bluuebunny/crossref_metadata_2025_split huggingface dataset:
Fetal Head Rotation During Instrumented Delivery: What Risks Do We Face? [16N]
Authors: Davila Jose Luis , Ortiz Marco Antonio , de Lourdes Gomez Maria , Nieto Vizhñay Karina P. , Avila Leidy Gavaleth , Ruiloba Francisco J. 
Published: April 2020

INTRODUCTION:
According to the degree of rotation of the cephalic pole, forceps are divided into exit forceps (rotation less than 45°), low (less than 45°) and medium (rotation up to 180°); Our objective was to determine the association between the degree of rotation required during instrumented delivery and the presence of severe perineal tears.

METHODS:
Retrospective Cohort study, patients in which an instrumental delivery was performed from January 2017 to June 2019 on a single center were included. Patients with incomplete clinical records were excluded. The degree of rotation was evaluated depending on the variety of position prior to placement. Descriptive statistics were performed, χ2 for qualitative variables and Student t for quantitative variables; to determine association, the odds ratio and 95% CI were obtained

RESULTS:
131 instrumented deliveries were included; in 100, rotations less than 45° were performed and in 31, rotations equal to or greater than 45° were performed. Severe perineal tears showed no significant difference, however association with lesions of the vaginal wall OR 2.19 (1.31–3.69 95% CI) were observed, with no difference in the amount of bleeding, atony or the presence of obstetric hemorrhage. Of the fetal outcomes, no difference was significant.

CONCLUSION:
The use of forceps with rotations greater than 45° was not associated with the presence of severe perineal tears only associated with vaginal wall tears, so the decision to perform an instrumented delivery should be conditioned by the development of the work of delivery and not for the degree of rotation that is required.
Characteristics and Outcomes Among Pregnant Women With ESRD on Hemodialysis: A Population-Based Study [05N]
Authors: Lavie Anat , Czuzoj-Shulman Nicholas , Spence Andrea , Abenhaim Haim Arie 
Published: April 2020

INTRODUCTION:
Dialysis patients historically have had poor pregnancy outcomes, but these have improved over the years with better delivery of dialysis care. The purpose of our study is to describe baseline characteristics and pregnancy outcomes among women with end stage renal disease (ESRD) on hemodialysis (HD).

METHODS:
We carried out a cohort study on all births using the United States' Healthcare Cost and Utilization Project-Nationwide Inpatient Sample database between 2005 and 2015. Descriptive statistics were used to measure baseline characteristics and maternal and neonatal outcomes of women with ESRD under HD treatment. We created a composite measure of vascular mediated adverse pregnancy outcomes which included intrauterine growth restriction (IUGR), preeclampsia and intrauterine fetal death (IUFD). Then, using this composite measure, multivariate logistic regression analyses were used to identify risk factors for the development of vascular mediated adverse outcomes of pregnancy among women with ESRD who were on HD.

RESULTS:
We identified 307 birth records to women with a ESRD on HD among 8,765,973 births. There was an increase in the number of patients with ESRD on HR over the 10-year study period. None of the baseline characteristics were found to be significantly correlated to the occurrence of the composite outcome.

CONCLUSION:
The incidence of pregnant women with ESRD on HD in the US is rising, with adverse pregnancy complications for both the mother and fetus. Since no specific predictors for the adverse outcomes were found, this entire group of patients should be considered at high risk, strengthening the need for an early multidisciplinary team management.
Primary care of children with autism spectrum disorders
Authors: Kilmer Michele 
Published: April 2020

Abstract:
This series of articles aims to equip primary care providers (PCPs) with the tools to become healthcare leaders managing patients with pediatric autism spectrum disorder (ASD). Individuals with ASD can experience optimal health outcomes when timely, evidence-based interventions are implemented in the primary care setting. PCPs are uniquely situated to institute changes that redirect the trajectory of ASD.
Nursing attitudes and practices for routine I.V. catheter resiting
Authors: Evers Frances , Morelock Skip , Walsh Judith , Khoja Sharifa 
Published: April 2020

Abstract

Purpose:
To understand nursing perceptions of hospital requirements for routine resiting of short peripheral catheters (SPCs).

Methods:
This exploratory research project at the authors' medium-sized regional referral and trauma center utilized an online survey to assess the perceived efficacy and patient disruption related to SPC resiting among acute care nurses.

Results:
Out of 203 eligible nurses, 81 participated. The survey results support the perception that SPC insertions and resiting can be time-consuming and disruptive to the flow of care. The strongest correlation occurred between patients who had requested no SPC resiting and the reported disruption from SPC resiting.

Conclusion:
Based on the survey results, a formal recommendation was made within the hospital system to amend the existing policy and remove the requirement for SPC resiting after 96 hours in favor of the nurses' best clinical judgment.
Effect of Wound Closure Technique in Proximal Femoral Fractures: A Prospective Cohort Study
Authors: Badres Inas Azzah , Suen Kary , Tran Phong 
Published: April 2020

Objectives:
To compare the effect of different wound closure techniques on wound drainage, postoperative length of stay, and complications in patients with proximal femoral fractures, including femoral neck fractures (31A fractures) and peritrochanteric fractures (31B fractures).

Design:
Prospective cohort study.

Setting:
Footscray Hospital, Western Health, Victoria, Australia; an acute teaching hospital.

Patients and Participants:
All inpatients receiving surgery for proximal femoral fractures at our facility between May 2016 and August 2017. A total of 486 consecutive patients who presented during the study period were included in the study.

Intervention:
Three cohorts of consecutive patients were assigned to use either skin staples, monofilament absorbable subcuticular sutures (Monocryl), or, sutures with the addition of 2-octylcyanoacrylate (OCA) (Monocryl and Dermabond), respectively, for skin closure according to when the patients entered the study.

Main Outcome Measurements:
The primary outcome of interest was prolonged wound drainage measured using a standardized technique after postoperative day 3. Secondary outcomes included inpatient length of stay and overall complications.

Results:
We found a statistically significant increase in prolonged wound drainage in the staples cohort compared with the subcuticular sutures cohort and the sutures and OCA cohort (21.1% vs. 8.5% vs. 4.4%, P < 0.001). Inpatient length of stay was also significantly increased in the staples cohort (5.83 days vs. 4.78 days vs. 5.5 days, P = 0.005). There were no statistically significant differences between the 3 cohorts when comparing incidence of any medical complications, withholding of thromboprophylactic agents, or usage of topical negative pressure dressings.

Conclusions:
In patients with proximal femoral fractures, closure with staples has the highest rate of prolonged wound drainage and length of stay. Subcuticular sutures in combination with OCA result in the lowest incidence of prolonged wound drainage.

Level of Evidence:
Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
Predicting Length of Stay and Readmissions After an Ankle Fracture Using a Risk Stratification Tool (STTGMA)
Authors: Simske Natasha M. , Benedick Alex , Kavanagh Michael D. , Vallier Heather A. 
Published: April 2020

Objectives:
To determine the usefulness of a validated trauma triage score to stratify short-term outcomes including hospital length of stay (LOS), in-hospital complications, discharge location, and rate of readmission after an ankle fracture.

Design:
Retrospective cohort.

Setting:
Level 1 trauma center.

Patients:
Four hundred fifteen patients, age ≥55 with 431 ankle fractures.

Intervention:
Closed or open reduction.

Main Outcome Measurements:
Score for Trauma Triage in the Geriatric and Middle-Aged (STTGMA).

Results:
Of the 415 patients, 38% were male, 72% were white, and the mean age was 66 years. The mean LOS was 4.4 days, and this increased from 2.6 days in the minimal-risk group to 11.8 days in the high-risk group (P < 0.001). Similarly, 74% of minimal-risk patients were discharged home versus 13% of high-risk patients (P < 0.001). There were 19 readmissions (4.6%) within 30 days, ranging from 1.5% to 10% depending on the risk cohort (P = 0.006). Seventy-three patients (18%) experienced an in-hospital complication. On multiple linear regression, moderate- and high-risk STTGMA stratification was predictive of a longer hospital LOS, and moderate-risk STTGMA stratification was predictive of subsequent readmission after injury.

Conclusions:
Calculation of the STTGMA score is helpful for stratifying patients according to hospital LOS and readmission rates, which have substantial bearing on resource utilization and cost of care. The STTGMA tool may allow for effective identification of patients to potentially ameliorate these common issues and to inform payers and policymakers regarding patients at risk for greater costs of care.

Level of Evidence:
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Birth weight and perfluorooctane sulfonic acid: a random-effects meta-regression analysis
Authors: Dzierlenga Michael W. , Crawford Lori , Longnecker Matthew P. 
Published: April 2020

Background:
Perfluorooctane sulfonic acid (PFOS) is a ubiquitous environmental contaminant. Most people in developed countries have detectable serum concentrations. Lower birth weight has been associated with serum PFOS in studies world-wide, many of which have been published only recently.

Methods:
To facilitate a causal assessment of the birth weight and PFOS association, we updated previous meta-analyses of the association and employed a method that facilitated inclusion of all available data in one analysis. Our analysis was based on observations from 29 studies.

Results:
The random effects summary was −3.22 g/ng/ml (95% confidence interval [CI] = −5.11, −1.33). In a subgroup analysis stratified by when in pregnancy the PFOS concentration was measured, the summary for the early group was −1.35 (95% CI = −2.33, −0.37) and for the later group was −7.17 (95% CI = −10.93, −3.41). In a meta-regression model including a term for timing of blood draw, the intercept was slightly positive but essentially zero (0.59 g/ng/ml, 95% CI = −1.94, 3.11). In other words, the model indicated that when blood was drawn at the very beginning of pregnancy, there was essentially no relation of birth weight to PFOS. The results from the subgroup analyses differed from those from the model because the average gestational age at blood draw in the early group was 14 weeks, when bias would still be expected. A stronger inverse association in Asian studies was not completely explained by their blood draws being from later in pregnancy.

Conclusions:
The evidence was weakly or not supportive of a causal association.
Estimating the number of excess deaths attributable to heat in 297 United States counties
Authors: Weinberger Kate R. , Harris Daniel , Spangler Keith R. , Zanobetti Antonella , Wellenius Gregory A. 
Published: April 2020

Background:
There is a well-established relationship between high ambient temperature and risk of death. However, the number of deaths attributable to heat each year in the United States remains incompletely quantified.

Methods:
We replicated the approach from a large, international study to estimate temperature-mortality associations in 297 United States counties and additionally calculated the number of deaths attributable to heat, a quantity of likely interest to policymakers and the public.

Results:
Across 297 counties representing 61.9% of the United States population in 2000, we estimate that an average of 5,608 (95% empirical confidence interval = 4,748, 6,291) deaths were attributable to heat annually, 1997–2006.

Conclusions:
Our results suggest that the number of deaths related to heat in the United States is substantially larger than previously reported.
Robotically Assisted Omentum Flap Harvest: A Novel, Minimally Invasive Approach for Vascularized Lymph Node Transfer
Authors: Frey Jordan D. , Yu Jason W. , Cohen Steven M. , Zhao Lee C. , Choi Mihye , Levine Jamie P. 
Published: April 2020

Background:
The omentum provides abundant lymphatic tissue with reliable vascular anatomy, representing an ideal donor for vascularized lymph node transfer without risk for donor site lymphedema. We describe a novel, robotically assisted approach for omental flap harvest.

Methods:
All patients undergoing robotically assisted omentum harvest for vascularized lymph node transfer from 2017 to 2019 were identified. Patient demographics, intraoperative variables, and postoperative outcomes were reviewed.

Results:
Five patients underwent robotically assisted omentum flap harvest for vascularized lymph node transfer. The average patient age and body mass index were 51.2 years and 29.80 kg/m2, respectively. Indications for lymph node transfer were upper extremity lymphedema following mastectomy, radiation, and lymphadenectomy (60.0%); congenital unilateral lower extremity lymphedema (20.0%); and bilateral lower extremity/scrotal lymphedema following partial penectomy and bilateral inguinal/pelvic lymphadenectomy (20.0%). Four patients (80.0%) underwent standard robotic harvest, whereas 1 patient underwent single-port robotic harvest. The average number of port sites was 4.4. All patients underwent omentum flap transfer to 2 sites; in 2 cases, the flap was conjoined, and in 3 cases, the flap was segmented. The average overall operative time was 9:19. The average inpatient hospitalization was 5.2 days. Two patients experienced cellulitis, which is resolved with oral antibiotics. There were no major complications. All patients reported subjective improvement in swelling and softness of the affected extremity. The average follow-up was 8.8 months.

Conclusions:
Robotically assisted omental harvest for vascularized lymph node transfer is a novel, safe, and viable minimally invasive approach offering improved intra-abdominal visibility and maneuverability for flap dissection.
Trends and Perceptions of Electronic Health Record Usage among Plastic Surgeons
Authors: Seu Michelle , Cho Brian H. , Pigott Rachel , Sarmiento Samuel , Pedreira Rachel , Bhat Deepa , Sacks Justin 
Published: April 2020

Background:
Electronic health records (EHRs) should help physicians stay organized, improve patient safety, and facilitate communication with both patients and fellow healthcare providers. However, few studies have directly evaluated physician satisfaction with EHR and its perceived impact on patient care. This study assessed trends and perceptions of EHR within the American plastic surgery community.

Methods:
An Institutional Review Board–approved survey that assessed demographics, patterns of EHR use, and attitudes toward EHR was deployed by the American Society of Plastic Surgeons Member Survey Research Services. Statistical analyses were performed using Stata 14.2 and QDA Miner Lite software (Version 2.0; Provalis, Montreal, Canada). Significance level was P < 0.05.

Results:
Among plastic surgeons who use EHR, EPIC Systems software (Epic, Verona, Wisc.) was the most common vendor, with users noting a net positive effect on the quality of care they provided to patients. Younger age and less years of experience were correlated with a more positive attitude toward EHR. Positive attitude was closely linked to shared responsibility among support staff over data entry, whereas negative attitude was tightly tied to the perceived time wasted because of EHR, followed by poor technical support and design.

Conclusions:
EHR use among plastic surgeons was more common in academic-associated specialties and larger practice groups. Overall, age and practice type had weak associations with perceptions of EHR usage. On average, there were slightly more positive perceptions of EHR usage than negative. The most commonly perceived issues with EHR were wasted time and barriers to user-friendliness. These findings suggest the need for greater physician involvement in EHR optimization.
Pelvic/Perineal Reconstruction: Time to Consider the Anterolateral Thigh Flap as a First-line Option?
Authors: Perrault David , Kin Cindy , Wan Derrick C. , Kirilcuk Natalie , Shelton Andrew , Momeni Arash 
Published: April 2020

Background:
Abdominoperineal resection (APR) and pelvic exenteration continue to be common procedures for the treatment of colorectal malignancy. The workhorse flap for reconstruction in these instances has been the vertical rectus abdominis myocutaneous flap. The associated donor site morbidity, however, cannot be ignored. Here, we provide a review of the literature and present the senior author’s (A.M.) experience using the pedicled anterolateral thigh (ALT) flap for reconstruction of soft tissue defects following APR and pelvic exenteration.

Methods:
Patients who underwent pelvic/perineal reconstruction with pedicled ALT flaps between 2017 and 2019 were included in the study. Parameters of interest included age, gender, body mass index, comorbidities, history of radiation, extent of ablative surgery, and postoperative complication rate.

Results:
A total of 23 patients (16 men and 7 women) with a median age and body mass index of 66 years (inter-quartile range [IQR]: 49–71 years) and 24.9 kg/m2 (IQR: 24.2–26.7 kg/m2) were included in the study, respectively. Thirteen (56.5%) patients presented with rectal cancer, 5 (21.7%) with anal squamous cell carcinoma (SCC), 4 (17.4%) with Crohn’s disease, and 1 (4.3%) with Paget’s disease. Nineteen patients (82.6%) received neoadjuvant radiation. Nine (39.1%) patients experienced 11 complications (2 major and 9 minor). The most common complication was partial perineal wound dehiscence (N = 6 [26.1%]). Stable soft tissue coverage was achieved in all but one patient.

Conclusions:
The ALT flap allows for stable soft tissue coverage following APR and pelvic exenteration without being associated with abdominal donor site morbidity. Consideration to its use as a first-line reconstructive option should be given in pelvic/perineal reconstruction.
Mitigation of Postsurgical Scars Using Lasers: A Review
Authors: Artzi Ofir , Friedman Or , Al-niaimi Firas , Wolf Yoram , Mehrabi Joseph N. 
Published: April 2020

Background:
Most postsurgical scars are considered esthetically and functionally acceptable. Currently, there is no definite consensus treatment for postsurgical scarring. The purpose of this review is to shed some light on the value of scar mitigation and the efficacy of different lasers employed on postsurgical wounds.

Methods:
A systematic literature review and computational analysis were conducted to identify relevant clinical articles that pertained to the use of lasers for mitigating postsurgical scars. Articles included the National Institutes of Health–National Center for Biotechnology Information–PubMed search and sources cited from relevant studies after 1995. Trials that attributed pre- and posttreatment scores of scar severity based on a verified scar evaluation scale (eg, Patient and Observer Scar Assessment Scale, Vancouver Scar Scale, Global Assessment Scale) were chosen. Clinical assessments varied for each study. To adequately assess the efficacy of the modalities, the final scaled scar appearance scores were realigned and normalized to a standard scale for unbiased comparison.

Results:
After filtering through a total of 124 studies, 14 relevant studies were isolated and thus included in the review. Studied lasers were as follows: Pulsed dye laser (PDL), carbon dioxide, diode, potassium titanyl phosphate (KTP), and erbium glass (Er-Glass) lasers.

Conclusion:
Treatment with lasers in the postsurgical wound healing phase is safe, effective, and advised in mitigation of pathologic scar formation.
Use of Decision Analysis and Economic Evaluation in Breast Reconstruction: A Systematic Review
Authors: Bouhadana Gabriel , Safran Tyler , Al-Halabi Becher , Davison Peter G. 
Published: April 2020

Background:
Decision analysis allows clinicians to compare different strategies in the context of uncertainty, through explicit and quantitative measures such as quality of life outcomes and costing data. This is especially important in breast reconstruction, where multiple strategies can be offered to patients. This systematic review aims to appraise and review the different decision analytic models used in breast reconstruction.

Methods:
A search of English articles in PubMed, Ovid, and Embase databases was performed. All articles regardless of date of publishing were considered. Two reviewers independently assessed each article, based on strict inclusion criteria.

Results:
Out of 442 articles identified, 27 fit within the inclusion criteria. These were then grouped according to aspects of breast reconstruction, with implant-based reconstruction (n = 13) being the most commonly reported. Decision analysis (n = 19) and/or economic analyses (n = 27) were employed to discuss reconstructive options. The most common outcome was cost (n = 27). The decision analysis models compared and contrasted surgical strategies, management options, and novel adjuncts.

Conclusions:
Decision analysis in breast reconstruction is growing exponentially.The most common model used was a simple decision tree. Models published were of high quality but could be improved with a more in-depth sensitivity analysis. It is essential for surgeons to familiarize themselves with the concept of decision analysis to better tackle complicated decisions, due to its intrinsic advantage of being able to weigh risks and benefits of multiple strategies while using probabilistic models.
Body Composition Changes During Traditional Versus Intensive Cardiac Rehabilitation in Coronary Artery Disease
Authors: Mirman Alex M. , Nardoni Nolan R. , Chen Alessandra Y. , Horwich Tamara B. 
Published: April 2020

Purpose:
Intensive cardiac rehabilitation (CR) was recently approved by Medicare and includes more hours and more focus on nutrition, stress management, and group support than a traditional, exercise-focused CR. The purpose of this study was to compare changes in body composition and cardiovascular (CV) risk factors after intensive versus traditional CR programs in patients with coronary artery disease (CAD).

Methods:
We studied 715 patients with CAD who completed a traditional versus intensive CR program at UCLA Medical Center between 2014 and 2018. Markers of CV health, including body composition using bioelectrical impedance analysis, were assessed pre- and post-program participation.

Results:
In both types of CR programs, body mass index, body fat percentage, blood pressure, and cholesterol levels (total cholesterol and low-density lipoprotein cholesterol) were significantly lower post- compared with pre-program. Exercise capacity was increased in both groups. Intensive CR patients had greater reductions in body mass index, body fat percentage, visceral adipose tissue, and diastolic blood pressure. Traditional CR patients demonstrated greater increases in high-density lipoprotein cholesterol and estimated lean mass.

Conclusions:
In patients with CAD, both traditional and intensive CR programs led to improvements in CV risk factors, though the magnitude of the effects of the program differed between the programs. Further studies, including studies analyzing CV outcomes, are needed to help determine optimal CR program choice for CAD patients based on their risk factor and body composition profile.