bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pressure Injury Prevention in Patients with Prolonged ED Stays Prior to Admission
Authors: Edwards Amanda , Sitanggang Novi , Wolff Kelly , Role Jewel , Cardona Trisha , Sanchez Myra , Radovich Patricia 
Published: January 2021

ABSTRACT

Purpose:
The purpose of this project was to examine whether initiating a standardized pressure injury (PI) assessment and prevention protocol early in adult patients' ED stay reduces hospital-acquired PIs (HAPIs) in those patients admitted from the ED to acute care inpatient medical units.

Methods:
A nurse-led evidence-based practice team studied the problem of increasing HAPIs on four acute care inpatient units and found that, among patients who had been admitted to inpatient care from the ED, longer ED boarding times correlated with a higher rate of HAPIs. ED staff and acute care unit nurses collaborated to develop new protocols to prevent HAPIs in the ED, including staff education and standardized assessments and prevention care for at-risk patients. Data collection was performed at three time periods over approximately two and a half years: baseline, intervention, and postintervention.

Results:
The incidence rate for HAPIs decreased from 3.56 per 1,000 patient-days at baseline to 1.31 per 1,000 patient-days during the intervention period. This reduction was sustained over the next five months, during which the HAPI incidence rate was 1.53 per 1,000 patient-days.

Implications:
At a time when ED length of stay is difficult to manage and continues to increase, the use of evidence-based interventions and protocols can reduce the rate of PIs in high-risk patients waiting for hospital admission, leading to a reduction in PI rates and overall hospital costs.
Beyond Screening: Health Systems Invest in Social Determinants of Health
Authors: Fauteux Nicole 
Published: January 2021

This is the second of three articles exploring ways in which frontline nurses may be affected by recommendations of the forthcoming National Academy of Medicine Future of Nursing 2020-2030 study.
As pioneering health systems begin investing in housing and other services to support individuals and bolster communities, nurses gain new opportunities and responsibilities. On the one hand, nurses should expect their work to entail more tracking and sharing of patient data. On the other, nurses can apply their creativity and holistic approach to care to assist health systems in making an overdue cultural shift.
Health After Cancer: An Innovative Continuing Medical Education Course Integrating Cancer Survivorship Into Primary Care
Authors: Smith Stephanie M. , Williams Pamela , Kim Jennifer , Alberto Jayzona , Schapira Lidia 
Published: January 2021

Problem
The transition from oncology care back to primary care after cancer therapy is challenging for cancer survivors who seek services that address the effect of their cancer history on their present health. Lack of knowledge about the health needs of cancer survivors is a barrier to incorporating survivorship care into primary care practice. Formal training in cancer survivorship is rarely included in medical education and presents an opportunity for intervention.

Approach
The authors developed (January 2019–March 2020) an online continuing medical education (CME) course for primary care physicians (PCPs) that launched in April 2020. Course design and content were informed by critically reviewing cancer survivorship CME courses and understanding cancer survivors’ clinical experiences in a primary care setting. The course aims to pique learners’ interest through a concise, practical educational experience using peer-to-peer primary care-focused instruction in a case-based, multimedia-enriched format. In the course, 4 patient cases illustrate the physical and psychological effects of cancer treatment, and a primary care narrator demonstrates ways to approach these concerns during a clinic visit, providing tips for empathic communication with cancer survivors. The course development team—including a PCP, medical and pediatric oncologists, and medical educators with expertise in instructional design—used an iterative process to review and revise the content. PCPs and specialists reviewed the script and provided constructive feedback that was incorporated into revisions.

Outcomes
The authors will evaluate course effectiveness based upon user experience and perceived effect on clinical practice and professional growth. A follow-up survey will assess barriers to course completion and durability of effect.

Next Steps
Future directions include dissemination of the course to a broader audience including medical trainees, evaluation of higher-level learning outcomes (e.g., effect on PCPs’ clinical practice), and adaptation of the course for patients with a focus on self-management.
Preoperative Thoracic Curve Magnitude and L4 End Vertebra Were Risk Factors for Subjacent Disc Wedging After Selective Thoracolumbar/Lumbar Fusion with L3 as the Lowest Instrumented Vertebra in Lenke Type 5 Curve Patients
Authors: Banno Tomohiro , Yamato Yu , Oba Hiroki , Ohba Tetsuro , Hasegawa Tomohiko , Yoshida Go , Arima Hideyuki , Oe Shin , Mihara Yuki , Ushirozako Hiroki , Takahashi Jun , Haro Hirotaka , Matsuyama Yukihiro 
Published: January 2021

Study Design.
Retrospective multicenter study.

Objective.
This study aimed to investigate the incidence and risk factors of subjacent disc wedging (SDW) in adolescent idiopathic scoliosis (AIS) patients with Lenke type 5 curve.

Summary of Background Data.
SDW is frequently observed after surgery; however, data about its mechanism and relations with outcome are limited.

Methods.
Data of 59 patients with AIS with Lenke type 5 curves who underwent posterior spinal fusion to L3 as the lowest instrumented vertebra (LIV) were retrospectively analyzed. The subjacent disc angle (SDA) was defined as the angle between L3 (LIV) and L4. SDW was defined as the absolute value of SDA of 10° or higher 2 years postoperatively. The incidence of SDW was investigated between nonselective and selective thoracolumbar/lumbar (TL/L) fusion group. In the selective group, patients with and without SDW were compared.

Results.
Among 59 patients, 11 had nonselective and 48 had selective fusion. No patients in the nonselective group showed SDW versus 13 patients in the selective group (27%) showed SDW. In the selective group, patients with SDW showed significantly greater main thoracic curve, apical vertebral translation of the main thoracic curve, upper instrumented vertebra tilt, LIV tilt, and SDA 2 years postoperatively, whereas no differences were found in the coronal balance or clinical outcome. Multivariate analysis revealed preoperative T curve and SDA as predictors of SDW occurrence. T curve greater than 30° and SDA greater than 0° were calculated as cutoff values based on the receiver operating characteristic curve.

Conclusion.
SDW is sometimes seen in Lenke type 5 patients with AIS who underwent selective TL/L fusion. SDW seemed to occur as a compensation mechanism for progressing deformity of unfused segments (thoracic curve and residual lumbar curve) to maintain coronal alignment. Preoperative T curve > 30° and SDA > 0° (lower-end vertebra as L4) were determined as risk factors for SDW occurrence.

Level of Evidence: 3
How Preoperative Motor Weakness Affects the Extent of Recovery After Elective Spine Surgery in Patients with Degenerative Lumbar Spinal Stenosis
Authors: Yagi Mitsuru , Suzuki Satoshi , Nori Satoshi , Okada Eijiro , Tsuji Osahiko , Nagoshi Narihito , Nakamura Masaya , Matsumoto Morio , Watanabe Kota 
Published: January 2021

Study Design.
Retrospective review.

Objective.
This study sought to determine how baseline motor weakness (MW) affects elective spine surgery in patients with degenerative lumbar spinal stenosis (LSS).

Summary of Background Data.
Favorable clinical outcomes have been described for elective spine surgery in patients with LSS. However, the way preoperative MW affects the patient's health-related quality of life (HRQoL) after surgery is not well understood.

Methods.
A retrospective review of prospectively collected data from 305 surgically treated patients with LSS who had 2-year follow-up was performed (age 71 ± 9 yrs, male 62%). Demographic, radiographic, and clinical outcomes were analyzed at baseline and at 1-year, 2-year, and 3-year postoperation. The Japanese Orthopedic Association Back Pain Evaluation Questionnaire was used to assess the HRQoLs. The HRQoLs were compared between those with or without preop MW. Adjusted multivariate logistic regression analyses were performed to determine whether MW affected HRQoLs.

Results.
One hundred sixteen patients (38%) were categorized as MW+. The patient background including age, sex, presence of degenerative spondylolisthesis, type of surgery, and presence of neurological claudication were similar between the two groups. However, the 1-, 2-, and 3-year postoperative visual analogue scale of back pain, leg pain, leg numbness, the Japanese Orthopedic Association Back Pain Evaluation Questionnaire lumbar function, social life, mental health, and walking ability were all inferior in the MW+ group, whereas a similar percentage of patients achieved a minimum clinically important difference in all subdomains at 3 years. The adjusted multivariate logistic regression analyses showed that having ≥2 muscles with MW, and severity of MW (manual motor test grade) were independent risk factors for both difficulty climbing stairs and walking >15 minutes. (muscles with MW≥2; stair climbing: OR 6.4[2.3–17.4], walking: OR 3.2[1.4–7.3], severity of MW; stair climbing: OR 2.5[1.4–4.4], walking: OR 2.2[1.3–3.7]).

Conclusion.
The patients with baseline MW had inferior HRQoL for up to 3 years compared with that of those without MW; however, the amount of improvement in HRQoL was comparable. Timely follow-up is important to find out the deterioration of motor function.

Level of Evidence: 4
Understanding Restrictive Versus Liberal Fluid Therapy for Major Abdominal Surgery Trial Results: Did Liberal Fluids Associate With Increased Endothelial Injury Markers?
Authors: Bihari Shailesh , Dixon Dani-Louise , Painter Thomas , Myles Paul , Bersten Andrew D. 
Published: January 2021

Objectives:
Liberal fluid strategies in critically ill patients are associated with harm, thought to be due to endothelial and glycocalyx injury. As the restrictive versus liberal fluid therapy for major abdominal surgery trial not only failed to report survival benefit with restrictive fluids but was associated with a higher rate of acute kidney injury, we hypothesized that factors other than endothelial and glycocalyx injury were likely to account for these findings. Consequently, we measured injury biomarkers in a cohort of the restrictive versus liberal fluid therapy for major abdominal surgery trial.

Design:
The restrictive versus liberal fluid therapy for major abdominal surgery trial was an international, randomized, assessor-blinded trial comparing restrictive with liberal IV fluid regimens that represented traditional care in patients undergoing major abdominal surgery.

Setting and Patients:
Cohort of restrictive versus liberal fluid therapy for major abdominal surgery bloods was collected at a single major site (161 patients) prior to, day 1 and day 3 after surgery.

Intervention:
Bloods were blindly and randomly batch analyzed for plasma markers of endothelial/glycocalyx injury—angiopoietin-1, angiopoietin-2, soluble tyrosine-protein kinase-2 receptor, soluble intracellular adhesion molecule-1, syndecan, and tumor necrosis factor-α. Data were examined as restrictive versus liberal enrollment groups and high versus low (± 5,000 mL) fluid groups. Differences were examined by linear mixed modeling.

Measurement and Main Results:
There were no significant differences in any biomarkers between the restrictive (n = 75) and liberal (n = 86) groups. When examined as low (n = 81) and high (n = 79) fluid groups, plasma angiopoietin-2 (p = 0.009) and soluble intracellular adhesion molecule-1 (p = 0.01) were elevated in the high fluid group. There were no differences in other biomarkers.

Conclusions:
Although these results are consistent with previous findings of vascular injury following liberal fluid therapy, they suggest alternative mechanisms underlie the clinical outcomes from restrictive versus liberal fluid therapy for major abdominal surgery study.

ClinicalTrials.gov identifier:
NCT01424150.
Developmental Regression, Depression, and Psychosocial Stress in an Adolescent with Down Syndrome
Authors: Stein David S. , Munir Kerim M. , Karweck Andrea J. , Davidson Emily J. , Stein Martin T. 
Published: January 2021

CASE: Kristen is a 13-year-old girl with Down syndrome (DS) who was seen urgently with concerns of cognitive and developmental regression including loss of language, social, and toileting skills. The evaluation in the DS clinic focused on potential medical diagnoses including atlantoaxial joint instability, vitamin deficiency, obstructive sleep apnea (OSA), and seizures. A comprehensive medical evaluation yielded only a finding of moderate OSA. A reactive depression was considered in association with several psychosocial factors including moving homes, entering puberty/onset of menses, and classroom change from an integrated setting to a self- contained classroom comprising unfamiliar peers with behavior challenges.
Urgent referrals for psychological and psychiatric evaluations were initiated. Neuropsychological testing did not suggest true regression in cognitive, language, and academic skills, although decreases in motivation and performance were noted with a reaction to stress and multiple environmental changes as a potential causative factor. Psychiatry consultation supported this finding in that psychosocial stress temporally correlated with Kristen's regression in skills.
Working collaboratively, the team determined that Kristen's presentation was consistent with a reactive form of depression (DSM-IV-TR: depressive disorder, not otherwise specified). Kristen's presentation was exacerbated by salient environmental stress and sleep apnea, rather than a cognitive regression associated with a medical cause. Treatment consisted of an antidepressant medication, continuous positive airway pressure for OSA, and increased psychosocial supports. Her school initiated a change in classroom placement. With this multimodal approach to evaluation and intervention, Kristen steadily improved and she returned to her baseline function.
Uncomplicated Sigmoid Volvulus Is Ideal for Laparoscopic Sigmoidectomy With Transrectal Natural Orifice Specimen Extraction
Authors: Seow-En Isaac , Chang Sheng-Chi , Ke Tao-Wei , Shen Ming-Yin , Chen Hong-Chang , William Tzu-Liang Chen  
Published: January 2021

INTRODUCTION:
Natural orifice specimen extraction is the next step in minimally invasive colorectal surgery but can be technically challenging, with additional risks, especially for oncologic surgery. For several key reasons, sigmoid volvulus is well suited for natural orifice specimen extraction surgery. We describe our method and experience with double-stapled anastomosis transrectal natural orifice specimen extraction for sigmoid volvulus.

TECHNIQUE:
Using 3- or 4-port laparoscopy, the mesentery is separated from the long sigmoid loop. After the distal bowel is tied off and washed out, the rectum is completely transected and the proximal bowel delivered transrectally through a wound protector. Proximal transection is performed externally, and the circular stapler anvil is set before the bowel is returned into the abdominal cavity. The rectum stump is closed with an endoscopic linear stapler, and a circular-stapled anastomosis is performed.

RESULTS:
After successful endoscopic decompression, 6 patients underwent elective laparoscopic sigmoidectomy with natural orifice specimen extraction for volvulus at China Medical University Hospital from 2015 to 2020. The median operative time was 179 minutes (range, 151–236 min). No intraoperative complications were encountered. The median postoperative length of stay was 4 days (range, 2–9 d). One patient experienced postoperative small-bowel ileus resulting in readmission. The median follow-up duration was 12 months (range, 2–49 mo). One recurrence of volvulus was recorded 27 months postsurgery.

CONCLUSION:
Uncomplicated sigmoid volvulus can be treated effectively with sigmoidectomy and natural orifice specimen extraction. Surgeons who attempt this procedure should be well versed with conventional laparoscopy but do not necessarily need to be experienced with natural orifice specimen extraction for successful surgery.
How Fat Grafting Works
Authors: Evans Brogan G. A. , Gronet Edward M. , Saint-Cyr Michel H. 
Published: January 2021

Background:
Fat grafting has been shown to improve diseased soft issue. Although the mechanism behind fat grafting’s regenerative properties is currently debated, published studies agree that there is an associated vasculogenic effect. A systematic literature review was conducted to elucidate the biochemical pathways responsible for establishing neo-vasculature to grafted fat.

Methods:
A systematic literature review was conducted by searching PubMed for current basic science and clinical research relating to fat grafting. In total, 144 of 269 (54%) articles met the inclusion criteria for our literature review. These 144 articles were summarized, with 86 of them (60%) used to construct this article at the authors’ discretion.

Results:
Fat grafting–induced neovascularization can be divided into 3 parts. First, tissue trauma induced via fat injection activates a host inflammatory response necessary for cellular recruitment. Recruited cells promote the formation of connective tissue and neo-vasculature at the graft site. Second, cellular elements within the lipoaspirate contribute to neovascularization through a cytokine burst. Third, a synergistic relationship is established between recruited inflammatory cells and the cytokine burst of grafted fat. The end product of these processes is the differentiation of progenitor cells and the creation of neo-vasculature at the graft site.

Conclusions:
Establishing neovasculature is paramount for the survival of grafted fat. Fat graft take can be divided into 2 steps: imbibition and neovascularization. We believe this process occurs through 3 distinct concepts: host inflammation via graft injection, hypoxic response of lipoaspirate-derived cellular elements, and a synergistic relationship between host inflammation and grafted fat.
Progressive Surgical Management of Hemifacial Myohyperplasia for Improved Functional and Aesthetic Results
Authors: Zissman Sivan , Cooperman Yael , Leshem David , Gur Eyal 
Published: January 2021

Summary:
Hemifacial myohyperplasia (HMH) is a rare congenital disorder characterized by the unilateral enlargement of facial muscles and unilateral hypoplasia of the skeletal structures. The causes, risk of recurrence in subsequent offspring, and pathogenesis of HMH remain unclear, and the condition can involve a number of features. Among them are pronounced facial asymmetry and changes to both hard and soft tissue structures, as well as facial hemiparesis. We describe the long-term surgical management of HMH in a 3-year-old girl who presented to our department with no other systemic manifestation. We describe the treatment options as well as our approach, which included the use of botulinum toxin injections, and our considerations when choosing to employ careful preservation of the facial nerve and facial mimetic muscles (rather than facial paralysis and facial reanimation) in 2 stages using muscle and nerve grafts. We found that sequential debulking procedures undertaken at significant intervals have offered our patient improved aesthetic and functional results in comparison with the use of nonsurgical techniques, comparable to the more complex grafting technique used in facial reanimation surgery. Due, in part, to the rarity of HMH, there is currently no consensus regarding the optimal treatment approach to the condition. Our use of serial debulking rather than the more complex and problematic microsurgical approach of facial reanimation surgery offers a feasible surgical solution with both aesthetic and functional improvement for these patients.
Dupuytren’s Fasciectomy: Surgical Pearls in Planning and Dissection
Authors: Hever Pennylouise , Smith Oliver J. , Nikkhah Dariush 
Published: January 2021

Summary:
Fasciectomy remains the mainstay of surgical treatment for Dupuytren’s disease at many units worldwide, particularly in cases of recurrence after aponeurotomy or enzymatic fasciotomy. In some series, this has been reported as high as 48% in 3 years. The lead author has since abandoned the use of collagenase altogether. In this innovation article, we describe simple maneuvers to aid the planning and dissection of a Dupuytren’s fasciectomy. We describe techniques to enable efficient dissection of the cord and minimize problems when designing skin flaps. We also highlight technical points in revision cases.
Microsurgery Training in Plastic Surgery
Authors: Kania Kasia , Chang Daniel K. , Abu-Ghname Amjed , Reece Edward M. , Chu Carrie K. , Maricevich Marco , Buchanan Edward P. , Winocour Sebastian 
Published: January 2021

Summary:Advances in surgical instruments, magnification technology, perforator dissection techniques, and vascular imaging over the past decades have facilitated exponential growth in the field of microsurgery. With wide application potential including but not limited to limb salvage, breast reconstruction, lymphedema treatment, and sex affirmation surgery, microsurgery represents a critical skill set that powerfully augments the reconstructive armamentarium of plastic surgeons. Accordingly, microsurgical training is now a critical component of the plastic surgery residency education curriculum. Trainees must meet minimum microsurgery case requirements in addition to the core competencies outlined by the Accreditation Council for Graduate Medical Education. Through the use of simulation models, residency programs increasingly incorporate early skills development and assessment in microsurgery in the laboratory. Beyond residency, microsurgery fellowships offer additional exposure and refinement by offering volume, complexity, autonomy, and possible focused specialization. With continued refinement in technology and advances in knowledge, new types of simulation training models will continue to be developed and incorporated into microsurgery training curricula.