bluuebunny/crossref_metadata_2025 huggingface dataset:
Building Interprofessional Collaborative Practices Through a Support Program for Patients With Type 2 Diabetes in Primary Care
Authors: Bawab Noura , Moullin Joanna , Jotterand Sébastien , Rossier Christophe , Schneider Marie-Paule , Perraudin Clémence
Published: March 2023

Introduction:

The building of interprofessional collaborative practices throughout the implementation process of a patient support program (Siscare) in primary care for patients with type 2 diabetes was assessed. Siscare included regular patient–pharmacist motivational-based interviews; medication adherence, patient-reported, and clinical outcomes monitoring; and physician–pharmacist interactions.

Method:

This investigation was a prospective, multicenter, observational, mixed-methods cohort study. Interprofessionality was operationalized through four progressive levels of interrelationship practices between the health care professionals. The target number of patients per pharmacy was 10 among 20 pharmacies.

Results:

The project started with the recognition of Siscare by stakeholders, the creation of an interprofessional steering committee, and the adoption of Siscare by 41 pharmacies among 47 pharmacies in April 2016. Nineteen pharmacies presented Siscare at 43 meetings attended by 115 physicians. Twenty-seven pharmacies included 212 patients; however, no physician prescribed Siscare. Collaboration primarily occurred through the unidirectional transmission of information from the pharmacist to the physician (level 1: 70% of pharmacists transmitted interview reports to physicians), bidirectional exchange of information sometimes occurred (level 2: 42% received physician responses), and concerted measures of treatment objectives took place occasionally (level 3). Twenty-nine of 33 physicians surveyed were in favor of this collaboration.

Discussion:

Despite multiple implementation strategies, physician resistance and lack of motivation to participate exists, but Siscare was well received by pharmacists, patients, and physicians. Barriers to collaborative practice (financial and IT) need to be further explored. Interprofessional collaboration is a clear need to improve type 2 diabetes adherence and outcomes.
Are We Ever Going Back? Exploring the Views of Health Professionals on Postpandemic Continuing Professional Development Modalities
Authors: Cassidy Dara , Edwards Gareth , Bruen Catherine , Kelly Helen , Arnett Richard , Illing Jan
Published: March 2023

Introduction:

The COVID-19 pandemic has profoundly altered the ways in which health care professionals engage with continuing professional development (CPD), but the extent to which these changes are permanent remains unknown at present. This mixed-methods research aims to capture the perspectives of health professionals on their preferences for CPD formats, including the conditions that inform preferences for in-person and online CPD events and the optimum length and type of online and in-person events.

Methods:

A survey was used to gain a high-level perspective on health professionals' engagement with CPD, areas of interest, and capabilities and preferences in relation to online formats. A total of 340 health care professionals across 21 countries responded to the survey. Follow-up semistructured interviews were conducted with 16 respondents to gain deeper insights into their perspectives.

Results:

Key themes include CPD activity before and during COVID, social and networking aspects, access versus engagement, cost, and time and timing.

Discussion:

Recommendations regarding the design of both in-person and online events are included. Beyond merely moving in-person events online, innovative design approaches should be adopted to capitalize on the affordances of digital technologies and enhance engagement.
Differences in Physician Performance and Self-rated Confidence on High- and Low-Stakes Knowledge Assessments in Board Certification
Authors: Price David W. , Wang Ting , O'Neill Thomas R. , Bazemore Andrew , Newton Warren P.
Published: March 2023

Introduction:

Evidence links assessment to optimal learning, affirming that physicians are more likely to study, learn, and practice skills when some form of consequence (“stakes”) may result from an assessment. We lack evidence, however, on how physicians' confidence in their knowledge relates to performance on assessments, and whether this varies based on the stakes of the assessment.

Methods:

Our retrospective repeated-measures design compared differences in patterns of physician answer accuracy and answer confidence among physicians participating in both a high-stakes and a low-stakes longitudinal assessment of the American Board of Family Medicine.

Results:

After 1 and 2 years, participants were more often correct but less confident in their accuracy on a higher-stakes longitudinal knowledge assessment compared with a lower-stakes assessment. There were no differences in question difficulty between the two platforms. Variation existed between platforms in time spent answering questions, use of resources to answer questions, and perceived question relevance to practice.

Discussion:

This novel study of physician certification suggests that the accuracy of physician performance increases with higher stakes, even as self-reported confidence in their knowledge declines. It suggests that physicians may be more engaged in higher-stakes compared with lower-stakes assessments. With medical knowledge growing exponentially, these analyses provide an example of the complementary roles of higher- and lower-stakes knowledge assessment in supporting physician learning during continuing specialty board certification.
Is Academic Medicine Prepared to Teach About the Intersection of Childhood Experiences and Health? An Exploratory Survey of Faculty
Authors: Koo Angie , Irwin Jordyn , Sturgis Morgan , Schwartz Alan , Hasnain Memoona , Davis Elizabeth , Stillerman Audrey
Published: March 2023

Introduction:

Childhood experiences affect health across the lifespan. Evidence-based strategies targeting early-life stress are emerging. Nevertheless, faculty physicians' preparation to incorporate this science into practice has not been well studied. This study explores medical faculty knowledge and beliefs, timing and route of knowledge acquisition, perceived relevance and application of study topics, and characteristics associated with concept mastery.

Methods:

The authors developed and administered an exploratory survey to faculty from six departments at two medical schools. The team analyzed responses using quantitative and qualitative methods.

Results:

Eighty-one (8.8%) eligible faculty completed the survey. Of respondents, 53 (65.4%) achieved high knowledge, 34 (42.0%) high beliefs, and 42 (59.1%) high concept exposure question scores, but only 6 (7.4%) through a formal route. Although 78 (96.8%) respondents indicated that survey concepts are relevant, only 18 (22.2%) reported fully incorporating them in their work, and 48 (59.2%) identified the need for additional coaching. Respondents reporting full incorporation were significantly more likely to attain high concept exposure scores (17 respondents, 94.4%, versus 25 respondents, 39.7%,P< .001). Quantitative and qualitative analysis highlighted limited respondent awareness of trauma prevalence among health care workers, lack of familiarity with interventions, and time and resource challenges addressing childhood adversity.

Discussion:

Although survey respondents had some familiarity with study concepts and perceived their relevance, most are not fully applying them. Results suggest that exposure to study concepts is associated with full incorporation. Therefore, intentional faculty development is essential to prepare faculty to include this science in practice.
Effects of visual restoration on gait performance and kinematics of lower extremities in patients with age-related cataract
Authors: Ao Mingxin , Shi Huijuan , Li Xuemin , Huang Hongshi , Ao Yingfang , Wang Wei
Published: March 2023

Background:

Visual inputs are critical for locomotor navigation and sensorimotor integration in the elderly; however, the mechanism needs to be explored intensively. The present study assessed the gait pattern after cataract surgery to investigate the effects of visual restoration on locomotion.

Methods:

The prospective study recruited 32 patients (70.1 ± 5.2 years old) with bilateral age-related cataracts in the Department of Ophthalmology at Peking University Third Hospital from October 2016 to December 2019. The temporal-spatial gait parameters and kinematic parameters were measured by the Footscan system and inertial measurement units. Paired t-test was employed to compare data normally distributed and Wilcoxon rank-sum test for non-normally distributed.

Results:

After visual restoration, the walking speed increased by 9.3% (1.19 ± 0.40 m/s vs. 1.09 ± 0.34 m/s, P=0.008) and exhibited an efficient gait pattern with significant decrease in gait cycle (1.02 ± 0.08 s vs. 1.04 ± 0.07 s, P=0.012), stance time (0.66 ± 0.06 s vs. 0.68 ± 0.06 s, P=0.045), and single support time (0.36 ± 0.03 s vs. 0.37 ± 0.02 s, P=0.011). High amplitude of joint motion was detected in the sagittal plane in the left hip (37.6° ± 5.3° vs. 35.5° ± 6.2°, P=0.014), left thigh (38.0° ± 5.2° vs. 36.4° ± 5.8°, P=0.026), left shank (71.9° ± 5.7° vs. 70.1° ± 5.6°, P=0.031), and right knee (59.1° ± 4.8° vs. 56.4° ± 4.8°, P=0.001). The motor symmetry of thigh improved from 8.35 ± 5.30% to 6.30 ± 4.73% (P=0.042).

Conclusions:

The accelerated gait in response to visual restoration is characterized by decreased stance time and increased range of joint motion. Training programs for improving muscle strength of lower extremities might be helpful to facilitate the adaptation to these changes in gait.
Rising to “The Highest Morals”—The Rich History of Nursing Ethics
Authors: Fowler Marsha D. , Schoonover-Shoffner Kathy
Published: March 2023

Modern nursing is supported by a rich ethical tradition dating back to the mid-19th century. Moving illustrations of nursing practice and “the highest morals” (McIsaac, 1901) relay the distinguished history and distinctives of nursing ethics from the 1860s to the present day. Of note is that nursing ethics is relationally focused, virtue-based, preventative, and central to the identity of nursing. A brief history of how bioethics emerged in the mid-20th century and an overview of the development of nursing ethics unveils differences between the two ethical paradigms.
2000 Years of Clinical Trials
Authors: Zrelak Patricia Ann
Published: March 2023

Although the first documented clinical trial as described in the biblical book of Daniel dates to 606 BC, the prophet Daniel's nutrition study is contemporary in both approach and topic and could be considered the first comparative effectiveness research (CER) trial. This article summarizes the historical evolution of clinical trials and associated regulatory legislation. Ethical considerations foundational to nursing and evidence-based practice (EBP) in the 21st century are examined. Distinguishing features of CER, various study designs and checklists, and EBP are detailed. Biblical foundations for research and the Bible's relevance to modern research methods are discussed.
Persevering in Nursing with Godly Purpose
Authors: Biber Duke
Published: March 2023

COVID-19 impacted the psychological and spiritual wellness of healthcare providers, in addition to their physical health. Christian nurses must continue to look for reassurance of God's provision and control of circumstances as a means of coping through adversity in their work. Practical Scripture applications are provided to sustain nurses' resilience and encouragement.
The Presence of Implicit Gender Bias in Colon and Rectal Surgery Residency Letters of Recommendation
Authors: Al Jabri Ali , Bhat Hina , Abelson Jonathan S. , Breen Elizabeth M. , Kuhnen Angela H. , Stein Sharon L. , Steinhagen Emily , Saraidaridis Julia T.
Published: March 2023

BACKGROUND:

Selection for colorectal surgery residency relies upon letters of recommendation for subjective assessment of candidates’ strengths and weaknesses. It is unclear if this process incorporates implicit gender bias.

OBJECTIVE:

To assess the presence of gender bias in letters of recommendation for colorectal surgery residency.

DESIGN:

Mixed methods assessment of the characteristics described within the blinded letters of the 2019 application cycle to a single academic residency.

SETTINGS:

Academic medical center.

PATIENTS/STUDY SUBJECTS:

Blinded letters from the 2019 colorectal surgery residency application cycle.

INTERVENTIONS:

Characteristics of the letters were determined using qualitative and quantitative measures.

MAIN OUTCOME MEASURES:

Association of gender with the presence of descriptors within the letters.

RESULTS:

There were 111 applicants, 409 letter writers, and 658 letters were analyzed. 43% of applicants were female. Female and male applicants had equal mean number of positive (5.4 vs. 5.8; p = 0.10) and negative (0.5 vs. 0.4; p = 0.07) attributes represented. Female applicants were more likely to be described as having poor academic skills (6.0 vs. 3.4%, p = 0.04) and possess negative leadership qualities (5.2% vs. 1.4%; p < 0.01) than male applicants. Male applicants were more likely to be described as being kind (36.6% vs. 28.3%; p = 0.03), curious (16.4% vs. 9.2%; p = 0.01), possessing positive academic skills (33.7% vs. 20.0%; p < 0.01), and positive teaching skills (23.5% vs. 17.0%; p = 0.04).

LIMITATIONS:

This study analyzed a single year of applications to an academic center and may not be generalizable.

CONCLUSION:

There are differences in the qualities used to describe female versus male applicants in colorectal surgery residency application letters of recommendation. Female applicants were more often described in negative academic terms and possessing negative leadership qualities. Males were more likely to be described as kind, curious, academically impressive, and possessing good teaching skills. The field may benefit from educational initiatives to reduce implicit gender bias in letters of recommendation.
Combined Endoscopic Robotic Surgery for Complex Colon Polyps
Authors: Broome Jacob M. , Coonan Erin E. , Jones Austin T. , Zelhart Matthew D.
Published: March 2023

BACKGROUND:

Combined endoscopic robotic surgery is a surgical technique that modifies traditional endoscopic laparoscopic surgery with robotic assistance to aid in the removal of complex colonic polyps. This technique is previously described in the literature but lacks patient follow-up data.

OBJECTIVE:

This study aimed to evaluate the safety and outcomes of combined endoscopic robotic surgery.

DESIGN:

A retrospective review of a prospective database.

SETTING:

East Jefferson General Hospital, Metairie Louisiana

PATIENTS:

The ninety-three consecutive patients who underwent combined endoscopic robotic surgery by a single colorectal surgeon from March 2018 to October 2021.

MAIN OUTCOME MEASURES:

Operative time, intraoperative complication, 30-day postoperative complication, hospital length of stay, and follow-up pathology report results.

RESULTS:

Combined endoscopic robotic surgery was completed in 88 of 93 (95%). Among the 88 participants who completed combined endoscopic robotic surgery, the average age was 66 years (standard deviation = 10), body mass index was 28.8 (standard deviation = 6), and history of previous abdominal surgeries was 1 (standard deviation = 1). Median operative time and polyp size were 72 minutes (range 31-184 minutes) and 40 millimeters (range 5-180 millimeters), respectively. The most common polyp locations were the cecum, ascending, and transverse colon (31%, 28%, 25%). Pathology mainly demonstrated tubular adenoma (76%). Data on 40 patients that underwent follow-up colonoscopy was available. The average follow-up time was 7 months (range 3-22 months). One patient (2.5%) had resection site polyp recurrence.

LIMITATIONS:

Limitations for our study include a lack of randomization and follow-up rate to assess for recurrence. The low compliance rate may be due to patient reluctance to get a colonoscopy or procedure cancelations/difficulty scheduling due to changing COVID-19.

CONCLUSION:

Compared to literature-reported statistics for its laparoscopic counterpart, combined endoscopic robotic surgery was associated with decreased operation times and resection site polyp recurrence.
The Learning Curve for Advanced Endoscopy for Colorectal Lesions: A Surgeon’s Experience at a High-Volume Center
Authors: Giugliano Danica N. , Feinberg Adina E. , Sapci Ipek , Ozgur Ilker , Valente Michael A. , Steele Scott R. , Gorgun Emre
Published: March 2023

BACKGROUND:

Advanced endoscopy can be utilized for complete removal of large colorectal polyps. To date, few surgeons perform advanced endoscopy, and it is unknown how many procedures are needed to reach proficiency.

AIM:

To determine the learning curve for colorectal advanced endoscopy.

DESIGN:

Retrospective.

SETTING:

Tertiary referral center.

PATIENTS:

We queried a prospectively maintained institutional database of advanced endoscopy performed by a high-volume colorectal surgeon between 2011 and 2018.

MAIN OUTCOME MEASURES:

Advanced endoscopy characteristics were compared for 6 chronological intervals. Primary endpoints were the rates of complications and polyp recurrence. Secondary endpoint was the change in polyp removal rate (mm/hour) over time. Proficiency was defined as achieving low complication and polyp recurrence rates, high en-bloc resection rate, and an efficient removal rate, equivalent to the median polyp size per hour.

RESULTS:

Total of 207 patients underwent advanced endoscopy for a single colorectal polyp. Median polyp size was 30 (4-70) mm, 61.5% were located in right colon, and 8.8% were malignant. Mean procedure time was 77 (range, 16-320) minutes. Immediate colon resection occurred in 25 patients due to suspicion of cancer or concern for perforation and were excluded from learning curve analysis. The remaining 182 advanced endoscopy procedures were divided into intervals of 30 procedures. Median removal rate was highest in the last interval and in the endoscopy suite. A removal rate of 30 mm/hour was achieved after performing 100 cases. Complication rate (bleeding or return to OR) was 12.1% and was similar across intervals. Readmission rate was 11.5%, and 6.6% of 6-month follow-up colonoscopies showed polyp recurrence at the resection site.

LIMITATIONS:

Retrospective design, single surgeon.

CONCLUSION:

The learning curve for achieving proficiency with advanced endoscopy in the colon and rectum requires a minimum of 100 cases with a low complication rate, low polyp recurrence rate, high en-bloc resection rate, and a polyp removal rate of 30mm/hr.
Predictive model for early urosepsis prediction by using systemic inflammatory response syndrome after percutaneous nephrolithotomy
Authors: Jakjaroenrit Nattawit , Tanthanuch Monthira , Bejrananda Tanan
Published: March 2023

Objectives

The aims of the study are to analyze the potential risk factors associated with systemic inflammatory response syndrome after percutaneous nephrolithotomy for renal stones and to establish a predictive model to prevent postoperative early urosepsis postoperative with percutaneous nephrolithotomy and develop a novel nomogram.

Methods

Patients who had undergone percutaneous nephrolithotomy between June 2012 and December 2019 were enrolled and classified into two groups according to their systemic inflammatory response status. Univariable and multivariable logistic regression analyses were performed to identify the predictive factors associated with systemic inflammatory response syndrome after percutaneous nephrolithotomy. The nomograms were developed by using the significant factors, and the discriminative ability was assessed using receiver operating characteristic curve analyses.

Results

Two hundred sixty two patients with renal stones treated with percutaneous nephrolithotomy were enrolled, and systemic inflammatory response syndrome occurred in 117 patients (44%) after percutaneous nephrolithotomy. Multivariable logistic regression analysis revealed that the three factors independently related to systemic inflammatory response syndrome: renal stone size ≥3 cm, positive preoperative urine white blood cells, and positive preoperative urine culture. According to the results, the logistic regression analyses of significant factors were used to develop the nomogram. Developed nomogram prediction model displayed favorable fitting in the Hosmer-Lemeshow test (P = 0.938). Internal validation of the nomogram showed that the area under the receiver operating characteristic curve was 0.702.

Conclusions

Positive preoperative urine white blood cells, positive urine culture, and renal stone size ≥3 cm are the most significant predictors. The novel nomogram helps identify high-risk individuals and facilitates the early detection of systemic inflammatory response syndrome after percutaneous nephrolithotomy.
Comparison of Wound Healing Effect of Skin Micrograft Impregnated into Two Kinds of Artificial Dermis in a Murine Wound Model
Authors: Li Yuanjiaozi , Sakamoto Michiharu , Sawaragi Eiichi , Nakano Takashi , Katayama Yasuhiro , Yamanaka Hiroki , Tsuge Itaru , Morimoto Naoki
Published: March 2023

Background:

A micrograft (MG) suspension produced by the Rigenera protocol has been used to stimulate tissue regeneration. Recently, a combination therapy of an artificial dermis and skin MG has been used to promote angiogenesis and granulation tissue formation in the artificial dermis. There are no reports comparing the differences in MG impregnation efficiency between different artificial dermis products. Therefore, we compared the impregnation of skin MG in Pelnac Gplus and Integra.

Methods:

Skin MG was prepared from the skin of C57BL/6JJcl mice using Rigeneracons and administered onto Pelnac Gplus and Integra sheets. The amount of MG suspension impregnated in Pelnac Gplus and Integra was evaluated. Pelnac Gplus and Integra sheets combined with MG were applied to murine defects, and wound area, neoepithelium length, granulation tissue formation, and newly formed capillaries were compared with the control groups on days 7 and 14.

Results:

The weight percentage of the MG absorbed by Pelnac Gplus and Integra was 88.8% ± 3.5% and 28.2% ± 7.0%, respectively (P< 0.05). In the in vivo experiment, the area of newly formed granulation tissue and both the number and area of newly formed capillaries in the PelnacG + MG group were significantly larger than those in the control group at 14 days after implantation (P< 0.05).

Conclusions:

Skin MG was successfully impregnated into Pelnac Gplus by simple administration but not into Integra. Administration of skin MG into the Pelnac Gplus promoted granulation formation and angiogenesis. Pelnac Gplus was more suitable than Integra in the combination therapy.
Pronator Quadratus: A Preferable Recipient for Targeted Muscle Reinnervation of Neuromas in the Hand
Authors: Felder John M. , Saoud Karim
Published: March 2023

Targeted muscle reinnervation (TMR) has emerged as a useful solution to the problem of painful neuromas and is increasingly being applied in many clinical circumstances. Relatively little has been written about TMR for painful neuromas of the hand, and what has been written describes use of the intrinsic muscles as recipients for the nerve transfer. Except in cases of amputation, intrinsic muscle sacrifice carries morbidity. Furthermore, TMR to intrinsic muscles will place the nerve coaptation in areas subject to pressure with loading of the palm. For these reasons, the pronator quadratus may be a preferable target muscle when performing TMR for painful neuromas of the hand. In this report, we describe the rationale for its use and demonstrate the surgical technique and outcomes with case examples.
The Role of Surgical Drainage on Complications after Sentinel Lymph Node Biopsy for Melanoma
Authors: Torresetti Matteo , Scalise Alessandro , Pelliccioni Michele , Taddei Francesco Mauro Junior , Di Benedetto Giovanni
Published: March 2023

Background:

The real benefit of using drains for reducing the risk of complications in sentinel lymph node biopsy (SLNB) has not been investigated yet. We aimed to evaluate the role of drain after SLNB and to determine if a correlation exists between drains and early complications.

Methods:

This is a retrospective study of patients who underwent SLNB for melanoma from 2016 to 2021. Patients were dichotomized into two groups according to the use of drain. The between-group comparison (drainage group versus no drainage group) was performed by using Mann-Whitney U test and chi-square test. A regression analysis was conducted to identify predictors of complications.

Results:

Of 218 individuals analyzed, 18 (8.4%) had postoperative complications. The most common complications were seroma (5.1%) and wound dehiscence (1.4%). The between-group analysis showed no significant differences in complication rate, whereas the operative time was significantly higher in the drainage group (P = 0.007), as well as the hospital stay (P ≤ 0.0001) and the duration of postoperative antibiotic therapy (P = 0.02). The regression analysis found body mass index and multiple basins of SLNB (axilla with groin) to be significant predictors of having a complication (P = 0.03 and P = 0.05, respectively). The operative time was found to be a predictor of seroma (P = 0.04).

Conclusions:

Drainage use in SLNB prolonged hospital stays and duration of postoperative antibiotic therapy, thus resulting in higher costs. The preemptive use of drainage is suggested in selected settings of patients.
Patterns and Characteristics of Intentional Self-inflicted Hand Injuries among Military Personnel: A Retrospective Study and Proposal of Treatment Algorithm
Authors: Alowais Fahad Abdullah , Alfaqeeh Faisal A. , Alammar Alwaleed K. , Mortada Hatan , Skef Zafer , Alshammari Mishal , Idrees Yasser Elsayed
Published: March 2023

Background:

Self-inflicted hand injuries have been described in the literature with varying nomenclature (factitious, malingering, and self-induced hand injuries). Identifying and treating these patients is complex and requires a multidisciplinary team approach at a high cost. There is a lack of literature that describes the different patterns and characteristics of hand injuries among military personnel, especially in Saudi Arabia. We conducted a chart review study involving military personnel who attended the emergency department with hand injuries in Saudi Arabia to fill this gap.

Methods:

This retrospective chart review study was conducted at a tertiary hospital in Riyadh, Saudi Arabia. Our inclusion criteria included military personnel patients who presented to the emergency department with intentional self-inflicted hand-related injuries between 2016 and 2018.

Results:

A total of 274 cases were included; 241 (88%) were men. Injuries to the left hand (52.2%) were more common than injuries to the right hand. The most common injury site involved the little finger (45.6%). The majority were followed up (97.8%), and 28.8% of cases had a complication. The majority of fractures were managed with open reduction and internal fixation (63.9%). Moreover, the mean sick leave duration was 23 days.

Conclusions:

Self-inflicted injuries can be challenging to diagnose when patients are manipulative about the cause and mechanism. Most self-inflicted injuries involved the left little finger, and most were treated with open reduction and internal fixation. A self-inflicted injury is possible in the context of an unusual injury with a vague medical history.
Temporal Artery Biopsy Debate: Positive TAB Result Prolongs Steroid Use in Giant Cell Arteritis
Authors: Ponich Brett , Lafreniere Ann-Sophie , Hartley Rebecca , Temple-Oberle Claire F.
Published: March 2023

Background:

Temporal artery biopsy (TAB) in diagnosing giant cell arteritis has been criticized due to surgical risks, a high false negative rate, and redundant information when patients already met American College of Rheumatology criteria. The objective of this study was to investigate TAB's impact on steroid treatment duration.

Methods:

A retrospective chart review garnered patient demographics, symptoms, comorbidities, and steroid treatment duration in patients undergoing TAB at a single center. Steroid treatment was compared between TAB+ and TAB - patients.

Results:

One hundred seven patients undergoing TAB were included. Patients were predominantly women (70.1%) with a median age of 74 years (46 -91). Of 107 TAB results, 74 (69.2%) were negative, 23 (21.5%) were positive, and 10 (9.3%) were found to be indeterminate. In TAB+ patients, the mean erythrocyte sedimentation rate was not significantly different than TAB - patients (60.2 versus 43.7, P = 0.45), nor was the median C-reactive protein (38.8 versus 18.1, P = 0.17). Regarding steroid use, both TAB+ and TAB - patients had a similarly high rate of prebiopsy steroid initiation (82.6% versus 70.3%, P = 0.32). More TAB+ patients remained on steroids at 6 weeks (95.0% versus 57.4%, P = 0.004), 6 months (95% versus 37.7%, P < 0.001), 1 year (65.0% versus 31.1%, P = 0.024), and 18 months (50.0% versus 19.7%, P = 0.045). By 2 years, the difference no longer met significance (35.0% versus 14.8%, P = 0.12). P = 0.12).

Conclusion:

TAB positivity does seem to influence maintenance of steroids up to 18 months after biopsy.
Clostridium Histolyticum Collagenase Underdosed for Multicord Injection in Dupuytren’s Disease: A Retrospective Cohort Study
Authors: Boriani Filippo , Raggini Filippo , Evangelista Andrea , Gustar Adrian , Figus Andrea
Published: March 2023

Background:

An underdosing of collagenase clostridium histolyticum (0.32 mg) is proposed as a potentially effective option in patients with additional cords in the same hand, after the first cord has been treated with the regular dose of 0.58 mg. The aim of this study was to analyze whether this additional dose is tolerated and effective.

Methods:

Patients with Dupuytren’s disease affecting MCP joints with at least two independent pathological cords, causing deformity of two digits, were considered, with their written informed consent, for a simultaneous injection of the two cords with a single vial of collagenase. Digits treated with the standard dose of 0.58 mg were compared with digits injected with the smaller dose of 0.32 mg. Passive extension deficit and range of motion were evaluated after injection. Complications were also compared.

Results:

A total of 26 patients (29 hands) were included in the study. Of these, nine patients had two independent cords within one hand, and 17 patients had a single cord (three of these with a cord in each hand). Thirty-five digits were injected, 23 with 0.58 mg and 12 with 0.32 mg. Apart from a smaller mean percentage variation in passive extension deficit within 24 hours in the 0.58-mg dose compared with 0.32 mg (29% versus 40%, P = 0.031), no other differences emerged if a dose of 0.32 mg is used instead of 0.58 mg, in terms of selected outcome measures and rate of complications (P > 0.05).

Conclusion:

Underdosing collagenase clostridium histolyticum is equally effective in the treatment of Dupuytren’s disease.
A Pilot Randomized Clinical Trial of Early Ambulation after Groin Reconstruction with Sartorius Muscle Flaps
Authors: Nguyen Audrey B. , Kohn Michael A. , Lentz Rachel , Hansen Scott L.
Published: March 2023

Background:

The use of muscle flaps, such as the sartorius muscle, for groin coverage in high-risk vascular patients has been shown to reduce complication rates. However, it remains unknown whether earlier postoperative ambulation is associated with improved postoperative outcomes for groin muscle flaps following infrainguinal vascular surgery.

Methods:

We performed a pilot randomized trial to analyze the effect of early ambulation on postoperative outcomes in patients who had groin reconstruction with sartorius muscle flaps following infrainguinal vascular surgery at our academic institution.

Results:

Fourteen patients were randomized to standard ambulation (on postoperative day 6), and 14 patients were randomized to early ambulation (on postoperative day 2). The treatment arms were similar with respect to age, body mass index, risk category, smoking status, and comorbidities. Median length of stay was 6 days in the early group versus 7 days in the standard group. Immediate and long-term physical function and general health were better in the early group There were slightly more wound complications in the standard (57.1%) versus the early group (42.9%), and the early group had more lymphatic complications (35.7% versus 14.3%).

Conclusions:

The decision to ambulate a patient after this surgery continues to be a decision between the vascular and plastic surgeons. However, this pilot trial has shown the safety profile of early ambulation and that it should be considered for specific patients. Additionally, this trial has provided valuable information for performing a larger scale randomized controlled trial to determine the optimal postoperative protocol for patients with these reconstructions.
Pulsed Dye Laser for Treatment of Basal Cell Carcinoma
Authors: Baran Kelsey L. , Cheung Tiffany C. , Csank George A. , Michaels Basil M.
Published: March 2023

Background:

Basal cell carcinoma (BCC) is the most common malignancy worldwide. The incidence of BCC is increasing up to 10% per year worldwide. Surgical excision and Mohs surgery are the gold standard treatment modalities. However, patients may not be candidates for surgery. Pulsed dye laser (PDL) is a novel technique for treating BCC.

Methods:

Patients with biopsy-proven BCC underwent two treatments with PDL at 6-week intervals at Berkshire Cosmetic and Reconstructive Surgery Center. Patients returned 6 weeks after the second treatment for evaluation for response to treatment. Follow-up examinations were conducted at 6, 12, and 18 months after treatment with PDL.

Results:

Twenty patients with 21 biopsy-proven BCCs were treated with PDL at Berkshire Cosmetic and Reconstructive Surgery Center between 2019 and 2021. Nineteen BCCs had a complete response after two treatments, for a clearance rate of 90%. Two of the 21 lesions did not respond for an incomplete response rate of 10%.

Conclusion:

PDL is an effective nonsurgical treatment option in the management of BCC.
Folded Radial Forearm Free Flap for the Reconstruction of Total Soft Palate Defects: Operative Technique
Authors: Nocini Riccardo , Favero Vittorio , Molteni Gabriele , Pinto Valentina , Chiarini Luigi , Nocini Pier Francesco
Published: March 2023

Background:

The surgical plan to reconstruct the palate must be carefully prepared given the morphological peculiarity of the soft palate forming both the roof of the mouth and the floor of the nasal cavity. This article focuses on the use of folded radial forearm free flaps to manage isolated defects of the soft palate in the absence of tonsillar pillar involvement.

Methods:

Three patients affected by squamous cell carcinoma of the palate underwent resection of the soft palate and immediate reconstruction with a folded radial forearm free flap.

Results:

All three patients showed good short-term morphological-functional outcomes as far as swallowing, breathing, and phonation were concerned.

Conclusions:

The folded radial forearm free flap seems to be an efficacious way to manage localized defects of the soft palate, given the positive outcomes of the three patients treated, and in accordance with other authors. In general, the radial forearm free flap was confirmed to be a versatile solution for those intraoral defects of the soft tissue requiring a limited quantity of volume as in the case of the soft palate.
Analgesia and Sedation at Terminal Extubation: A Secondary Analysis From Death One Hour After Terminal Extubation Study Data*
Authors: Tripathi Sandeep , Laksana Eugene , McCrory Michael C. , Hsu Stephanie , Zhou Alice X. , Burkiewicz Kimberly , Ledbetter David R. , Aczon Melissa D. , Shah Sareen , Siegel Linda , Fainberg Nina , Morrow Katie R. , Avesar Michael , Chandnani Harsha K. , Shah Jui , Pringle Charlene , Winter Meredith C.
Published: March 2023

Objectives:

To describe the doses of opioids and benzodiazepines administered around the time of terminal extubation (TE) to children who died within 1 hour of TE and to identify their association with the time to death (TTD).

Design:

Secondary analysis of data collected for the Death One Hour After Terminal Extubation study.

Setting:

Nine U.S. hospitals.

Patients:

Six hundred eighty patients between 0 and 21 years who died within 1 hour after TE (2010–2021).

Measurements and Main Results:

Medications included total doses of opioids and benzodiazepines 24 hours before and 1 hour after TE. Correlations between drug doses and TTD in minutes were calculated, and multivariable linear regression performed to determine their association with TTD after adjusting for age, sex, last recorded oxygen saturation/Fio
2 ratio and Glasgow Coma Scale score, inotrope requirement in the last 24 hours, and use of muscle relaxants within 1 hour of TE. Median age of the study population was 2.1 years (interquartile range [IQR], 0.4–11.0 yr). The median TTD was 15 minutes (IQR, 8–23 min). Forty percent patients (278/680) received either opioids or benzodiazepines within 1 hour after TE, with the largest proportion receiving opioids only (23%, 159/680). Among patients who received medications, the median IV morphine equivalent within 1 hour after TE was 0.75 mg/kg/hr (IQR, 0.3–1.8 mg/kg/hr) (n = 263), and median lorazepam equivalent was 0.22 mg/kg/hr (IQR, 0.11–0.44 mg/kg/hr) (n = 118). The median morphine equivalent and lorazepam equivalent rates after TE were 7.5-fold and 22-fold greater than the median pre-extubation rates, respectively. No significant direct correlation was observed between either opioid or benzodiazepine doses before or after TE and TTD. After adjusting for confounding variables, regression analysis also failed to show any association between drug dose and TTD.

Conclusions:

Children after TE are often prescribed opioids and benzodiazepines. For patients dying within 1 hour of TE, TTD is not associated with the dose of medication administered as part of comfort care.
Reoperative Transaxillary Subfascial Breast Augmentation and Fat Grafting: Technical Highlights and a Step-by-Step Video Guide
Authors: Munhoz Alexandre Mendonça , Marques Neto Ary de Azevedo , Maximiliano João
Published: March 2023

Reoperative procedures following breast augmentation are frequently more complex than primary cases because of local complications and insufficient soft tissue coverage. While the transaxillary (TA) incision is more indicated in primary breast augmentation, limitations of this approach include secondary surgeries and correcting complications after using this approach by the same incision. Combining the TA technique with a subfascial pocket has been suggested to avoid breast scarring and the limitations of submuscular pockets represented by breast animation. With advances in autogenous fat grafting (AFG) techniques, implant coverage alternatives and more natural outcomes have been reported from more superficial implant pockets. The simultaneous AFG with silicone implants (defined as hybrid breast augmentation) has recently been evaluated as an attractive procedure. These two techniques combine to provide breast projection and natural cleavage while camouflaging the implant edges. AFG is also important to reduce the intermammary distance and achieve a smoother transition between the breasts. The TA approach can be useful in reoperative breast augmentation, as our results show, and also avoids additional scarring on the breast. This article and the accompanying videos provide a detailed, step-by-step guide to reoperative hybrid breast augmentation using a subfascial TA approach, with a predictable and optimized surgical outcome.
“Weight Control Following Body Contouring Surgery – Long-Term Assessment of Postbariatric and Non-bariatric Patients”
Authors: Henderson Joshua T. , Koenig Zachary A. , Woodberry Kerri M.
Published: March 2023

Background:

Few reports of weight maintenance following body contouring (BC) surgery present weight measurements as percent weight change, and most of these studies do not isolate BC to specific body areas. This study analyzes weight control in the trunk-based BC population and further compares BC outcomes in postbariatric and non-bariatric patients.

Methods:

We performed a retrospective cohort study of consecutive postbariatric and non-bariatric patients who underwent trunk-based BC (abdominoplasty, panniculectomy, and circumferential lipectomy) from 1/1/2009 through 7/31/2020 at West Virginia University. A minimum twelve-month follow-up was required for inclusion. With BC surgery date as the reference point, percent total weight loss (%TWL) was assessed at six-month intervals for two years following BC and every year thereafter. Change over time was compared between postbariatric and non-bariatric patients.

Results:

Within the twelve-year timeframe, 121 patients meeting criteria underwent trunk-based BC. Average follow-up from date of BC was 42.9 months. Sixty patients (49.6 %) had previously undergone bariatric surgery. From pre-BC to endpoint follow-up, postbariatric and non-bariatric patients experienced a 4.39 ± 10.93% and 0.25 ± 9.43% increase in weight from baseline, respectively (p=0.0273). Once nadir weight loss was attained, weight regain occurred through endpoint follow-up in both groups (11.81% in the postbariatric patients and 7.56% in the non-bariatric BC cohort, p=0.0106).

Conclusion:

Long-term weight regain is common following trunk-based BC surgeries, specifically in postbariatric patients. Although this should not contend with the psychological benefit of removing this excess tissue, it is important to report results with ideal weight metrics to optimally assess outcomes in this population.
The Changes of Sonographic Thickness with Identification of 9-Layers, Roughness, and Hydration in Dorsal Hand after Injection of Hyaluronic Acid Filler
Authors: Kim Jong Seo
Published: March 2023

Background:

Using high resolution sonography, soft tissue thickness with detailed soft tissue layers can be measured accurately to assess volumizing effects of fillers.

Methods:

In this prospective study, 1cc of monophasic stabilized hyaluronic acid (mS-HA) filler was injected utilizing subdermal scrapping fanning injection technique (ssFIT) into the dorsal superficial lamina (DSL) and dorsal intermediate lamina(DIL) for 20 patients, and the results were measured utilizing sonographic evaluation of soft tissue thickness, topographic computer analysis (TCA) of skin roughness, stratum corneum hydration (SCH) at 1-week,1,2,3,6-months.

Results:

The hand appearance and skin roughness improved in all patients. Soft tissue thickness in sonography was increased by 4.52mm(immediately-post-treatment), 5.52mm(1week), 4.89mm(1month), 4.25mm(2m), 4.08mm(3m), and 3.86mm(6m) from the pre-treatment baseline of 3.20mm. Roughness evaluated by TCA in 50(10) magnification dermascope photos, was reduced by 15.39(16.17)% at 1-month post-treatment, 21.5(18.12)% at 2-months, 22.7(23.91)% at 3-months, 27.16(38.12)% at 6-months, indicating improvements in fine wrinkles after the procedure. SCH on hand dorsum also improved during the follow up.

Conclusions:

Detail subdivided 9-layers of hand dorsum were established in author’s sonography study for the first time. Soft tissue thickness was increased more than 207% during follow-up after 1-session of the treatment, and placed HA materials was confirmed in DSL and DIL. The hand appearance and skin roughness improved in all patients. Veins and tendons became less apparent after the single injection, showing volumizing effects lasting more than 6 months. All patients stated that their skin became more moisturized with increased SCH, youthful and smooth during the follow-up period after only 1-session of ssFIT.
Multiplanar (4-Dimension) Breast Augmentation—A Personal Surgical Concept for Dynamic Implant-Tissue Interaction Providing Sustainable Shape Stability
Authors: Vogt Peter M. , Mackowski Marian S. , Dastagir Khaled
Published: March 2023

Background:

In esthetic breast augmentation long-term shape stability and natural appearance remain an ongoing challenge. The authors found that to reduce the incidence of secondary deformity and increase the natural feel and appearance, a standard multiplanar procedure combining a subfascial and dual plane approach with fasciotomies will provide long-term stability and esthetic quality.

Patients and Methods:

The technique involves a submuscular dissection, release of the infranipple portion of the pectoralis muscle combined with the wide subfascial release of the breast gland, and scoring of the deep plane of the superficial glandular fascia. For long-term stability, a firm fixation of the glandular fascia at the inframammary fold to the deep layer of the abdomino-pectoral fascia is critical. Long-term results were analyzed for up to 10 years.

Results:

Postoperative measurements proved the intrinsic balance of the breasts without significant changes over time. The overall complication rate was <5%. Shape stability was observed over 10 years in more than 95% of the patients. Unsightly muscular animation could be avoided in almost every patient.

Conclusions:

Our results indicate that a technique of multiplane breast augmentation provides long-term stability and esthetic quality. By combining the benefits of well-established techniques of a submuscular dual plane, additional shaping through a controlled deep fasciotomy and stable inframammary fold fixation some of the existing tradeoffs of the different methods can be avoided.
Maxillectomy and Flap Reconstruction of Maxillary Defects After Cancer Ablation Through the Lip-Split Parasymphyseal Mandibulotomy Approach in Patients With Advanced-Stage Maxillary Malignant Tumors
Authors: Chen Wei-liang , Zhou Bin , Huang Zi-xian , Chen Rui , Hong Lei , Dong Xiao-yu
Published: March 2023

Background:

The conventional approach for maxillectomy has some common and serious complications.

Aims:

The present study evaluated the outcomes of maxillectomy and flap reconstruction after cancer ablation using the lip-split parasymphyseal mandibulotomy (LPM) approach.

Methods:

Twenty-eight patients with malignant tumors, including squamous cell carcinoma, adenoid cystic carcinoma, and mucoepidermoid carcinoma, underwent maxillectomy through the LPM approach. Brown classes II and III were reconstructed with the facial-submental artery submental island flap, an extensive segmental pectoralis major myocutaneous flap, and a free anterolateral thigh flap with the use of a titanium mesh, respectively.

Results:

All proximal margin frozen section specimens showed negative surgical margins. Anterolateral thigh flap failure occurred in 1 patient, whereas ophthalmic and mandibulotomy complications developed in 4 and 7 patients, respectively. In all, 84.6% of the patients had satisfactory or excellent lip esthetic results. Of the patients, 57.1% were alive with no evidence of disease, whereas 28.6% were alive with disease and 14.3% died of local recurrence or distant metastasis. No significant survival difference was evident among the squamous cell carcinoma, adenoid cystic carcinoma, and mucoepidermoid carcinoma groups.

Conclusions:

The LPM approach can provide good surgical access, facilitating maxillectomy in advanced-stage malignant tumors with minimal morbidity. Facial-submental artery submental island flap and anterolateral thigh flap or extensive segmental pectoralis major myocutaneous flap with a titanium mesh are ideal techniques for reconstructing Brown classes II and III defects, respectively.