6 pounds 4 ounces following a fraternal twin gestation. Both children were “on target” with their milestones, but Cayden did not seem to progress as quickly as his sister. He did not initiate play with his sister when they were toddlers and Cayden was the “shy” one.
“When the Prescription Pad Is Not Enough”: Attention-Deficit Hyperactivity Disorder Management 2.0
Authors: Radesky Jenny , Reddy Arathi , Steiner Naomi , Augustyn Marilyn
Published: January 2021

CASE: Jose is a 13-year-old boy who presents to his primary care provider after struggling in school for many years. When he was in the first grade, he was diagnosed at a tertiary center with attention-deficit hyperactivity disorder. Multiple medication trials have produced few benefits and many side effects including poor sleep, morbid thoughts, lack of motivation, and, according to his parents, “he seemed like a robot.”

He comes now for his annual physical in April, and the parents tell you that the school is threatening that he be retained in the seventh grade. Parents are very adamant they do not want to try another medication. They have brought you their own and his advisor's Vanderbilt's, which each endorse 7 of 9 inattentive symptoms including trouble organizing, poor attention to detail, and easily distracted and forgetful in daily activities.

His birth history and developmental history before beginning formal schooling are unremarkable. His first language was English whereas his parents speak Spanish to each other but not the children. He is healthy and without a history of head trauma, seizures, meningitis, or lead poisoning. An aunt has “learning problems.”

Jose's family lives in a crowded section of a large urban area. They share an apartment with another family, and both parents are employed full time with his father holding 2 full time jobs working double shifts. Their annual income is at the poverty line. There are 4 children in the family aged between 6 and 13 years.

His school has been deemed a “recovery school” because of performing below standard on district-wide achievement tests. His classroom has 27 students, many of whom are English language learners, and he is not on an individualized education plan or 504 accommodations.

The family is very concerned about the possibility of retention but have decided that “medicine does not help,” and they look to you for other recommendations. Where do you go next?
Risk of Postoperative Venous Thromboembolism After Surgery for Colorectal Malignancy: A Systematic Review and Meta-analysis
Authors: Lewis-Lloyd Christopher A. , Pettitt Eleanor M. , Adiamah Alfred , Crooks Colin J. , Humes David J.
Published: January 2021

BACKGROUND:

Colorectal cancer has the second highest mortality of any malignancy, and venous thromboembolism is a major postoperative complication.

OBJECTIVE:

This study aimed to determine the variation in incidence of venous thromboembolism after colorectal cancer resection.

DATA SOURCES:

Following PRISMA and MOOSE guidelines (PROSPERO, ID: CRD42019148828), Medline and Embase databases were searched from database inception to August 2019 including 3 other registered medical databases.

STUDY SELECTION:

Two blinded reviewers screened studies with a third reviewer adjudicating any discordance. Eligibility criteria: Patients post colorectal cancer resection aged ≥18 years. Exclusion criteria: Patients undergoing completely endoscopic surgery and those without cancer resection. Selected studies were randomized controlled trials and population-based database/registry cohorts.

MAIN OUTCOME MEASURES:

Thirty- and 90-day incidence rates of venous thromboembolism per 1000 person-years following colorectal cancer surgery.

RESULTS:

Of 6441 studies retrieved, 28 met inclusion criteria. Eighteen were available for meta-analysis reporting on 539,390 patients. Pooled 30- and 90-day incidence rates of venous thromboembolism following resection were 195 (95% CI, 148–256, I
2 99.1%) and 91 (95% CI, 56–146, I
2 99.2%) per 1000 person-years. When separated by United Nations Geoscheme Areas, differences in the incidence of postoperative venous thromboembolism were observed with 30- and 90-day pooled rates per 1000 person-years of 284 (95% CI, 238–339) and 121 (95% CI, 82–179) in the Americas and 71 (95% CI, 60–84) and 57 (95% CI, 47–69) in Europe.

LIMITATIONS:

A high degree of heterogeneity was observed within meta-analyses attributable to large cohorts minimizing within-study variance.

CONCLUSION:

The incidence of venous thromboembolism following colorectal cancer resection is high and remains so more than 1 month after surgery. There is clear disparity between the incidence of venous thromboembolism after colorectal cancer surgery by global region. More robust population studies are required to further investigate these geographical differences to determine valid regional incidence rates of venous thromboembolism following colorectal cancer resection.
Infectious Complications Associated with the Use of Integra: A Systematic Review of the Literature
Authors: Gonzalez Santiago R. , Wolter Keith G. , Yuen James C.
Published: January 2021

Background:

Dermal regeneration templates such as Integra are effective reconstructive biomaterials used in a variety of soft-tissue defects. Fully understanding the complications associated with their use is paramount to improve outcomes and maximize patient safety. In this study, our purpose is to perform a comprehensive literature review to assess the previously reported infectious complications linked to Integra-based wound closure.

Methods:

We conducted a systematic review of the literature to identify previous articles indexed in PubMed and Ovid for Integra and its synonymous terms. We used these search terms: [Integra OR (dermal regenerative matrix) OR (dermal regeneration matrix) OR (dermal regenerative template) OR (dermal regeneration template) OR (dermal substitute) OR (skin substitute) OR (artificial skin)] AND infection.

Results:

Of the 3508 articles for initial review, 69 reported rates of infection, of which 26 reported ≥1 infection within their cohort. Of these 26 articles, the patients (n = 602) underwent Integra-based reconstruction in 1254 sites and had reported infections in 212 of the sites (16.9%). Among these, we encountered a single report of a fatal case of toxic shock syndrome (TSS) related to the use of Integra in secondary burn reconstruction.

Conclusions:

While Integra offers many benefits, surgeons must be aware that infectious complications are not uncommon. As a result, a careful risk–benefit analysis of its use in reconstruction must be performed, and open discussion with the patient preoperatively regarding infection rate is of utmost importance.
Integrated Plastic Surgery Applicant Review: Important Factors and Selection Criteria
Authors: Schultz Kelly P. , Shih Linden , Davis Matthew J. , Reece Edward M. , Buchanan Edward P. , Maricevich Renata S. , Winocour Sebastian
Published: January 2021

Matching into integrated plastic surgery residency is highly competitive. Applicants to these programs are among the most accomplished graduating medical students, consistently demonstrating some of the highest United States Medical Licensing Examination scores, mean numbers of research publications, and rates of Alpha Omega Alpha Honor Medical Society membership. The applicant review process requires programs to rely on a number of objective and subjective factors to determine which of these qualified applicants have the most potential for success. We outline these factors, discuss their correlation with resident performance, and provide our institution’s applicant review process both for applicants hoping to optimize their applications for success in the National Resident Matching Program and for program faculty hoping to optimize their resident selection process.
Online Resources in Plastic Surgery Education: A Toolbox for Modern Trainees and Plastic Surgeons
Authors: Ali Kausar , Colchado Daniel , Davis Matthew J. , Abu-Ghname Amjed , Winocour Sebastian , Buchanan Edward P. , Reece Edward M.
Published: January 2021

Plastic surgery is a rapidly evolving field that requires novel approaches in providing continuous and dynamic educational resources to address the increasing time and skill demands from residents. Online resources in their various forms, such as books, journals, simulators, and applications, are increasingly used by residents, notably over traditional print and in-person counterparts. In this digital era, it is imperative to understand the scope and utility of online resources that have the potential to revolutionize plastic surgery education. In this review article, we first discuss the current model of plastic surgery education and the challenges of meeting its goals and then suggest reasons by which online resources close this gap. We also offer an exposition on the benefits of distinct types of resources and current trends regarding their use. Our goal is to create a framework within which learners and educators are able to organize online resources in plastic surgery.
The Effectiveness of Burn Scar Contracture Release Surgery in Low- and Middle-income Countries
Authors: Botman Matthijs , Hendriks Thom C. C. , de Haas Louise E. M. , Mtui Grayson S. , Nuwass Emanuel Q. , Jaspers Mariëlle E. H. , Niemeijer Anuschka S. , Nieuwenhuis Marianne K. , Winters Henri A. H. , Van Zuijlen Paul P. M.
Published: January 2021

Background:

Worldwide, many scar contracture release surgeries are performed to improve range of motion (ROM) after a burn injury. There is a particular need in low- and middle-income countries (LMICs) for such procedures. However, well-designed longitudinal studies on this topic are lacking globally. The present study therefore aimed to evaluate the long-term effectiveness of contracture release surgery performed in an LMIC.

Methods:

This pre-/postintervention study was conducted in a rural regional referral hospital in Tanzania. All patients undergoing contracture release surgery during surgical missions were eligible. ROM data were indexed to normal values to compare various joints. Surgery was considered effective if the ROM of all planes of motion of a single joint increased at least 25% postoperatively or if the ROM reached 100% of normal ROM. Follow-ups were at discharge and at 1, 3, 6, and 12 months postoperatively.

Results:

A total of 70 joints of 44 patients were included. Follow-up rate at 12 months was 86%. Contracture release surgery was effective in 79% of the joints (P < 0.001) and resulted in a mean ROM improvement from 32% to 90% of the normal value (P < 0.001). A predictive factor for a quicker rehabilitation was lower age (R
2 = 11%, P = 0.001). Complication rate was 52%, consisting of mostly minor complications.

Conclusions:

This is the first study to evaluate the long-term effectiveness of contracture release surgery in an LMIC. The follow-up rate was high and showed that contracture release surgery is safe, effective, and sustainable. We call for the implementation of outcome research in future surgical missions.
Risk Factors for Lymphedema after Thigh Sarcoma Resection and Reconstruction
Authors: Wu Peter , Elswick Sarah M. , Akhavan Arya , Molinar Vanessa E. , Mohan Anita T. , Curiel Daniel , Sim Frank H. , Martinez-Jorge Jorys , Saint-Cyr Michel
Published: January 2021

Background:

Secondary lymphedema can be a lifelong and debilitating consequence of lower extremity oncologic resection and reconstruction. The goal of this study was to identify risk factors for the development of lymphedema in patients treated for thigh sarcoma.

Methods:

A retrospective review analyzed all patients who underwent thigh sarcoma resection and reconstruction by a plastic surgeon at the Mayo Clinic between 1997 and 2014. Patient demographics, tumor characteristics, surgical management, adjunctive therapies, and complications of patients who did and did not develop postoperative lymphedema were compared.

Results:

A total of 148 patients were identified. Twelve percent of patients developed lymphedema postoperatively during an average follow-up of 26 months. Risk factors for the development of lymphedema included defect location in the medial thigh (P = 0.04), arterial resection (P = 0.001), arterial reconstruction (P = 0.027), and a history of cardiac disease (P = 0.03). Twenty-two percent of patients who developed lymphedema also experienced wound dehiscence compared with 4.6% of patients without lymphedema (P = 0.02). There were no differences in age, body mass index, smoking, history of deep venous thrombosis or venous stasis, wound dimensions, or type of reconstruction performed in patients with and without lymphedema.

Conclusions:

Lymphedema is common following major oncologic resection. Preexisting cardiac disease, tumor location in the medial thigh, and arterial resection and reconstruction were associated with a higher risk of postoperative lymphedema. Noninfectious wound dehiscence may be secondary to lymphedema or represent an early indicator of patients who will ultimately develop lymphedema.
Scrotal Tissues: The Perfect Material for Urogenital Reconstruction
Authors: Adamyan Ruben T. , Kamalov Armais A. , Ehoyan Misak M. , Starceva Olesya I. , Urshevich Eduard N. , Sinelnikov Mikhail Y.
Published: January 2021

Background:

Correction of male urogenital pathology of different severity is complicated by the anatomical aspects of the penis. Skin texture, internal structures, and perfusion dynamics of the urogenital area make it a difficult area to reconstruct. We provide our experience with axial scrotal flaps for correction of penile defects of different severity and believe that these local flaps offer sufficient tissue characteristics for proper restoration of this complex region.

Methods:

Forty-eight patients were divided into 3 groups depending on penile defect genesis and severity. Axial scrotal flap reconstruction was used for the correction of defects in all cases, when necessary in combination with other flaps.

Results:

Axial scrotal flaps for total and subtotal penile reconstruction serve as valuable material for reconstruction of the urogenital area, and are to be combined with other flaps for restoration of bulk tissues. Localized defects of the penis and urethra reconstructed by axial scrotal flaps provide excellent aesthetic results with minimal scaring, stable perfusion dynamics, and high satisfaction rate.

Conclusions:

Scrotal tissues provide an excellent reconstruction material for penile defects because of their highly similar tissue structure as that of the penis. Scrotal axial flaps do not provide excess bulking in the postoperative period and are recommended for reconstruction of urethral and localized penile defects. Multistage surgery is recommended in cases of severe tissue damage, in combination with other flaps (inguinal, thoracodorsal, and radial).
Four Ways Plastic Surgeons Can Fight Climate Change
Authors: Brown Ciara , Meals Clifton
Published: January 2021

Background:

The climate crisis demands that surgeons reduce their environmental impact. Operating rooms are resource-intensive and are often wasteful. This makes them fitting targets for climate-conscious decision making.

Methods:

We searched for peer-reviewed literature describing how plastic surgeons might positively affect the environment through action in the operating room.

Results:

Several evidence-based, pro-climate practices may be undertaken by plastic surgeons. These strategies may be grouped into 4 types: material, energy, technique, and dissemination. Each strategy is a way to reduce, reuse, recycle, research, or rethink.

Conclusions:

Administrative obstacles to greener operating rooms are predictable and surmountable, especially because environmentally minded decisions are likely to save money. We anticipate a surge of environmental consciousness in healthcare. Plastic surgeons, as thought leaders, are well positioned to champion this cause.
The Prepectoral, Hybrid Breast Reconstruction: The Synergy of Lipofilling and Breast Implants
Authors: Stillaert Filip B. J. L. , Lannau Bernd , Van Landuyt Koenraad , Blondeel Phillip N.
Published: January 2021

Background:

Breast reconstruction modalities are based on autologous tissue transfer, implants, or a combination of both. The aim of an allogeneic breast reconstruction is to minimize the impact of the implant on surrounding tissues to achieve an aesthetically pleasing result. Accurate tissue coverage, proper implant selection, and implant location are the absolute concerns in planning an implant-based reconstruction.

Methods:

A single surgeon’s experience with the ergonomic, hybrid approach in primary and secondary breast reconstructions is presented. The hybrid approach is based on tissue expansion followed by serial sessions of fat grafting to augment the residual autologous (subcutaneous) compartment. The last step included the insertion of a prepectoral, ergonomic implant to obtain central core projection and additional volume.

Results:

Fifty-six hybrid breast reconstructions were performed with a mean follow-up of 24.1 months. Aesthetic outcomes and patient satisfaction have been good with pleasing breast projection, natural breast motion, and optimal coverage of the prepectoral implants.

Conclusions:

The hybrid reconstructive approach is a reliable technique to improve the outcomes in implant-based breast reconstructions. The 2-step, prepectoral approach with expander-to-implant exchange allows better control of the final breast shape, and complications related to submuscular approaches are avoided. Fat grafting adds an autologous benefit to obtain natural results.
A Unique Case of Lower Limb Soft Tissue Reconstruction with a Prefabricated Bipedicled Deep Inferior Epigastric Artery Flap
Authors: Melnikov Dmitriy V. , Starceva Olesya I. , Ivanov Semen I. , Garmi Rachid , Sinelnikov Mikhail Y.
Published: January 2021

Aesthetic lower-extremity reconstruction is a secondary field in lower limb reconstructive surgery. Nevertheless, it plays an important role in the final stages of patient rehabilitation after traumatic events, treatment of deformations, and oncoplastic surgery, and in unique cases of purely aesthetic reconstruction. We present a clinical case of lower limb reconstruction with a prefabricated bipedicled deep inferior epigastric artery (DIEP) flap in a young patient who underwent a massive congenital circular pigmented nevus excision surgery. Due to the lack of sufficient donor site tissues anywhere on the body, a bilateral DIEP flap was prefabricated using tissue expansion. Two expanders were used to prepare the donor site. Six months after expansion, lower limb reconstruction was performed. A large (50 × 25cm2) surgical defect was covered by a prefabricated DIEP flap. Flap positioning was regarded with extra care due to importance of proper venous outflow in accordance with lower limb venous anatomy. Treatment results were above the satisfactory level both aesthetically and therapeutically. Aesthetic and therapeutic incentives were assessed before surgical treatment decision. Large defects of the lower limbs require significant amount of excess tissue in the donor site and may require prefabrication. In young patients with low BMI, flap transfer is nearly impossible without prior expansion. In this case, we successfully performed giant pigmented nevus excision, with immediate reconstruction with a prefabricated bilateral DIEP flap. Venous outflow was problematic due to the anatomical structure of lower limb veins. This required extra venous drainage and special regard to positioning of the flap.
Surgical Technique for Below-knee Amputation with Concurrent Targeted Muscle Reinnervation
Authors: Daugherty Timothy H. F. , Parikh Rajiv , Mailey Brian A. , Felder John M. , Bueno Reuben A.
Published: January 2021

Targeted muscle reinnervation (TMR) is beneficial for decreasing pain following below-knee amputation (BKA). While most current literature describes the principles behind primary TMR, they provide few principles key to the amputation, as the BKA is usually performed by another surgeon. When the BKA and TMR are performed by the same surgeon, it can be performed through the same surgical access as needed for both procedures. The purpose of this article is to describe our anatomically based BKA technique in the setting of planned primary TMR as performed by 3, single, peripheral nerve plastic surgeons at 2 institutions. Advantages of the single-surgeon technique include efficiency in dissection, preservation of donor nerve length, limited proximal dissection, early identification of recipient motor nerves for coaptation, ability to stimulate these while still under tourniquet, and decreased tourniquet and operative time. This technique is quick, reliable, and reproducible to help promote widespread adoption of TMR at the time of BKA.
Necrobiosis Lipoidica Affecting the Leg: What Is the Best Treatment in a Patient with Very High Aesthetic Demand?
Authors: Baccarani Alessio , De Maria Federico , Pappalardo Marco , Pedone Antonio , De Santis Giorgio
Published: January 2021

Necrobiosis Lipoidica (NL) is a rare necrotising disorder of the skin characterized by collagen degeneration, thickening of blood vessels, and granulomatous inflammatory process. Its main clinical features are brownish-red papules and yellowish plaques with atrophic central areas. NL affects 0.3% -1.2% of the diabetic population, mostly women (female/male ratio is 3:1). Management of NL is challenging, especially for large lesions refractory to medical therapy, thus requiring surgical excision as an alternative option. Due to the rare occurrence of this condition no treatment guidelines exist and individualized treatment mostly depends on the severity of the lesion, location and patient's expectations. A case of a 30-year-old diabetic woman with very high aesthetic expectations was succesfully treated with staged resections of a giant NL to the leg and reconstruction with dermal template and full thickness skin grafts. Grafts were taken from the groin region bilaterally and from the lower abdomen after a cosmetic mini-abdominoplasty procedure. This approach allowed for a stable and very satisfactory aesthetic result with no donor site exposed scars.
Surgical Simulation Course for Facial Fracture Education
Authors: Wu Shannon S. , Patel Anooj , Alleyne Brendan , Metoyer Garyn , Chandrashekar Archana , Hassan Bashar , Hemal Kshipra , Gurunian Raffi
Published: January 2021

A hands-on facial fracture simulation course can be an important adjunct teaching modality in resident education and training, enhancing both resident confidence and competence in treatment of facial fractures. In this study, 11 plastic surgery residents participated in a surgical wet laboratory and lecture focusing on operative management of facial fractures. Pre- and post-course questionnaires were administered as clinical knowledge assessments. Pre-course, 40% of participating residents reported feeling comfortable with facial fracture management (>5 of 10) and 50% of residents achieved competence on clinical assessment (scoring >50%). Following the simulation course, these same assessments were re-administered. Post-course, comfortability with fracture management increased to 100% among participating residents, and 90% of residents scored >50%, demonstrating improvement in clinical competency.
Early full weight-bearing in patients with isolated displaced lateral malleolar fracture after rigid internal fixation with locking plates
Authors: Yeung Chi-Yung , Hung Shih-Hsin , Hsu Kuei-Hsiang , Chiu Fang-Yao
Published: January 2021

Background:

The timing of post-operative full weight-bearing in patients of isolated displaced lateral malleolar fractures remains controversial. The aim of this study was to evaluate the outcomes of early full weight-bearing after rigid internal fixation of such fractures with locking plates.

Methods:

From 2012 to 2018, 46 patients who had closed isolated displaced lateral malleolar fractures were included in the study. All fractures were managed with open reduction and internal fixation with locking plates. The patients were allowed to walk bearing their full weight 2 weeks after the operation. The follow-up period was 41.5 months on average (range: 12-70 months). The patients were available to evaluate union conditions, functional results, and complications.

Results:

The fractures united smoothly with an average union time of 10.5 weeks (range: 8-16). At the final follow-up, the average American Orthopaedic Foot and Ankle Score Ankle-Hindfoot Score was 91 (range: 85-98). No complications were observed.

Conclusion:

For patients with isolated displaced lateral malleolar fractures, full weight-bearing is safe and effective, without an increase in the rate of complications, 2 weeks after open reduction and rigid fixation with locking plates.
Pancreatic cystic tumors: an update
Authors: Xiao Shu-Yuan , Ye Ziyin
Published: January 2021

Pancreatic cystic tumors (PCTs) comprise a heterogeneous group of entities, accounting for 2% to 10% of pancreatic lesions. The most common types are intraductal papillary mucinous neoplasms (IPMNs), mucinous cystic neoplasm (MCN), and serous cystic neoplasm (SCN), which account for approximately 90% of PCTs. This review discusses updates in pathologic features, malignant transformation, biologic behavior, and molecular evolution of PCTs. IPMN includes main duct and branch duct types. These can also be classified into 4 histologic subtypes based on cell lineages of differentiation, and may be associated with different tumorigenic pathways and clinicopathologic characteristics. The gastric type is the most common and is rarely associated with carcinomas, whereas the pancreatobiliary type is significantly more associated with invasive carcinoma. MCN is a mucinous cystic lesion with the presence of ovarian-type pericystic stroma. Prognosis of the resected non-invasive MCN is excellent, but the long-term survival of MCNs with invasive carcinoma may be poor. SCN includes microcystic adenoma, macrocystic adenoma, and solid variant serous adenoma. Serous cystadenocarcinoma is defined by the presence of distant metastases, which is rare in literature. Intraductal tubulopapillary neoplasm is characterized by uniformly high-grade dysplasia and ductal differentiation without overt production of mucin, with high risk for developing invasion. Acinar cell cystadenoma is a rare benign lesion with acinar differentiation. In addition, some pancreatic neuroendocrine tumors may assume a cystic configuration, sometimes referred to as cystic pancreatic endocrine neoplasm tumor, with a lower pathologic stage. Solid pseudopapillary tumor is composed of poorly cohesive monomorphic epithelial cells forming solid and pseudopapillary structures, with excellent prognosis.