bluuebunny/crossref_metadata_2025 huggingface dataset:
Motor Vehicle Crash Risk among Adults Undergoing General Surgery: A Retrospective Case-crossover Study
Authors: Gaulton Timothy G. , Pfeiffer Melissa R. , Metzger Kristina B. , Curry Allison E. , Neuman Mark D.
Published: March 2023

Background

Surgery causes transient impairment in cognition and function, which may impact driving safety. The authors hypothesized that the risk of a motor vehicle crash would increase after compared to before surgery.

Methods

The authors performed a nested case-crossover study within population-based observational data from the New Jersey Safety Health Outcomes Data Warehouse. The study included adults 18 yr or older with a valid driver’s license who underwent general surgery in an acute care hospital in New Jersey between January 1, 2016, and November 30, 2017, and were discharged home. Individuals served as their own controls within a presurgery interval (56 days to 28 days before surgery) and postsurgery interval (discharge through 28 days after surgery). General surgery was defined by Common Procedural Terminology Codes. The primary outcome was a police-reported motor vehicle crash.

Results

In a cohort of 70,722 drivers, the number of crashes after surgery was 263 (0.37%) compared to 279 (0.39%) before surgery. Surgery was not associated with a change in crash incidence greater than 28 days using a case-crossover design (adjusted incidence rate ratio, 0.92; 95% CI, 0.78 to 1.09; P = 0.340). Statistical interaction was present for sex and hospital length of stay. Younger versus older adults (adjusted risk ratio, 1.87; 95% CI, 1.10 to 3.18; P = 0.021) and non-Hispanic Black individuals (adjusted risk ratio, 1.96; 95% CI, 1.33 to 2.88; P = 0.001) and Hispanic individuals (adjusted risk ratio, 1.38; 95% CI, 1.00 to 1.91; P = 0.047) versus non-Hispanic White individuals had a greater risk of a crash after surgery.

Conclusions

Using population-based crash and hospital discharge data, the incidence of motor vehicle crashes over a 28-day period did not change on average before compared to after surgery. The authors provide data on crash risk after surgery and highlight specific populations at risk.

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Info-NAS
Authors: Esteban-Sepúlveda Silvia , Giró-Formatger Dolors , Hernández-García Alicia F. , Serratosa-Cruzado Salvador , Moreno-Leyva Margarita , Terradas-Robledo Roser , Lacueva-Pérez Laia
Published: March 2023

The purpose of this study was to design an algorithm that allows automatic calculation of nursing workload in intensive care units, based on the Nursing Activities Score scale, through a computer program. Three methodological steps were used: (1) Delphi method (group of experts); (2) identification of the correspondence: Nursing Activities Score items-variables in the EHR, namely, standardized terminology, laboratory values, and prescriptions; and (3) weighting of variables independently by a group of experts. Finally, the algorithm of the computer program was tested. The results showed an algorithm that calculates the nursing workload in an ICU. The calculation is objective and automatic through the EHRs. This study shows the feasibility of the algorithm as a rapid and objective strategy to quantify adequate nurse staffing in intensive care units. Moreover, it provides nurses with a practical resource for the correct completion of records and is thus an incentive to maintain or improve their quality.
ACR–ARS Practice Parameter for the Performance of Total Body Irradiation
Authors: Reilly Michael , Dandapani Savita V. , Kumar Kiran A. , Constine Louis , Fogh Shannon E. , Roberts Kenneth B. , Small William , Schechter Naomi R.
Published: March 2023

Objectives:

This practice parameter was revised collaboratively by the American College of Radiology (ACR) and the American Radium Society (ARS). This practice parameter provides updated reference literature regarding both clinical-based conventional total body irradiation and evolving volumetric modulated total body irradiation.

Methods:

This practice parameter was developed according to the process described under the heading The Process for Developing ACR Practice Parameters and Technical Standards on the ACR website (https://www.acr.org/Clinical-Resources/Practice-Parameters-and-Technical-Standards) by the Committee on Practice Parameters—Radiation Oncology of the ACR Commission on Radiation Oncology in collaboration with the ARS

Results:

This practice parameter provides a comprehensive update to the reference literature regarding conventional total body irradiation and modulated total body irradiation. Dependence on dose rate remains an active area of ongoing investigation in both the conventional setting (where instantaneous dose rate can be varied) and in more modern rotational techniques, in which average dose rate is the relevant variable. The role of imaging during patient setup and the role of inhomogeneity corrections due to computer-based treatment planning systems are included as evolving areas of clinical interest notably surrounding the overall dose inhomogeneity. There is increasing emphasis on the importance of evaluating mean lung dose as it relates to toxicity during high-dose total body irradiation regimens.

Conclusions:

This practice parameter can be used as an effective tool in designing and evaluating a total body irradiation program that successfully incorporates the close interaction and coordination among the radiation oncologists, medical physicists, dosimetrists, nurses, and radiation therapists.
Discrepancy between Radiographic and Arthroscopic Findings of Thumb Basilar Joint Arthritis: A Preliminary Clinical Report
Authors: Sun Michael , Yoshida Ryu , Tsai Eugene , Kulber David
Published: March 2023

Background:

The radiographic staging of arthritic changes in the thumb carpometacarpal (CMC) joint is known to have poor correlation with pain level. This may be due to the limited ability of radiographs to evaluate degenerative changes. The purpose of this study was to examine the relationship between radiographic versus arthroscopic findings of thumb CMC and scaphotrapeziotrapezoidal (STT) joint arthritis.

Methods:

Twenty patients with symptomatic thumb CMC arthritis underwent arthroscopy of thumb CMC and STT joints with concomitant synovectomy or arthroplasty depending on the degree of articular degeneration found. All patients had preoperative radiographs of the thumb CMC and STT joints. Radiographic degeneration was graded based on the Eaton-Glickel classification. Intraoperative arthroscopic images were reviewed and graded based on the Brown grading system.

Results:

At the thumb CMC joint, five patients had discordant radiographic and arthroscopic findings of arthritis. At the STT joint, one patient had discordant radiographic and arthroscopic findings of arthritis.

Conclusions:

In comparing the two staging systems, we found a small subset of patients that demonstrated significant discrepancies. Clinical evaluation remains essential, and patients should be informed that radiographs may underestimate the actual severity of arthritis.
Efficacy of surgical treatment for post-prostatectomy urinary incontinence: a systematic review and network meta-analysis
Authors: Park Jae Joon , Hong Yejoon , Kwon Allison , Shim Sung Ryul , Kim Jae Heon
Published: March 2023

Objectives:

Post-prostatectomy urinary incontinence (PPUI) is a major complication that reduces the quality of life in patients undergoing prostatectomy for benign prostatic hyperplasia and prostate cancer. However, there are currently limited guidelines on which surgical techniques are preferred after conservative treatment for PPUI. In this study, a systematic review and network meta-analysis (NMA) that can help determine the priority for the selection of surgical methods were performed.

Materials and methods:

We retrieved data from electronic literature searches of PubMed and the Cochrane Library through August 2021. We searched for randomized controlled trials studies on the surgical treatment of PPUI after surgery for benign prostatic hyperplasia or prostate cancer and included the terms artificial urethral sphincter (AUS), adjustable sling, nonadjustable sling, and injection of the bulking agent.

The NMA pooled the odds ratios and 95% credible intervals (CrIs) using the number of patients achieving urinary continence, weight of pads used per day, number of pads used per day, and the International Consultation on Incontinence Questionnaire score. The therapeutic effect of each intervention on PPUI was compared and ranked using the surface under the cumulative ranking curve.

Results:

A final 11 studies, including 1116 participants, were included in our NMA. The pooled overall odds ratios of patients achieving urinary continence compared with no treatment was 3.31 (95% CrI: 0.749, 15.710) in AUS, 2.97 (95% CrI: 0.412, 16.000) in adjustable sling, 2.33 (95% CrI: 0.559, 8.290) in nonadjustable sling, and 0.26 (95% CrI: 0.025, 2.500) in injection of bulking agent. In addition, this study shows the surface under the cumulative ranking curve values of ranking probabilities for each treatment performance, which indicated that AUS ranked first in terms of continence rate, International Consultation on Incontinence Questionnaire, pad weight, and pad use count.

Conclusion:

The results of this study suggested that only AUS had a statistically significant effect compared to the nontreatment group and the highest PPUI treatment effect ranking among other surgical treatments.
Impact of guideline recommendation for novel surgical procedures on surgeons’ decisions: a time series analysis of gastric cancer surgeries from a nationwide cohort study
Authors: Honda Michitaka , Yasunaga Hideo , Michihata Nobuaki , Miyakawa Teppei , Kumazawa Ryosuke , Matsui Hiroki , Imaizumi Takahiro
Published: March 2023

Background:

Since two Japanese guidelines, for gastric cancer treatment and for minimally invasive surgery, were simultaneously revised in 2014, laparoscopic distal gastrectomy has been a standard procedure for clinical stage I gastric cancer.

Materials and methods:

We evaluated the impact of this revision on surgeons’ decision-making using a nationwide inpatient database in Japan. We described the time trends in the proportion of laparoscopic surgery from January 2011 to December 2018. We performed an interrupted time series analysis; the exposure time point was August 2014, and the main outcome was the change in slope before and after the revision of the guidelines. We performed a subgroup analysis of hospital volume and the odds ratio (OR) for postoperative complications according to exposure.

Results:

A total of 64 910 patients who underwent subtotal gastrectomy for stage I disease were identified. During the study period, the proportion of laparoscopic surgery showed a consistent increase from 47.4 to 81.2%. After the revision, the slope of the increase was rather slow; the OR [95% CI] was 0.601 [0.548–0.654] before the revision and 0.219 [0.176–0.260] after the revision. The adjusted ORs were 0.642 [0.575–0.709] before the revision and 0.240 [0.187–0.294] after the revision.

Conclusion:

The revision of the guidelines recommending laparoscopic surgery had little impact on surgeons’ decisions regarding the choice of procedure.
Impacts of ischemic preconditioning in liver resection: systematic review with meta-analysis
Authors: de Oliveira Glauber C. , de Oliveira Walmar K. , Yoshida Winston B. , Sobreira Marcone L.
Published: March 2023

Objective:

To assess the beneficial effects of ischemic preconditioning (IPC) in liver resection and evaluate its applicability in clinical practice.

Summary Background Data:

Liver surgeries are usually associated with intentional transient ischemia for hemostatic control. IPC is a surgical step that intends to reduce the effects of ischemia–reperfusion; however, there is no strong evidence about the real impact of the IPC, and it is necessary to effectively clarify what its effects are.

Methods:

Randomized clinical trials were selected, comparing IPC with no preconditioning in patients undergoing liver resection. Data were extracted by three independent researchers according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, Supplemental Digital Content 1, http://links.lww.com/JS9/A79. Several outcomes were evaluated, including postoperative peaks of transaminases and bilirubin, mortality, length of hospital stay, length of stay in the ICU, bleeding, and transfusion of blood products, among others. Bias risks were assessed using the Cochrane collaboration tool.

Results:

Seventeen articles were selected, with a total of 1052 patients. IPC did not change the surgical time of the liver resections while these patients bled less (Mean Difference: −49.97 ml; 95% CI: −86.32 to −13.6; I
2: 64%), needed less blood products [relative risk (RR): 0.71; 95% CI: 0.53–0.96; I
2=0%], and had a lower risk of postoperative ascites (RR: 0.40; 95% CI: 0.17–0.93; I
2=0%). The other outcomes had no statistical differences or could not have their meta-analyses conducted due to high heterogeneity.

Conclusions:

IPC is applicable in clinical practice, and it has some beneficial effects. However, there is not enough evidence to encourage its routine use.
Comparison of risk of complication between neuraxial anaesthesia and general anaesthesia for hip fracture surgery: a systematic review and meta-analysis
Authors: Chen Xi , Li Hairui , Li Songlin , Wang Yiou , Ma Ruichen , Qian Wenwei , Chen Gang , Li Jian
Published: March 2023

Background:

Controversy remains over the choice of anaesthetic technique for patients undergoing surgery for hip fracture.

Aim:

The aim was to compare the risk of complication of neuraxial anaesthesia with that of general anaesthesia in patients undergoing hip fracture surgery.

Methods:

This systematic review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines and was registered at PROSPERO (CRD42022337384). The study included eligible randomised controlled trials published before February 2022. Data synthesis was performed to compare the differences between general and neuraxial anaesthesia. Meta-regression analysis was performed to investigate the influence of the publication year. A subgroup analysis was performed based on patient age and the anaesthetic technique used. A grading of recommendations, assessment, development and evaluations assessment was performed to assess the quality of each outcome.

Results:

Twenty randomised controlled trials and 4802 patients were included. Data synthesis revealed significant higher risk of acute kidney injury in the general anaesthesia group (P=0.01). There were no significant differences between the two techniques in postoperative short-term mortality (P=0.34), delirium (P=0.40), postoperative nausea and vomiting (P=0.40), cardiac infarction (P=0.31), acute heart failure (P=0.34), pulmonary embolism (P=0.24) and pneumonia (P=0.15). Subgroup analysis based on patient age and use of sedative medication did not reveal any significant differences. Meta-regression analysis of the publication year versus each adverse event revealed no statistically significant differences.

Conclusion:

A significantly higher risk of postoperative acute kidney injury was found in patients receiving general anaesthesia. This study revealed no significant differences in terms of postoperative mortality and other complications between general and neuraxial anaesthesia. The results were consistent across the age groups.
Comparative analysis of prevalence, evaluation, management, and rehabilitation outcome of spontaneous isolated visceral artery dissection: a systematic review and meta-analysis of 80 reports
Authors: Shi Yan , Guo Jiangzhou , Dong Jige , Chen Xueli , Luo Lihua , Shen Yan
Published: March 2023

Background:

Because of relatively little data for management and evaluation surrounding spontaneous isolated visceral artery dissection (IVAD), existing studies have failed to provide comprehensive analysis for the management, evaluation, prevalence, as well as natural course of the disease. Therefore, we collected and analyzed current evidence on spontaneous IVAD with the aim of providing quantitative pooled data for the natural course and treatment standardization of the disease.

Methods:

A systematic search of PubMed, Embase, the Cochrane Library, and Web of Science up to 1 June 2022, was conducted for relevant studies that investigating the natural course, treatment, classification, and outcomes of IVAD. The primary outcomes were to determine the difference in prevalence, risk factors, and characteristics between different spontaneous IVAD. Two reviewers assessed the trial quality and extracted the data independently. All statistical analyses were performed using the standard statistical procedures provided in Review Manager 5.2 and Stata 12.0.

Results:

A total of 80 reports with 1040 patients were identified. The pooled results indicated that in IVAD, isolated superior mesenteric artery dissection (ISMAD) was more prevalent, with a pooled prevalence of 60% (95% CI: 50–71%), followed by isolated celiac artery dissection (ICAD) (prevalence: 37%; 95% CI: 27–46%). IVAD was male predominated with a pooled proportion of 80% (95% CI: 72–89%). Similar results were found in ICAD (prevalence: 73%; 95% CI: 52–93%). More IVAD patients were diagnosed with symptoms than ICAD (64 vs. 59%). Regarding to the risk factors, this pooled analysis found smoking and hypertension were the top two conditions in both spontaneous IVAD and ICAD patients, with proportion of 43, 41, 44, and 32%, respectively. It was observed that ICAD appeared shorter dissection length (mean difference: −3.4 cm; 95% CI: −4.9 to −2.0; P<0.0001), higher prevalence of Sakamoto’s classification Π (odds ratio: 5.31; 95% CI: 1.77−15.95; P=0.003) and late progression (odds ratio: 2.84; 95% CI: 1.02−7.87; P=0.05) than ISAMD.

Conclusions:

Spontaneous IVAD was male predominant and ISMAD was most prevalent followed by ICAD. Smoking and hypertension were the top two conditions in both spontaneous IVAD and ICAD patients. The majority of patients diagnosed with IVAD received observation and conservative treatment and experienced a low proportion of reintervention or progression, especially for ICAD patients. In addition, ICAD and ISMAD had several differences in clinical features and dissection characteristics. Future studies with enough sample size and long follow-up are required to clear the management, long-term outcome, and risk factors of the IVAD prognosis.
Textbook outcome as a composite outcome measure in laparoscopic pancreaticoduodenectomy: a multicenter retrospective cohort study
Authors: Wu Yi , Peng Bing , Liu Jianhua , Yin Xinmin , Tan Zhijian , Liu Rong , Hong Defei , Zhao Wenxing , Wu Heshui , Chen Rufu , Li Dewei , Huang Heguang , Miao Yi , Liu Yahui , Liang Tingbo , Wang Wei , Yuan Jingxiong , Li Shizhen , Zhang Hang , Wang Min , Qin Renyi ,   on behalf of the Minimally Invasive Treatment Group in the Pancreatic DiseaseBranch of China’s International Exchange and Promotion Association for Medicine and Healthcare (MITG-P-CPAM)
Published: March 2023

Background:

Textbook outcome (TO) is a composite outcome measure for surgical quality assessment. The aim of this study was to assess TO following laparoscopic pancreaticoduodenectomy (LPD), identify factors independently associated with achieving TO, and analyze hospital variations regarding the TO after case-mix adjustment.

Methods:

This multicenter cohort study retrospectively analyzed 1029 consecutive patients undergoing LPD at 16 high-volume pancreatic centers in China from January 2010 to August 2016. The percentage of patients achieving TO was calculated. Preoperative and intraoperative variables were compared between the TO and non-TO groups. Multivariate logistic regression was performed to identify factors independently associated with achieving TO. Hospital variations regarding the TO were analyzed by the observed/expected TO ratio after case-mix adjustment. Differences in expected TO rates between different types of hospitals were analyzed using the one-way analysis of variance test.

Results:

TO was achieved in 68.9% (n=709) of 1029 patients undergoing LPD, ranging from 46.4 to 85.0% between different hospitals. Dilated pancreatic duct (>3 mm) was associated with the increased probability of achieving TO [odds ratio (OR): 1.564; P=0.001], whereas advanced age (≥75 years) and concomitant cardiovascular disease were associated with a lower likelihood of achieving TO (OR: 0.545; P=0.037 and OR: 0.614; P=0.006, respectively). The observed/expected TO ratio varied from 0.62 to 1.22 after case-mix adjustment between different hospitals, but no significant hospital variations were observed. Hospital volume, the surgeon’s experience with open pancreaticoduodenectomy and minimally invasive surgery, and surpassing the LPD learning curve were significantly correlated with expected TO rates.

Conclusion:

TO was achieved by less than 70% of patients following LPD. Dilated pancreatic ducts, advanced age, and concomitant cardiovascular disease were independently associated with achieving TO. No significant hospital variations were observed after case-mix adjustment.
Cervical exenteration and its variants for locally advanced thyroid cancer: when, why, and how?
Authors: Piazza Cesare , Lancini Davide , Paderno Alberto
Published: March 2023

Purpose of review

To describe the modern surgical approach for management of advanced thyroid cancers infiltrating the cervicovisceral axis with special attention to well differentiated tumors not amenable to organ-sparing techniques. In particular, cervical exenteration, herein defined as the sum of total thyroidectomy, central compartment and lateral neck dissections, variously associated with total laryngectomy and possible partial or total pharyngoesophagectomy, represents an extreme surgical procedure that, in properly selected cases, allows for reasonable palliation of central compartment life-threatening signs/symptoms if not cure for an advanced oncologic condition.

Recent findings

Cervical exenteration is not contraindicated by the presence of limited distant metastases at presentation. Even though it requires that the patient is in general good health as it can be associated with a number of complications and long in-hospital stay, when appropriately planned and performed according to the most recent reconstructive nuances, it allows good oncologic outcomes that are not inferior to those described for similarly advanced primaries of the upper aerodigestive tract. In addition, quality of life and functional results are not significantly different from those described after total laryngectomy for primary laryngeal squamous cell carcinomas.

Cervical exenteration requires a tertiary, expert, multidisciplinary effort in terms of diagnosis, surgical performance, and postoperative care. A patient-centered decision process is strongly warranted taking into consideration alternative therapeutic and symptom-based palliative strategies.
Thyroid lymphoma
Authors: Rovira Aleix , Carroll Paul , Simo Ricard
Published: March 2023

Purpose of review

To highlight recent advances in our understanding of the epidemiology, incidence, evaluation, management and outcomes of primary thyroid lymphoma (PTL), and highlight the indications and limitations of surgery.

Recent findings

The differential diagnosis of a rapidly enlarging thyroid mass with or without obstructive symptoms should include PTL and anaplastic thyroid cancer. When PTL is suspected, initial investigations should include blood tests and ultrasound-guided biopsy preferably core need biopsy to allow tissue typing and immunohistochemistry analysis. Systemic imaging with FDG PET-CT is required for staging. Surgery is not recommended for treatment purposes and should be reserved for diagnosis and airway management. Treatment includes chemotherapy and radiotherapy and offer an excellent prognosis.

PTL is a rare malignancy making diagnosis and management challenging. Initial investigations of suspected PTL should include blood tests and ultrasound-guided biopsy, preferably core needle biopsy and systemic imaging is required for staging. Surgery is reserved for diagnosis and airway management. Chemotherapy and radiotherapy are the treatment of choice.
Adherence to swallowing recommendations during (chemo)radiotherapy in head and neck cancer survivors: a scoping review
Authors: Rowe Elizabeth A. , Dunton Jane , Cooke Samuel , Laparidou Despina , Patterson J. M.
Published: March 2023

Purpose of review

There is a paucity of knowledge regarding patient adherence to dysphagia recommendations. It is recognized that unique barriers and facilitators contribute to poor treatment adherence in head and neck cancer (HNC) survivors. This review aims to identify the key themes and knowledge gaps regarding adherence to swallowing recommendations in HNC survivors during (chemo)radiotherapy (C)RT.

Recent findings

Seven studies were identified. Six facilitators to adherence were extracted, namely pain relief, behavioural intervention, attendance at multidisciplinary clinic, individualised swallowing therapy, absence of prophylactic percutaneous endoscopic gastronomy (PEG) and positive social control from a spouse. Barriers to adherence included pain, depression and presence of prophylactic PEG. Adherence to swallowing recommendations positively impacted swallowing outcomes in one study.

Little is known about adherence to swallowing recommendations during (C)RT in HNC survivors. Capturing adherence is challenging. Several knowledge gaps were identified. Further research is needed to better understand the barriers and facilitators from the survivors’ perspective. This will inform development of best practice regarding how swallowing recommendations are provided to promote adherence and improve outcomes.
Audio Care for Managing Mental Health and Substance Use Disorders: A Rapid Review
Authors: Patel Sheila V. , Saavedra Lissette M. , Borja Ivette Rodriguez , Paterson Carly L. , Althuis Michelle , Philbrick Sarah , Schwimmer Manny , Ruwala Richa , Chue Amanda , Viswanathan Meera
Published: March 2023

We compared the effectiveness of audio care to usual care for managing mental health and substance use disorders.
Update on the treatment of chronic pulmonary aspergillosis
Authors: Armstrong-James Darius , Kosmidis Chris , Bromley Mike
Published: March 2023

Purpose of review

Chronic pulmonary aspergillosis is a major global infection in individuals with preexisting structural lung diseases and those with immunodeficiencies, in particular cytokine defects. Current treatment options are confined to just three drug classes, the triazoles, the echinocandins and amphotericin B. However, antifungal resistance is rapidly emerging for the triazoles, the only available oral therapy for this chronic condition.

Recent findings

Fortunately, there are now a number of novel antifungals in the development pipeline, mostly now in Phase 3 studies, with a potential for the treatment of chronic pulmonary aspergillosis. However, almost all current randomized triazoles of novel antifungals are primarily undertaken in patients with invasive candidiasis or invasive mould infections. Given the poor outcomes from treatment with antifungals in chronic pulmonary aspergillosis, in part associated with triazole resistance, we urgently need clinical trials of novel agents either as monotherapy or in combination for this disease. In addition, there is an emerging understanding of the role of immunotherapies for the treatment of chronic pulmonary aspergillosis, especially in the context of cytokine defects. Therefore, better understanding of the role of adjunctive immunotherapies such as interferon-gamma is also required.

In this review, we give an overview of current management of chronic pulmonary aspergillosis, and novel antifungals and immunotherapies for the future.
Statewide Perinatal Quality Improvement, Teamwork, and Communication Activities in Oklahoma and Texas
Authors: Stierman Elizabeth K. , O'Brien Barbara T. , Stagg Julie , Ouk Elizabeth , Alon Natanya , Engineer Lilly D. , Fabiyi Camille A. , Liu Tasnuva M. , Chew Emily , Benishek Lauren E. , Harding Brenda , Terhorst Raymond G. , Latif Asad , Berenholtz Sean M. , Mistry Kamila B. , Creanga Andreea A.
Published: March 2023

Background and Objective:

The purpose of this study was to describe statewide perinatal quality improvement (QI) activities, specifically implementation of Alliance for Innovation on Maternal Health (AIM) patient safety bundles and use of teamwork and communication tools in obstetric units in Oklahoma and Texas.

Methods:

In January-February 2020, we conducted a survey of AIM-enrolled hospitals in Oklahoma (n = 35) and Texas (n = 120) to gather data on obstetric unit organization and QI processes. Data were linked to hospital characteristics information from the 2019 American Hospital Association survey and hospitals' maternity levels of care from state agencies. We generated descriptive statistics for each state and created an index to summarize adoption of QI processes. We fitted linear regression models to examine how this index varied by hospital characteristics and self-reported ratings for patient safety and AIM bundle implementation.

Results:

Most obstetric units had standardized clinical processes for obstetric hemorrhage (94% Oklahoma; 97% Texas), massive transfusion (94% Oklahoma; 97% Texas), and severe hypertension in pregnancy (97% Oklahoma; 80% Texas); regularly conducted simulation drills for obstetric emergencies (89% Oklahoma; 92% Texas); had multidisciplinary QI committees (61% Oklahoma; 83% Texas); and conducted debriefs after major obstetric complications (45% Oklahoma; 86% Texas). Few obstetric units offered recent staff training on teamwork and communication to their staff (6% Oklahoma; 22% Texas); those who did were more likely to employ specific strategies to facilitate communication, escalate concerns, and manage staff conflicts. Overall, adoption of QI processes was significantly higher in hospitals in urban than rural areas, teaching than nonteaching, offering higher levels of maternity care, with more staff per shift, and greater delivery volume (all P < .05). The QI adoption index scores were strongly associated with respondents' ratings for patient safety and implementation of maternal safety bundles (both P < .001).

Conclusions:

Adoption of QI processes varies across obstetric units in Oklahoma and Texas, with implications for implementing future perinatal QI initiatives. Notably, findings highlight the need to reinforce support for rural obstetric units, which often face greater barriers to implementing patient safety and QI processes than urban units.
Promoting Publications Through Plastic Surgery Journal Instagram Accounts
Authors: Maisner Rose S. , Goydos Christopher , Ong Melody , Jain Shona , Shah Payal , Kim Brian , Wright Jack , Patel Nidhi , Kapadia Kailash , Lee Edward S.
Published: March 2023

Purpose

Journals are increasingly using social media to increase article engagement. We aim to determine the impact of Instagram promotion on, and identify social media tools that effectively enhance, plastic surgery article engagement and impact.

Methods

Instagram accounts for Plastic and Reconstructive Surgery, Annals of Plastic Surgery, Aesthetic Surgery Journal, and Aesthetic Plastic Surgery were reviewed for posts published by February 8, 2022. Open access journal articles were excluded. Post caption word count and number of likes, tagged accounts, and hashtags were recorded. Inclusion of videos, article links, or author introductions was noted. All articles from journal issues published between the dates of the first and last posts promoting articles were reviewed. Altmetric data approximated article engagement. Citation numbers from the National Institutes of Health iCite tool approximated impact. Differences in engagement and impact of articles with and without Instagram promotion were compared by Mann-Whitney U tests. Univariate and multivariable regressions identified factors predictive of more engagement (Altmetric Attention Score, ≥5) and citations (≥7).

Results

A total of 5037 articles were included, with 675 (13.4%) promoted on Instagram. Of posts featuring articles, 274 (40.6%) included videos, 469 (69.5%) included article links, and 123 included (18.2%) author introductions. Promoted articles had higher median Altmetric Attention Scores and citations (P < 0.001). On multivariable analysis, using more hashtags predicted higher article Altmetric Attention Scores (odds ratio [OR], 1.85; P = 0.002) and more citations (OR, 1.90; P < 0.001). Including article links (OR, 3.52; P < 0.001) and tagging more accounts (OR, 1.64; P = 0.022) predicted higher Altmetric Attention Scores. Including author introductions negatively predicted Altmetric Attention Scores (OR, 0.46; P < 0.001) and citations (OR, 0.65; P = 0.047). Caption word count had no significant impact on article engagement or impact.

Conclusions

Instagram promotion increases plastic surgery article engagement and impact. Journals should use more hashtags, tag more accounts, and include manuscript links to increase article metrics. We recommend that authors promote on journal social media to maximize article reach, engagement, and citations, which positively impacts research productivity with minimal additional effort in designing Instagram content.
Posterior Circumflex Humeral Artery Perforator Flap: A Cadaveric Study and Case Series
Authors: Garieri Pietro , Gatto Arianna , Brambilla Leonardo , Cavalli Erica , Codazzi Denis , Marchesi Andrea
Published: March 2023

Background

Reconstruction of soft tissue defects of the acromioclavicular region represents a relatively uncommon but challenging event. Many muscular, fasciocutaneous, and perforator flaps have been described, including the posterior circumflex humeral artery perforator (PCHAP) flap based on the direct cutaneous perforator of the PCHA. This study aims to describe a variant of the PCHAP flap, based on a constant musculocutaneous perforator, by means of a cadaveric study and a case series.

Methods

A cadaveric study was conducted using 11 upper limbs. The perforator vessels originating from the PCHA were dissected and the musculocutaneous ones were identified and measured in their length and distance from the deltoid tuberosity. Besides, we retrospectively analyzed the posterior shoulder reconstruction conducted among 2 plastic surgery department (San Gerardo Hospital, Monza and Hospital Papa Giovanni XXIII, Bergamo) using the musculocutaneous perforators of the PCHA.

Results

The cadaver dissection showed the presence of a constant musculocutaneous perforator arising from the PCHA. The mean pedicle length is 6.10 ± 1.18 cm, and the musculocutaneous perforator pierces the fascia at a mean distance of 10.4 ± 2.06 cm from the deltoid tuberosity. In all the cadaver dissected, the perforator of interest divided into 2 terminal branches, anterior and posterior, nourishing the skin paddle.

In our case series, the mean age of the patients was 66.7 years, the mean size of the defect was 46 cm2, the mean operating time was 79.3 minutes, the mean length of hospital stay was 2.7 days, and the complication rate was 28.6%.

Conclusions

According to this preliminary data, the PCHAP flap based on the musculocutaneous perforator seems to be a reliable alternative in posterior shoulder region reconstruction.
Efficacy Analysis of Extended Uvulopalatopharyngoplasty Combined With the Simultaneous Multiplane Operation to Treat Obstructive Sleep Apnea
Authors: Yuan FoLiang , Wu ShuXian , Tang JiaHui , Yuan HongYan , Zhang Song
Published: March 2023

Purpose:

The purpose of this study was to discuss the safety and long-term efficacy of extended uvulopalatopharyngoplasty combined with the simultaneous multiplane operation to treat obstructive sleep apnea (OSA).

Materials and Methods:

Sixty-two patients confirmed with OSA by polysomnography received physical examinations, determination of nasal resistance, Muller’s maneuver under electronic laryngoscope, and upper airway computed tomography scan to locate the obstruction planes. Then the patients received extended uvulopalatopharyngoplasty combined with the simultaneous multiplane operation of the nasal cavity and/or tongue root under general anesthesia. Body mass index, Epworth Sleepiness Scale (ESS) score, apnea-hypopnea index (AHI), and lowest arterial oxygen saturation (LSaO2) were compared before and after surgery. Postoperative complications were recorded. All patients were followed up for 12 to 24 months after surgery. The above-mentioned indicators were determined.

Results:

Fourteen patients (22.58%) achieved a cure, 20 patients (32.26%) marked effectiveness, 20 patients (32.26%) moderate effectiveness, and 8 patients (12.90%) ineffectiveness. The overall response rate was 87.10%. AHI and ESS score decreased, and LSaO2 increased after surgery than before, all in a significant manner (P<0.05). There was no significant difference in body mass index before and after surgery. No severe complications occurred in any patients.

Conclusions:

Extended uvulopalatopharyngoplasty combined with the simultaneous multiplane operation had a good safety for OSA, improving ESS, AHI, and LSaO2 significantly. The patients enjoyed an improved life quality after surgery.
Application of a Modified Perforator Flap of the Transverse Facial Artery for Zygomaticofacial Skin Defect Repair After Tumor Resection
Authors: Zhang Shuo , Zhao Shuhan , Song Peijun , Xu Jing
Published: March 2023

Background:

The transverse facial artery is an important source of zygomaticofacial blood, but its perforator flap is rarely reported. The aim of this study was to investigate the utility of a modified perforator flap based on facial aesthetic units and previous anatomic studies of transverse facial arteries.

Methods:

All 18 elderly patients with zygomatic facial tumors underwent Mohs surgery. The V-Y and propeller flaps were designed according to the aesthetic unit of the defect site. Only a small portion of the fascia and fat surrounding the blood vessel are left, the rest of the flap is pruned to a thickness closer to the surrounding tissues. The surgical effect was comprehensively evaluated by an expert group. To assess the patient’s postoperative quality of life, we administered the FACT-H & N (v 4.0) scale before and after surgery.

Results:

Among the 18 flaps, 10 were V-Y flaps and 8 were propeller flaps. The flaps of 18 patients survived, with adequate cheek, facial symmetry, and proper mouth opening. The flaps worked well and looked good at both the recipient and donor sites. According to the scale survey, the postoperative patients had a higher quality of life in terms of physiology, psychology, function, and other areas than the preoperative patients (P<0.05).

Conclusion:

A modified flap of the transverse facial artery can rotate flexibly and repair a larger area, as the blood flow is relatively constant near the zygomatic arch. It has a high clinical value in the treatment of zygomaticofacial tumors.
Ultrapulse Fractional CO2 Laser With Different Fluences and Densities in the Prevention of Periorbital Laceration Scars: A Split-Scar, Evaluator-Blinded Study
Authors: Wang Jue , Wu Jiang , Chen Baoguo , Gao Quanwen
Published: March 2023

Background:

Periorbital laceration can result in complex, permanent scars, and even lead to serious complications such as cicatricial ectropion. Early intervention with laser devices has been suggested as a novel modality to reduce scar formation. However, no consensus exists regarding the optimal treatment parameters for scar management. This study evaluated the efficacy and safety of ultrapulse fractional CO2 laser (UFCL) with different fluences and densities in preventing periorbital surgical scars.

Objective:

To assess the efficacy and safety of UFCL with different fluences and densities in the prevention of periorbital laceration scars.

Methods:

A prospective, randomized, blinded study was conducted on 90 patients with periorbital laceration scars of 2 weeks old. Four treatment sessions of UFCL were administered to each half of the scar at 4-week intervals, with halves treated with high fluences with low density versus low fluences with low-density treatment. Vancouver Scar Scale was used to assess the 2 portions of each individual scar at baseline, final treatment, and 6 months. The patient’s 4-point satisfaction scale was used to evaluate the patient’s satisfaction at baseline and 6 months. Safety was evaluated by registration of adverse events.

Results:

Eighty-two of 90 patients completed the clinical trial and follow-up. There was no significant difference in Vancouver Scar Scale and satisfaction score between different laser settings between the two groups (P > 0.05). Adverse events were minor and no long-term side effects were noted.

Conclusions:

Early application of UFCL is a safe, strategy to significantly improve the final traumatic periorbital scar appearance. Objective evaluation of scars did not identify differences in scar appearance between high fluences with low density versus low fluences with low density of UFCL treatment.

Level of Evidence:

Level III.
Worth Syndrome—Patient Report, Diagnostic Work-Up, and Surgical Management of a Rare Craniofacial Entity
Authors: Shafarenko Mark S. , Klieb Hagen B. , Antonyshyn Oleh M.
Published: March 2023

Worth syndrome is a rare genetic bone disorder that often presents with cortical thickening of the mandible and an increase in mandibular width. The authors report the preoperative considerations in a young female with Worth syndrome, operative planning, and successful mandibular reduction using cutting guides.
Lifestyle Optimization Leads to Superior Liver Regeneration in Live Liver Donors and Decreases Early Allograft Dysfunction in Recipients
Authors: Gupta Anish , Patil Nilesh Sadashiv , Mohapatra Nihar , Benjamin Jaya , Thapar Shalini , Kumar Anupam , Rastogi Archana , Pamecha Viniyendra
Published: March 2023

Introduction:

The aim of the current randomized control trial was to assess the efficacy of donor lifestyle optimization on liver regeneration and outcome following live donor liver transplantation.

Methods:

Live liver donors (LLDs) who were fit with no or minimal steatosis were randomized to receive either a customized low-calorie diet with calorie intake equalling their basal requirement along with exercise for 2 weeks before surgery versus to continue their normal routine lifestyle. Primary objectives were the difference in the day of normalization of serum bilirubin and PT-International normalized ratio and the percentage growth of the liver at postoperative day 7 and 14. Secondary objectives were differences in intraoperative liver biopsy, liver-regeneration markers, blood loss, hospital stay, the complication rate in LLDs, and rates of early graft dysfunction (EGD) in recipients.

Results:

Sixty-two consecutive LLDs were randomized (28 in intervention vs. 34 in control). Baseline parameters and graft parameters were similar in both groups. LLDs in the intervention arm had significantly decreased calorie intake (P<0.005), abdominal girth (P<0.005), BMI (P=0.05), and weight (P<0.0005). The mean blood loss (P=0.038), day of normalization of bilirubin (P=0.005) and International normalized ratio (P=0.061), postoperative peak aspartate transaminase (P=0.003), Alanine transaminase (P=0.025), and steatosis (P<0.005) were significantly less in the intervention group. There was significantly higher volume regeneration (P=0.03) in donors in the intervention arm. The levels of TNF-α, IL-6, and IL-10 levels were significantly higher, while the TGF-β level was lower in donors in the intervention group. The rate of EGD was significantly higher in recipients in the control group (P=0.043).

Conclusion:

Lifestyle optimization of LLD is simple to comply with, improves liver regeneration in LLDs, and decreases EGD in recipients, thus can enhance donor safety and outcomes in live donor liver transplantation.
Effects of selfing on the evolution of sexual reproduction
Authors: Xu Kuangyi
Published: March 2023

Plants exhibit diverse breeding systems, with populations capable of outcrossing, selfing, and/or asexual reproduction. However, interactions between the three reproductive pathways remain not fully clear. Sexual reproduction introduces segregation and recombination, but incurs several costs. Selfing can affect the relative costs and benefits of sexual vs. asexual reproduction. Building population genetic models, I explore how selfing affects the evolution of a sexual reproduction rate modifier via (1) indirect selection due to segregation, (2) indirect selection from changes in recombination rates, and (3) selection from the cost of meiosis and mate limitation. The dominant selective force mediating the evolution of sex is found to vary with the rate of sexual reproduction and selfing, but selective force (1) and (3) are generally stronger than selective force (2). A modifier enhancing sexual reproduction tends to be favored by indirect selection generated by partially recessive, small-effect deleterious mutations, while hindered by highly recessive lethal mutations. Overall, evolution towards higher sexual reproduction is hindered at low sexual reproduction rates and intermediate selfing rates, but favored under high selfing rates. The results suggest that asexual reproduction may precede the evolution of selfing, and offer insights into the evolution of mechanisms reducing geitonogamy in partially clonal populations.
Evolution of flowering time through the asynchrony of pollen dispersal
Authors: Xu Kuangyi
Published: March 2023

The evolution of flowering time is often attributed to variation of pollinator rates over time. This study proposes that flowering time can evolve through siring success variation among individuals caused by differential pollen dispersal timing (a result of flowering time variation itself). Quantitative genetic models show that earlier flowering evolves under low pollen removal rates, high pollen deposition rates, and a slow decline in the fertilization ability of removed pollen. Variations in pollen dispersal timing also select for a stable variance in flowering time, which is larger when pollen removal rates are either very low or high, pollen deposition rates are moderate, and the fertilization ability of removed pollen declines more rapidly. Also, a model on the coevolution of flower longevity and flowering time predicts that under constant pollination rates, non-random mating results in a weak correlation between late flowering and longer-lived flowers. This baseline finding suggests that the observed correlation between late flowering and shorter flowering duration in nature is influenced by other factors, such as declining pollination rates during late-stage flowering. I discuss the role of altered pollination rates under climate change during flowering time evolution and the importance of distinguishing between pollen removal and deposition rates.