bluuebunny/crossref_metadata_2025_split huggingface dataset:
Use of the Poisson Distribution Is a Helpful Tool That Is Underused in Nursing Practice
Authors: Zrelak Patricia A. 
Published: December 2021

Background:
The Poisson distribution is used to find the probability of an event occurring over an interval of time, distance, area, or volume.

Problem:
It is a helpful statistical tool, especially when evaluating rare events, and is underused in nursing practice.

Approach:
A single-group study design is used to demonstrate use of the Poisson distribution in determining whether a change in the number of discrete events is due to random variation or reflects a change in practice patterns and in determining the probability of seeing the number of observed events.

Outcomes:
Steps demonstrate how one can easily use the Poisson distribution to answer common questions.

Conclusion:
Use of the Poisson distribution can help nurses make better informed decisions about observed variations in care, especially when the data are not normally distributed, and can prevent undue concern when fluctuations in the number of events are associated with random fluctuations.
Knowledge and Perceived Effectiveness of Infection Prevention and Control Measures Among Health Care Workers During the COVID-19 Pandemic
Authors: Abed Alah Muna , Abdeen Sami , Selim Nagah , Hamdani Dhouha , Radwan Eman , Sharaf Nahla , Al-katheeri Huda , Bougmiza Iheb 
Published: December 2021

Background:
Being the first line of defense against COVID-19 infection, health care workers (HCWs) are at an increased risk of getting infected. Infection prevention and control (IPC) measures were deemed to be instrumental in protecting them and their patients against infection.

Purpose:
To assess HCWs' knowledge of IPC measures and their perceived effectiveness in protecting against COVID-19.

Methods:
A national web-based survey was conducted in different health care sectors in Qatar.

Results:
A total of 1757 HCWs completed the survey. HCWs believed in applying stricter IPC precautions while dealing with confirmed COVID-19 cases than with suspected cases. Males and physicians were more likely to have high perceived effectiveness of IPC measures than females, nurses, and pharmacists. Higher proportions of HCWs believed in the effectiveness of hand hygiene than most types of personal protective equipment.

Conclusion:
Further research is recommended to assess the impact of HCWs' knowledge and perceived effectiveness of IPC measures on their compliance.
Hip fracture care during the COVID-19 pandemic: retrospective cohort and literature review
Authors: Topor Lauren , Wood Lily , Switzer Julie A. , Schroder Lisa K. , Onizuka Naoko 
Published: December 2021

Abstract

Objectives:
The goal of this study was to investigate whether the COVID-19 pandemic has affected hip fracture care at a Level I Trauma hospital. The secondary goal was to summarize the published hip fracture reports during the pandemic.

Design:
A retrospective cohort study.

Setting:
Level I Trauma Center.

Patients/Participants:
Eighty-six operatively treated hip fracture patients age ≥65 years, occurring from January 17 to July 2, 2020.

Intervention (if any):
N/A.

Main Outcome Measurements:
We defined 3 phases of healthcare system response: pre-COVID-19 (period A), acute phase (period B), and subacute phase (period C). The primary outcome was 30-day mortality. Clinical outcomes including time to surgery (TTS) and length of stay (LOS) were extracted from the electronic medical record.

Results:
Twenty-seven patients from Period A, 27 patients from Period B, and 32 patients from Period C were included. The 30-day mortality was not statistically different. The mean TTS was 20.0 +/− 14.3 hours and was the longest in Period C (22.1 +/− 9.8 hours), but the difference was not statistically significant. The mean LOS was 113.0 +/− 66.2 hours and was longest in Period B (120.9 +/− 100.6 hours). However, the difference was not statistically significant.

Conclusions:
The 30-day mortality, TTS, and LOS were not statistically different across multiple phases of pandemic at a level 1 trauma center. Our results suggest that we successfully adapted new protocol changes and continued to provide evidence-based care for hip fracture patients. Our results were comparable with that of other authors around the world.
Forensic DNA Typing From Femurs and Bones of the Foot
Authors: Simões Dutra Corrêa Heitor , Cortellini Venusia , Franceschetti Lorenzo , Verzeletti Andrea 
Published: December 2021

Abstract
Evidence has been accumulating in the sense that femur may not always be the best option for DNA typing of skeletal remains. Recent studies have shown that bones of the hands and feet appear to be a superior source of preserved DNA. The current study reanalyzed DNA quantitation, degradation, and short tandem repeat typing in femurs, lateral cuneiforms, and distal foot phalanges. Data from 3 human identification cases involving corpses in an advanced decomposition state were collected. We found that in the studied cases, the femur provided equal or inferior results, recovering 84.9% of true alleles. Lateral cuneiforms (99.2%) and distal foot phalanges (96.8%) yielded higher percentages. In addition, more drop-ins and drop-outs were detected in femurs than cuneiforms and phalanges. This study adds to current findings that advocate for further investigation into bone selection for use in forensic practice. The impacts of our findings are limited by the small number of individuals studied and may not apply to old and degraded bones.
Systematic Review of the Use of Power Doppler Ultrasound in the Imaging of Peripheral Nerve Compression Neuropathy
Authors: Landau Andrew J. , Parameswaran Priyanka , Fresco Rabiah , Simon Laura , Dy Christopher J. , Brogan David M. 
Published: December 2021

Background:
Power Doppler ultrasonography has been used as an adjunct in the diagnosis of peripheral nerve compression neuropathy. To better characterize its sensitivity and specificity, the authors performed a systematic review of its use in carpal and cubital tunnel syndrome diagnosis.

Methods:
The authors systematically reviewed published literature on the use of power Doppler ultrasound to diagnose peripheral compression neuropathy using Ovid MEDLINE, Embase.com, Scopus, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Database of Abstracts of Reviews of Effects, Health Technology Assessment Database, NHS Economic Evaluation Database, World Health Organization International Clinical Trial Repository Platform, and Clinicaltrials.gov. No filters for language, date, or publication type were used.

Results:
After reviewing 1538 identified studies, 27 publications were included involving 1751 participants with compression neuropathy (2048 median and 172 ulnar). All but three studies examined patients with carpal tunnel syndrome. Heterogeneity between study design and methodology was a noted limitation. Sensitivity and specificity of power Doppler ultrasound in the diagnosis of carpal tunnel syndrome ranged from 2.2 to 93.4 percent, and 89 to 100 percent, respectively, whereas sensitivity for cubital tunnel syndrome was 15.3 to 78.9 percent. There was variability in power Doppler signal detection based on location, with higher sensitivities at the carpal tunnel inlet and in areas of increased nerve swelling.

Conclusions:
Power Doppler ultrasound is unreliable as a screening test but appears to increase diagnostic accuracy of ultrasonography in compression neuropathies. It is most beneficial in moderate to severe disease and may be valuable in detecting early cases and in disease surveillance.
Silent Rupture of Silicone Gel Breast Implants: High-Resolution Ultrasound Scans and Surveys of 584 Women
Authors: Salzman Marc J. 
Published: December 2021

Background:
Patient compliance has been low for U.S. Food and Drug Administration–recommended magnetic resonance imaging scans to screen silicone gel breast implants for silent rupture. High-resolution ultrasound scans are a convenient, in-office alternative that may improve screening compliance; however, women’s attitudes and feelings about silent rupture and their desire for rupture screening are unknown.

Methods:
Plastic surgeons and staff in nine private practices received 1-day training in high-resolution ultrasound scanning, then screened women with silicone gel implants implanted since 2000. Suspect scans were reviewed by a high-resolution ultrasound–experienced plastic surgeon to determine if they showed ruptures. Surgical and scan findings were correlated. To learn attitudes and feelings about silent rupture, women took surveys before and after the scan.

Results:
Of 584 women screened, 82 (14.0 percent) had scans showing ruptures; of 1153 implants, 92 (8.0 percent) showed ruptures. Forty women with scans showing ruptures underwent surgery, of which 30 (75 percent) had their ruptures confirmed. Surveys found 99.5 percent of women want to know if they have a rupture and 95.2 percent want the ruptured implant removed. If the scan showed no rupture, women felt relieved and 95.5 percent would get future high-resolution ultrasound screening for silent rupture. If a rupture was found, women expressed various concerns and 87.8 percent would remove the ruptured implant within 12 months.

Conclusions:
Surveys show that women with silicone gel implants have concerns and feel anxious about possible silent rupture. Based on 14 percent of women showing a ruptured implant on high-resolution ultrasound scans and 75 percent of ruptures on high-resolution ultrasound scans surgically confirmed, 10.6 percent of women in this study have a silent rupture.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Diagnostic, IV.
The Impact of Race on Perioperative and Patient-Reported Outcomes following Autologous Breast Reconstruction
Authors: Oskar Sabine , Nelson Jonas A. , Hicks Madeleine E. V. , Seier, M.S. Kenneth P. , Tan Kay See , Chu Jacqueline J. , West Scott , Allen Robert J. , Barrio Andrea V. , Matros Evan , Afonso Anoushka M. 
Published: December 2021

Background:
Racial disparities are evident in multiple aspects of the perioperative care of breast cancer patients, but data examining whether such differences translate to clinical and patient-reported outcomes are limited. This study examined the impact of race on perioperative outcomes in autologous breast reconstruction.

Methods:
A retrospective cohort study including all breast cancer patients who underwent immediate autologous breast reconstruction at a single institution from 2010 to 2017 was conducted. Self-reported race was used to classify patients into three groups: white, African American, and other. The primary and secondary endpoints were occurrence of any major complications within 30 days of surgery and patient-reported outcomes (measured with the BREAST-Q), respectively. Regression models were constructed to identify factors associated with the outcomes.

Results:
Overall, 404 patients, including 259 white (64 percent), 63 African American (16 percent), and 82 patients from other minority groups (20 percent), were included. African American patients had a significantly higher proportion of preoperative comorbidities. Postoperatively, African American patients had a higher incidence of 30-day major complications (p = 0.004) and were more likely to return to the operating room (p = 0.006). Univariable analyses examining complications demonstrated that race was the only factor associated with 30-day major complications (p = 0.001). Patient-reported outcomes were not statistically different at each time point through 3 years postoperatively.

Conclusions:
African American patients continue to present with increased comorbidities and may be more likely to experience major complications following immediate autologous breast reconstruction. However, patient-reported satisfaction or physical well-being outcomes may not differ between groups.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Risk, II.
An Analysis of the Modified Five-Item Frailty Index for Predicting Complications following Free Flap Breast Reconstruction
Authors: Magno-Pardon David A. , Luo Jessica , Carter Gentry C. , Agarwal Jayant P. , Kwok Alvin C. 
Published: December 2021

Background:
The modified five-item frailty index is a validated and effective tool for assessing risk in surgical candidates. The authors sought to compare the predictive ability of the modified five-item frailty index to established risk factors for complications in free flap breast reconstruction.

Methods:
The 2012 to 2018 American College of Surgeons National Surgical Quality Improvement Program database was queried for free flap breast reconstructive procedures. Univariate and multivariate regression analysis models were used to assess how modified five-item frailty index and factors commonly used to risk stratify (age, body mass index, American Society of Anesthesiologists classification, and history of smoking) were associated with complications.

Results:
Of the total 10,550 cases, 24.1 percent experienced complications. A high modified five-item frailty index score is associated with a higher overall rate of postoperative complications (p < 0.001). This significant trend was demonstrated in both surgical (p < 0.001) and medical (p < 0.001) complications. When controlling for other risk factors commonly used for risk stratification such as age, body mass index, American Society of Anesthesiologists classification, and history of smoking, the modified five-item frailty index was significantly associated with medical (OR, 1.75; 95 percent CI, 1.37 to 2.22; p = 0.001) and any complications (OR, 1.58; 95 percent CI, 1.29 to 1.93; p < 0.001) and had the largest effect size. Assessing for specific complications, the modified five-item frailty index is the strongest independent predictor of reoperation (OR, 1.41; 95 percent CI, 1.08 to 1.81; p = 0.009).

Conclusion:
The modified five-item frailty index is a useful predictor of postoperative outcomes in patients undergoing free flap breast reconstruction when compared to other historically considered risk factors for surgical complications.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Risk, III.
Piezosurgery versus Conventional Cutting Techniques in Craniofacial Surgery: A Systematic Review and Meta-Analysis
Authors: McGuire Connor , Boudreau Colton , Prabhu Neetin , Hong Paul , Bezuhly Michael 
Published: December 2021

Background:
Despite its increasing use in craniofacial surgery, the evidence for piezosurgery over conventional bone-cutting techniques has not been critically appraised. The purpose of this systematic review and meta-analysis was to identify and assess the evidence that exists for the use of piezosurgery in craniofacial surgery.

Methods:
A systematic review was undertaken using a computerized search. Publication descriptors, methodologic details, and outcomes were extracted. Articles were assessed using the methodologic index for nonrandomized studies and Cochrane instruments. Random effects meta-analysis was completed.

Results:
Thirty-nine studies were included. Most studies were published within the past 5 years (51.3 percent) and were randomized controlled trials (56.4 percent). The mean age of patients was 27 years (range, 0.2 to 57 years), and the mean sample size was 44 (range, 12 to 180). Meta-analysis revealed that compared to conventional instruments, piezosurgery had a lower postoperative incidence of sensory disturbance, principally in mandibular procedures (OR, 0.29; 95 percent CI, 0.11 to 0.77; p = 0.01) and pain at postoperative day 3 (mean difference, −0.86; 95 percent CI, −1.20 to –0.53; p < 0.01). There was no statistically significant difference in operating room time (mean difference, 8.60; 95 percent CI, −1.27 to 18.47; p = 0.80) or osteotomy time (mean difference, 0.35; 95 percent CI, −2.99 to 3.68; p = 0.84). Most studies were clinically homogenous (92 percent) and of high quality based on the methodologic index for nonrandomized studies instrument (84 percent). Few studies had domains at high risk of bias based on the Cochrane instrument (28.6 percent).

Conclusions:
Piezosurgery has considerable benefits when compared to conventional instruments. Future studies should investigate its cost-effectiveness and benefits in terms of blood loss, edema/ecchymosis, and patient satisfaction.
Early Alveolar Bone Grafting Is Associated with Lower Regraft Rates and Improvements in Long-Term Psychosocial Outcomes
Authors: Hu Allison C. , Jain Nirbhay S. , Chan Candace H. , Malapati Sri Harshini , Dang Brian N. , Bertrand Anthony A. , Squitieri Lee , Wilson Libby F. , Lee Justine C. 
Published: December 2021

Background:
Late childhood (8 to 10 years of age) has emerged as a vulnerable period in children with cleft and craniofacial anomalies such that increased interventions during this period are associated with worse long-term patient-reported anxiety and depressive symptoms. These findings suggest that one possible practice change may be to consider changes in timing for surgical treatment algorithms. In this work, the authors investigated outcomes in altering the timing of the most common operation in late childhood for cleft lip and palate patients, alveolar bone grafting.

Methods:
A two-part, multi-institutional cohort study was conducted. To understand the feasibility of changing alveolar bone graft timing with respect to surgical success, reoperation rates were retrospectively compared among patients grafted at different ages (4 to 7, 8 to 10, and 11 to 13 years of age). To understand the long-term effect of changing alveolar bone graft timing on psychosocial outcomes, the psychosocial suite of the Patient-Reported Outcomes Measurement Information System was prospectively administered to teenagers and adults with cleft lip and palate.

Results:
Among the three age groups, early grafting (4 to 7 years of age) demonstrated the lowest regraft rates compared with the other groups. As these results suggested that early grafting is a viable alternative to standard timing, we next compared the differences in long-term psychosocial outcomes. Patients who were grafted early reported lower levels of anxiety and depressive symptoms as teenagers and adults.

Conclusion:
Altering timing of one stage in cleft lip and palate reconstruction to an earlier age decreases regraft rates and improves long-term patient-reported anxiety and depressive symptoms.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.
Face Lift after Facial Feminization Surgery: Indications and Special Considerations
Authors: Rochlin Danielle H. , Morrison Shane D. , Harirah Muhammad , Rohrich Rod J. , Satterwhite Thomas 
Published: December 2021

Summary:
Iatrogenic jowling can be an unintended consequence of facial feminization surgery. Reduction of the mandible and chin without overlying changes to the soft tissue can lead to a redundant and deflated soft-tissue envelope, requiring a face lift to address jowling, cervicofacial laxity, and/or lower facial rhytids. Prospective quality-of-life outcomes data support this hypothesis, as patients who underwent mandible contouring with or without angle osteotomies were significantly more likely to express interest in face lift following facial feminization surgery on univariable analysis (90.0 percent versus 10.0 percent, p = 0.038). Patients with inherent skin laxity are at particularly high risk, such as those with advancing age, extrinsic skin damage (e.g., sun exposure, cigarette smoke), and history of massive weight loss. Before facial feminization surgery, the authors recommend comprehensive patient counseling that includes a discussion of the possible future need for a face lift, preferably around 1 year after facial feminization surgery. When performing a face lift after facial feminization surgery, technical considerations include those related to sequelae of prior facial surgery, anatomical differences between cismale and cisfemale facial soft tissue, and the mechanism of jowling after facial feminization surgery versus normal facial aging. The authors believe that these considerations can set more realistic expectations for facial feminization surgery patients, improve surgeons’ ability to skillfully execute this procedure, and ultimately contribute to ongoing quality-of-life improvements in facial feminization surgery patients.
One-Year Outcomes of the First Human Trial on Robot-Assisted Lymphaticovenous Anastomosis for Breast Cancer–Related Lymphedema
Authors: van Mulken Tom J. M. , Wolfs Joost A. G. N. , Qiu Shan S. , Scharmga Andrea M. J. , Schols Rutger M. , Spiekerman van Weezelenburg Merel A. , Cau Raimondo , van der Hulst Rene R. W. J. ,   MicroSurgical Robot Research Group
Published: December 2021

Background:
Lymphaticovenous anastomosis, a supermicrosurgical technique, creates bypasses between the lymphatic and venous systems. The quality of lymphaticovenous anastomosis depends on the surgeon’s dexterity and precision, and is subject to imperfections caused by the physiologic tremor of the human hand. A dedicated robot for microsurgery has been created to overcome these limitations (MUSA, MicroSure, Eindhoven, The Netherlands). This study describes 1-year clinical outcomes of the first-in-human trial of robot-assisted and manual lymphaticovenous anastomosis in patients with breast cancer–related lymphedema.

Methods:
In this prospective pilot study, women with breast cancer–related lymphedema were randomized into the robot-assisted or manual lymphaticovenous anastomosis group. Outcomes were quality of life, arm circumference, conservative treatment frequency, arm dermal backflow stage, and anastomosis patency.

Results:
Twenty women were included, of whom eight underwent robot-assisted lymphaticovenous anastomosis surgery and 12 underwent manual surgery. In both groups, quality of life significantly improved at 12 months (robot-assisted surgery, p = 0.045; manual surgery, p = 0.001). Arm circumference did not decrease (robot-assisted surgery, p = 0.094; manual surgery, p = 0.240). Daily use of compression garments decreased by 61.9 percent (robot-assisted surgery) and 70.2 percent (manual surgery). The frequency of manual lymphatic drainage remained similar compared with baseline. Arm dermal backflow stage was reduced in one patient in the robot-assisted group and in five cases in the manual group. Overall, 76.5 percent of the anastomoses were patent (robot-assisted surgery, 66.6 percent; manual surgery, 81.8 percent).

Conclusions:
After evaluating 1-year follow-up data, this study confirms the feasibility of robot-assisted lymphaticovenous anastomosis surgery. Clinical outcomes were comparable between robot-assisted and manual lymphaticovenous anastomosis. This encourages further research using the new microsurgical robot MUSA for lymphaticovenous anastomosis and other (super)microsurgical procedures.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, II.
Secondary Procedures following Flexor Tendon Reconstruction
Authors: Wu Kitty Yuechuan , Gillis Joshua A. , Moran Steven L. 
Published: December 2021

Learning Objectives:
After studying this article, the participant should be able to: 1. Understand the indications and management options for secondary flexor tendon reconstruction, including tenolysis, tendon grafting, and tendon transfers. 2. Understand the reconstructive options for pulley reconstruction. 3. Understand the options for management of isolated flexor digitorum profundus injuries.

Summary:
Despite current advances in flexor tendon repair, complications can still occur following surgery. This article presents the spectrum of treatment options for secondary flexor tendon reconstruction ranging from tenolysis to one- and two-stage tendon grafting, and tendon transfers. In addition, an overview of pulley reconstruction and the treatment of isolated flexor digitorum profundus injuries are discussed. A management algorithm for secondary flexor tendon reconstruction is provided.