bluuebunny/crossref_metadata_2025_split huggingface dataset:
Secondary Abdominoplasty: Management of the Umbilicus after Prior Stalk Transection
Authors: Dean Riley A. , Dean John A. , Matarasso Alan 
Published: March 2019

Summary:
Patients with prior umbilical stalk detachment, secondary to limited abdominoplasty or prior umbilical hernia repair, may in the future be candidates for full abdominoplasty. In these patients, a circumferential incision around the umbilicus detaches the remaining cutaneous blood supply, prompting concern for umbilical viability. Minimal literature exists to guide clinical decision-making for these patients. Inquiries were made to Louisiana Society of Plastic Surgery members and the Plastic Surgery Education Network online forum of the American Society of Plastic Surgeons. Metrics obtained included patient age, sex, nature of primary surgery, time between umbilical stalk detachment and secondary full abdominoplasty, complications, and whether rectus plication was performed at the time of secondary surgery. Eleven physicians provided complete documentation for 18 cases. All patients healed without evidence of umbilical ischemia or necrosis. Average patient age was 40.6 years. Average interval between procedures was 3.6 years. Sixty-seven percent of patients had the umbilicus delayed before the secondary procedure, with the median delay time being 18 days. Rectus fascia was plicated during secondary surgery in 72 percent of patients. This is the first reported series of patients undergoing full abdominoplasty after prior umbilical stalk detachment. It is also the first time the Plastic Surgery Education Network online forum has been used to collect research data, highlighting its potential as a valuable research tool. The data set was obtained from a wide range of practices, which allows for consideration of various technical solutions when this or other diverse clinical scenarios are encountered.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, V.
Foundation-Based Cleft Care in Developing Countries
Authors: Kantar Rami S. , Cammarata Michael J. , Rifkin William J. , Diaz-Siso J. Rodrigo , Hamdan Usama S. , Flores Roberto L. 
Published: March 2019

Background:
Cleft deformities of the lip and palate affect nearly one in 500 to 700 births, and lead to increased morbidity and mortality if untreated. Nevertheless, significant global disparities in access to timely and appropriate care still exist. The relatively basic infrastructure required to surgically correct these deformities and large unmet disease burden have resulted in a significant number of foundation-based cleft care initiatives focused on developing countries. In this study, the authors evaluate the peer-reviewed literature generated by these foundations in an attempt to assess their clinical, scientific, educational, and economic impact.

Methods:
A comprehensive review of the literature was performed using key search terms, and the level of evidence of identified articles was determined. Data were then analyzed to determine the different models of foundation-based cleft care in developing countries, and their clinical, scientific, educational, and economic impact.

Results:
A total of 244 articles were identified through the authors’ search and reviewed. Foundation-based cleft care initiatives in developing countries have significantly contributed to a better understanding of disease epidemiology, barriers to care, safety considerations, complications and outcomes, and international and local cleft surgery education. The cleft care center model is more cost-effective than the surgical mission model and provides more sustainable care.

Conclusions:
Foundation-based cleft care prevents significant morbidity in developing countries and has provided valuable resources for capacity building. The surgical mission model should be considered as a transitory conduit for establishing the more effective and sustainable cleft care center model of care.
Rheologic and Physicochemical Properties Used to Differentiate Injectable Hyaluronic Acid Filler Products
Authors: Fagien Steven , Bertucci Vince , von Grote Erika , Mashburn Jay H. 
Published: March 2019

Background:
Injectable hyaluronic acid fillers are routinely used for correction of soft-tissue volume loss and facial rejuvenation. Product differentiation has primarily been based on the rheologic parameter known as elastic modulus (G′), although other physicochemical properties are being explored to characterize potential product performance. As clinical data regarding product performance are lacking, the practical experience of injectors provides a valuable bridge in the knowledge gap between product rheologic data and product use.

Methods:
Rheologic and physicochemical measurements (swelling factor and cohesion) were collected for 18 products. To observe the impact of G′ and hyaluronic acid concentration on swelling factor and cohesion, proportional relationships were evaluated. Contributing authors were queried regarding their G′-based selection of products when considering skin quality, degree of correction, injection depth, and anatomical location.

Results:
Relationships were observable between G′ and swelling factor and G′ and cohesion only when limited to products manufactured by the same crosslinking technology and the same concentration. No relationship between isolated hyaluronic acid concentration and swelling factor or cohesion was apparent. Although rheological parameters and the assumptions of ex vivo data translating to in vivo performance are oftentimes not completely aligned, in the clinical experience of the authors, in general, higher G′ products are better suited for thicker skin and deeper injection planes, whereas lower G′ products are better for more superficial planes, although exceptions to these trends are also made based on technical experience.

Conclusions:
While rheologic and physicochemical characteristics can vary widely between products and the methods and measurements of these parameters are often difficult to correlate, G′ represents a useful and consistent parameter for product differentiation. Understanding how to select products based on G′ is valuable knowledge for customizing injection plans and contributes to an optimal aesthetic outcome.
Dual-Anchor Cog Threads in Fat Grafting Breast Augmentation: A Novel Scarless Method for Defining Breast Footprint and Enhancing Shape
Authors: Visconti Giuseppe , Salgarello Marzia 
Published: March 2019

Background:
Modern fat grafting breast augmentation allows successful breast enhancement. However, there is no fine control of breast footprint, shape, and inframammary fold. The purpose of this article is to report a novel scarless technique and to evaluate its beneficial effect by retrospectively reviewing case-control consecutive data from 51 patients.

Methods:
Fifty-one consecutive patients undergoing cosmetic breast augmentation with fat only between September of 2012 and August of 2016 were retrospectively reviewed. In the first 29 cases (56 percent), the authors did not use threads (group A, control group), whereas in the remaining 22 cases (44 percent), the authors used dual-anchor cog threads (group B, case group). Breast shape analysis was performed separately by a blinded group of plastic surgeons and by the attending surgeon using a standardized evaluation method. The BREAST-Q was used to study patient satisfaction. The Mann-Whitney U and chi-square tests were used for categorical variables, and the independent-samples t test was used for continuous variables.

Results:
No significant difference in mean graft take was found (group A, 71.2 percent; group B, 71.6 percent; p < 0.05). Group B showed a significantly higher rating than group A for lower pole profile, inframammary fold, and lateral footprint definition. No major postoperative complications were experienced in either group. In group B, no thread-related complications were experienced.

Conclusions:
The dual-anchor thread suture is a novel, effective, simple, reliable, safe, and scarless method of improving breast shape in fat grafting breast augmentation. Larger series are needed to further confirm the authors’ findings.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.
Oral Surgeons as Cosmetic Surgeons and Their Scope of Practice
Authors: Davison Steven P. , Hancock Melyssa , Sinkiat Matt , Enchill Zenaida 
Published: March 2019

Background:
In recent years, the practice of cosmetic surgery has expanded to include oral and maxillofacial surgeons. The groundwork for this scope-of-practice expansion was laid in part by the American Dental Association’s definition change of the practice of dentistry. This change modified the scope of dentistry from the earlier “teeth and surrounding and supporting structures” to the maxillofacial area and beyond. A number of states adopted this new definition into legislation, giving practitioners the premise on which to perform cosmetic and other medical procedures on the face and potentially other parts of the body. This expansion has created legal and regulatory issues over scope and truth in advertising. The authors hypothesize that this is confused by a lack of federal guidelines and state-by-state variations in scope-of-practice laws for oral and maxillofacial surgeons.

Methods:
This article provides a brief overview of the key legal issues and their impact on legislation in some of the battleground states. The authors review the national distribution of scope of practice for oral and maxillofacial surgeons.

Results:
The most successful path to expanded scope for dentistry has been through control of certification and credentialing. This has marginalized medicine boards from contributory oversight, thus circumventing any arguments over practice parameters. The scope-of-practice dispute is further complicated by the existence of dual-degree oral and maxillofacial surgeons.

Conclusions:
With increasing demand for cosmetic surgical interventions, establishing scope-of-practice standards for single-degreed oral and maxillofacial surgeons is critically important. As physicians, the oral and maxillofacial surgery graduates of the dual M.D./D.D.S. degree programs have no such scope-of-practice restrictions. Furthermore, if plastic surgery is to effectively argue against expanded scope of practice for oral and maxillofacial surgeons, more objective data will be necessary.
Increased Incidence of Symptomatic Venous Thromboembolism following Pedicled Lower Extremity Flap Harvest for Abdominal and Perineal Reconstruction in Patients Receiving Mechanical Prophylaxis and Chemoprophylaxis: A Case for Heightened Awareness
Authors: Broyles Justin M. , Khavanin Nima , Walia Gurjot S. , Ostrander Benjamin T. , Bello Ricardo , Carl Hannah M. , Pedreira Rachel A. , Sacks Justin M. 
Published: March 2019

Background:
Postsurgical venous thromboembolism remains a leading cause of hospital morbidity. Data to support venous thromboembolism prophylaxis guidelines in lower extremity flap surgery are lacking. The purpose of this study was to explore the effect of pedicled lower extremity flap harvest on venous thromboembolism development in the setting of abdominal or perineal reconstruction.

Methods:
One hundred twenty-six patients undergoing unilateral lower extremity flap harvest for abdominal or perineal reconstruction were included. The contralateral leg served as an internal control. Sixty comorbidity-matched patients who underwent abdominal/perineal resection without flap reconstruction provided an external control. Bivariate analyses included chi-square and t tests; logistic regression adjusted for confounding variables on venous thromboembolism development.

Results:
All patients underwent flap reconstruction for an oncologic defect of the abdomen or perineum, with 80 percent undergoing perineal reconstruction. Most patients underwent anterolateral thigh (41 percent) or gracilis flap (40 percent) harvest. Eleven patients developed deep venous thromboses in one or more legs (9 percent): 10 of 11 (90.9 percent) in the donor extremity and five (45.5 percent) contralaterally (p = 0.022). Patients who underwent flap harvest had a 10-fold higher odds of venous thromboembolism formation when compared to comorbidity-matched controls without flap reconstruction (OR, 10.64; 95 percent CI, 1.11 to 102.34; p = 0.041).

Conclusions:
The rate of venous thromboembolism is higher than previously appreciated for reconstructive procedures of the abdomen and/or perineum that use pedicled lower extremity flaps—particularly in the operative extremity. Additional research can clarify the role for further prophylaxis or screening.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.
Teamwork Among Medicine House Staff During Work Rounds: Development of a Direct Observation Tool
Authors: Weingart Saul N. , Coakley Meagan , Yaghi Omar , Shayani Ariella , Sweeney Megan 
Published: March 2019

Objective
Teamwork is integral to effective health care but difficult to evaluate. Few tools have been tested outside of classroom or medical simulation settings. Accordingly, we aimed to develop and pilot test an easy-to-use direct observation instrument for measuring teamwork among medical house staff.

Methods
We performed direct observations of 18 inpatient medicine house staff teams at a teaching hospital using an instrument constructed from existing teamwork tools, expert panel review, and pilot testing. We examined differences across teams using the Kruskal-Wallis statistic. We examined interrater reliability with the κ statistic, domain scales using Cronbach α, and construct validity using correlation and multivariable regression analyses of quality and utilization metrics. Observers rated team performance before and after providing feedback to 12 of the 18 team leaders and assessed changes in team performance using paired two-tailed t tests.

Results
We found variation in team performance in the situation monitoring, mutual support, and communication domains. The instrument evidenced good interrater reliability among concurrent, independent observers (κ = 0.7, P < 0.001). It had satisfactory face validity based on expert panel review and the assessments of resident team leaders. Construct validity was supported by a positive correlation between team performance and the Hospital Consumer Assessment of Healthcare Providers and Systems physician communication score (r = 0.6, P = 0.03). Providing resident physicians with information about their teams’ performance was associated with improved mean performance in follow-up observations (3.6–3.8/4.0, P = 0.001).

Conclusions
Direct observation of teamwork behaviors by medicine house staff on ward rounds is feasible and feedback may improve performance.
Impact of Medication Reviews Delivered by Community Pharmacist to Elderly Patients on Polypharmacy: A Meta-analysis of Randomized Controlled Trials
Authors: Tasai Sudprattana , Kumpat Nattikarn , Dilokthornsakul Piyameth , Chaiyakunapruk Nathorn , Saini Bandana , Dhippayom Teerapon 
Published: March 2019

Objective
The aim of the study was to assess the impact of medication reviews delivered by community pharmacists to elderly patients on polypharmacy.

Methods
A systematic literature search was performed in four bibliographic databases/search engine (PubMed, Embase, CENTRAL, and IPA) and three gray literature sources (OpenGrey, ClinicalTrials.gov, and Digital Access to Research Theses – Europe) from inception to January 2018. Randomized controlled trials were selected if they met the following criteria: (a) studied in patients 65 years or older who were taking four or more prescribed medications; (b) the “test” interventions were delivered by community pharmacists; and (c) measured one of these following outcomes: hospitalization, emergency department (ED) visit, quality of life, or adherence. Quality of the included studies was assessed using the Cochrane Effective Practice and Organization of Care Group risk of bias tool. Random-effects model meta-analyses were performed.

Results
Of the 3634 articles screened, four studies with a total of 4633 participants were included. The intervention provided in all included studies was clinical medication review. Three studies were at low risk of bias, and the remaining study had unclear risk of bias. When compared with usual care, medication reviews provided by community pharmacist significantly reduced risk of ED visits (risk ratio = 0.68; 95% confidence interval = 0.48–0.96). There was also a tendency that pharmacist interventions decreased risk of hospitalizations (risk ratio = 0.88; 95% CI = 0.78–1.00), although no statistical significant.

Conclusions
The current evidence demonstrates that clinical medication reviews for older people with polypharmacy reduces the risk of ED visits. Medication reviews can be considered as another area where community pharmacists can contribute to improve patient safety.
Lyme neuroborreliosis
Authors: Halperin John J. 
Published: March 2019

Purpose of review
To review the recent evidence clarifying the symptomatology and diagnosis of nervous system Lyme disease.

Recent findings
Two-tier testing combining pairs of ELISAs, using C6 or VlsE assays to replace second tier Western blots, may eliminate confusion about test interpretation. Cerebrospinal fluid (CSF) can be informative in diagnosing central nervous system (CNS) Lyme disease, not peripheral nervous system (PNS) disorders. CSF CXCL13 may provide useful adjunctive information in CNS infection; its specificity remains to be defined. Lyme encephalopathy is not indicative of CNS infection. Post treatment Lyme disease symptoms do not occur in patients who have had definite CNS Lyme infection. Whether post treatment Lyme disease symptom (PTLDS) is an actual entity, or reflects anchoring bias when commonly occurring symptoms arise in patients previously treated for Lyme disease, remains to be determined. Regardless, these symptoms do not reflect CNS infection and do not respond to additional antimicrobial therapy.

Summary
Serologic testing is robust in individuals with a priori likelihood of infection of greater than 2–6 weeks duration. Western blots provide useful confirmation of screening ELISAs, but may be replaced by second ELISAs. CSF testing, including CXCL13, may be informative in CNS Lyme, not PNS, and is generally normal in Lyme encephalopathy. PTLDS does not occur following CNS infection, and may not be a distinct entity.
Herpes simplex virus encephalitis update
Authors: Stahl Jean Paul , Mailles Alexandra 
Published: March 2019

Purpose of review
HSV is the most frequently identified cause of infectious encephalitis, in Western countries. This article is an update on the topic based on a review of recent studies from 2017 to 2018.

Recent findings
Acyclovir is still the first line treatment, and no new drugs are currently available for clinical use. The major considerations for HSV encephalitis are as follows: point one, clinical evaluation remains the most important factor, as though CSF HSV PCR has a good sensitivity, in a small proportion of patients the initial testing might be negative. MRI brain is the first line imaging test, and mesial temporal lobe involvement and other typical findings are important for diagnosis; point 2, there should be emphasis on sequela, short-term, and long-term outcomes, and not just case fatality rated in future studies and clinical management. Auto-immune encephalitis can be triggered by HSV, and should be considered in patients who are not responding to treatment; point 3, future studies should be on better management of sequela, and better treatment regimens including those targeting the immune response.

Summary
Autoimmune encephalitis is a clearly identified complication of HSV encephalitis. Inflammatory mechanisms are linked to the clinical presentation as well as severity and poor outcome. Initial corticosteroid therapy has to be evaluated in order to prevent complications.
Hospital Responses to Mortality Measures: A Survey of Hospital Administrative Leaders
Authors: Soelch Luke A. , Repp Allen B. 
Published: March 2019

Background:
Standardized hospital mortality ratios (SHMRs) are widely used for quality improvement, hospital ratings, and health care payment.

Objectives:
(1) To characterize the programs implemented at hospitals in response to SHMRs.
(2) To describe hospital leaders' perceptions of SHMRs as indicators of care quality.

Methods:
Electronic survey of administrative leaders at US academic medical centers who subscribed to Vizient leadership networks.

Results:
Forty-seven administrative leaders from 37 US academic medical centers completed the survey. Respondents reported that SHMRs had the largest role in the decision to implement inpatient hospice programs, electronic early warning systems, and clinical documentation specialist programs at their institution. Respondents perceived clinical documentation specialist programs and condition-specific care pathways as the most effective programs to improve performance on SHMRs. Only 29% of respondents agreed that SHMRs accurately reflect the number of preventable deaths in hospitals, but 78% agreed that SHMRs have helped their hospital reduce preventable deaths.

Conclusions:
Hospitals have employed various strategies in response to SHMRs—including clinical programs that focus on reducing preventable deaths and other programs that target improvement in SHMR performance without reducing preventable deaths. Hospital administrative leaders identify significant benefits and flaws of SHMRs as quality indicators.
Unusual Intraventricular Tumor Mimicker; Choroid Plexus Arteriovenous Malformation
Authors: Izgi Emine , Ogul Hayri 
Published: March 2019

Abstract
Arteriovenous malformations (AVMs) are basically abnormal vessel networks consisting of one or more feeding arteries, central nidus, and dilated drainage veins. They are divided into subtypes as fistulose, mixed (fistulose-plexiform), or plexiform. Intraventricular location of AVMs is unusual. In this location, the lesion may mimic neoplastic processes. Here the authors reported uncommon case of an AVM located in the right choroid plexus presenting with intraventricular hemorrhage.
Best Buy in Public Health or Luxury Expense?
Authors: Yap Ava , Cheung Maija , Muzira Arlene , Healy James , Kakembo Nasser , Kisa Phyllis , Cunningham David , Youngson George , Sekabira John , Yaesoubi Reza , Ozgediz Doruk 
Published: March 2019

Objective:
To determine the cost-effectiveness of building and maintaining a dedicated pediatric operating room (OR) in Uganda from the societal perspective.

Background:
Despite the heavy burden of pediatric surgical disease in low-income countries, definitive treatment is limited as surgical infrastructure is inadequate to meet the need, leading to preventable morbidity and mortality in children.

Methods:
In this economic model, we used a decision tree template to compare the intervention of a dedicated pediatric OR in Uganda for a year versus the absence of a pediatric OR. Costs were included from the government, charity, and patient perspectives. OR and ward case-log informed epidemiological and patient outcomes data, and measured cost per disability adjusted life year averted and cost per life saved. The incremental cost-effectiveness ratio (ICER) was calculated between the intervention and counterfactual scenario. Costs are reported in 2015 US$ and inflated by 5.5%.

Findings:
In Uganda, the implementation of a dedicated pediatric OR has an ICER of $37.25 per disability adjusted life year averted or $3321 per life saved, compared with no existing operating room. The ICER is well below multiple cost-effectiveness thresholds including one times the country's gross domestic product per capita ($694). The ICER remained robust under 1-way and probabilistic sensitivity analyses.

Conclusion:
Our model ICER suggests that the construction and maintenance of a dedicated pediatric operating room in sub-Saharan Africa is very-cost effective if hospital space and personnel pre-exist to staff the facility. This supports infrastructure implementation for surgery in sub-Saharan Africa as a worthwhile investment.