bluuebunny/crossref_metadata_2025_split huggingface dataset:
Minimally invasive gynecologic surgery in the pregnant patient: considerations, techniques, and postoperative management per trimester
Authors: Dizon Arthur M. , Carey Erin T. 
Published: June 2018

Purpose of review
Nonobstetric surgery is performed in 1 : 200 to 1 : 500 of pregnant women in the United States annually. Previously, many argued that laparoscopy was contraindicated during pregnancy because of concerns for uterine injury and fetal malperfusion. Because surgeons have gained more experience with laparoscopy, it has become the preferred treatment modality for many surgical diseases in the gravid patient.

Recent findings
Specific preoperative considerations, intraoperative techniques, and postoperative management per trimester will be reviewed to optimize patient and surgical outcomes.

Summary
The advantages of laparoscopic surgery are similar for pregnant and nonpregnant women. Surgery during pregnancy should minimize risks to both the fetus and the mother. Whenever a pregnant woman undergoes nonobstetric surgery, consultations among her surgical team are important to coordinate management. Both anatomic and physiologic changes related to pregnancy may require modifications in management. Surgeons must be aware of considerations, techniques, and postoperative management used for pregnant patients to optimize outcomes for both the fetus and mother.
Preoperative evaluation for gynecologic surgery: a guide to judicious, evidence-based testing
Authors: Shields Jessica , Lupo Andrew , Walsh Teresa , Kho Kimberly 
Published: June 2018

Purpose of review
Preoperative testing is a routine component of surgical planning, however, the majority of literature agree that laboratory and diagnostic studies are over utilized. We aim to summarize the available literature and provide gynecologists performing elective surgery for benign indications guidance to determine when, in whom, and in what time frame preoperative studies should be collected.

Recent findings
Current literature supports previous publications indicating routine laboratory and diagnostic testing for elective surgery is unnecessary and continues to be excessive. The frequency of abnormal results is high, whereas the impact on surgical planning and outcomes is negligible.

Summary
The preoperative evaluation including thorough history and physical examination should be the cornerstones for eliciting underlying disease, which may alter a surgical strategy. Devising a protocol to direct preoperative testing has been shown to decrease unnecessary tests without compromising prediction of perioperative morbidity/mortality or case cancellation and changes. Avoidance of ‘routine preoperative testing’ and instead, thoughtful risk stratification of individual patients, should be a goal of providing value-based care.
The Utility of a Master of Business Administration Degree in Plastic Surgery: Determining Motivations and Outcomes of a Formal Business Education Among Plastic Surgeons
Authors: Lee Cody S. , Ooi Adrian S. H. , Zenn Michael R. , Song David H. 
Published: June 2018

Background:
With the increasing complexity of health care, the knowledge of business in medicine is growing more valuable. Plastic surgeons in all practice settings are constantly forced to navigate endeavors that could be better faced with the leadership, management, and administrative skills honed through a formal business education. The purpose of this study was to gather data and draw conclusions related to the motivations and outcomes of plastic surgeons with a Master of Business Administration degree (MBA).

Methods:
An online survey was distributed to plastic surgeons in the United States who have earned an MBA. The survey was divided into 4 main sections: demographics, MBA program description, objective assessment, and subjective assessment.

Results:
The majority of plastic surgeons with an MBA are in practice at an academic medical center. The 2 most popular tracks of completing the degree are during medical school and after 5 years of practice. A large proportion of plastic surgeons with an MBA experienced changes in their existing career position, namely in patient care and business roles outside of clinical practice. The most important skills surgeons subjectively felt they had improved as a result of their business education were in the areas of leadership, management, and administration.

Conclusions:
Overall, all the plastic surgeons felt that their MBA experience met their expectations and would recommend the degree to fellow physicians. Prime motivations included adding a new dynamic to their existing career, satisfying entrepreneurial drive, and gaining credibility in business, with monetary gains being low on the list.
Isotopic Split-skin Graft for Resurfacing of Deliberate Self-harm Scars
Authors: Goutos Ioannis , Ogawa Rei 
Published: June 2018

Summary:
We present a novel surgical approach for the revision of deliberate self-harm scars. The isotopic skin graft technique employs the harvest of a thin split-skin graft from the affected area, excision and closure of wide dermal scars with replacement of the graft back onto the harvest site. We present the sequential steps of the surgical technique and a case series of 2 patients treated with our novel approach.
Institutional Collaboration in Plastic Surgery Research: A Solution to Resource Limitations
Authors: Chi David , Curiel Daniel , Bucknor Alexandra , Peymani Abbas , Chattha Anmol , Chen Austin D. , Bletsis Patrick , Kamali Parisa , Lin Samuel 
Published: June 2018

Background:
The current climate of health care reform and research funding restrictions presents new challenges for academic plastic surgery. Collaboration with private enterprise has been associated with greater research productivity in the general biomedical literature. This study seeks to analyze publication trends in Plastic and Reconstructive Surgery (PRS) to evaluate any changes in institutional collaboration over time.

Methods:
Bibliographic data were retrospectively analyzed for all original research and discussion articles published in PRS from 2012 to 2016. The institutional affiliation for each publication was characterized from its author list as solely academic, private, government, or combinations of these (defined here as “institutional collaborations”). Annual National Institutes of Health (NIH) funding data were also collected over the same period, and associations were analyzed by linear regression.

Results:
In total, 2,595 publications were retrieved from PRS between 2012 and 2016, of which 2,027 (78.1%) originated solely from academic institutions and 411 (15.8%) from institutional collaborations. Although the proportion of academic-only publications decreased from 82% to 74%, the proportion of institutional collaborations increased from 10% to 20% (P = 0.038). Concurrently, NIH funding declined from $33.4 billion to a low of $30.7 billion, which was associated with the decreasing proportion of academic-only publications (P = 0.025) and increasing proportion of institutional collaborations (P = 0.0053).

Conclusions:
Traditional sources of academic research funding have been restricted during the politically and financially tumultuous recent years. With no signs of improving access to financial resources from the NIH, academic plastic surgeons may consider diversifying their institutional partnerships to continue pioneering advances in the field.
Characterization of Ivoclar Vivadent Dental Restoration Material for 137Cs Retrospective Radiation Dosimetry
Authors: Ratliff Steven T. , Barry Kawsu 
Published: June 2018

Abstract
Retrospective dosimetry is the method of using materials on or near a person who is exposed to ionizing radiation to determine the amount of radiation received by the person. A possible candidate material for retrospective dosimetry is Ivoclar Vivadent IPS e.max® CAD ceramic dental restoration material, which exhibits radiation-induced thermoluminescence when exposed to gamma- and x-ray radiation from a 137Cs source. The purpose of this paper is to characterize the material and study the behavior of the thermoluminescence signal with radiation dose and with delay time between radiation exposure and thermoluminescence measurement. The first glow peak is well-modeled by a first-order glow curve deconvolution formula. The height of the first glow peak is approximately linear with dose. The fading of the signal with time is approximately described by a power law curve with cutoff. The material appears to be suitable for retrospective radiation dosimetry.
Review of Cases of Occult Radiation Exposure and an Analysis of Time to Diagnosis
Authors: Kunkler Jillian , Adams Grace G. , Manger Morgan , Casagrande Rocco 
Published: June 2018

Abstract
Radiation sickness is challenging to diagnose, and the diagnosis is often based on nonclinical data. In accidents where patients are not aware of their exposure to radiation (so-called “occult exposures”), a correct diagnosis can take weeks or months. The purpose of this study is to review the time to diagnosis of radiation sickness for occult exposures where neither the physician nor the patients are aware of their exposure. We reviewed eight case reports involving occult exposures and examined the factors that contributed to a diagnosis. We found that an average of 23 d after exposure were required for diagnosis, regardless of route of intake. In only one case was radiation injury diagnosed within the first week. Although all but one of these cases occurred in the developing world, the factors confounding diagnosis are common to the U.S. medical system. Therefore, an urgent need exists for properly training physicians on radiation sickness so they can more quickly diagnose and treat radiation exposures when the patients are unaware of the exposure event.
Case Study of the Minimum Provable Risk Considering the Variation in Background Risk: Effect of Residual Risk on Epidemiological Studies and a Comparative Assessment of Fatal Disease Risk Due to Radiation Exposure
Authors: Sasaki Michiya , Ogino Haruyuki , Hattori Takatoshi 
Published: June 2018

Abstract
In order to prove a small increment in a risk of concern in an epidemiological study, a large sample of a population is generally required. Since the background risk of an end point of interest, such as cancer mortality, is affected by various factors, such as lifestyle (diet, smoking, etc.), adjustment for such factors is necessary. However, it is impossible to inclusively and completely adjust for such factors; therefore, uncertainty in the background risk remains for control and exposed populations, indicating that there is a minimum limit to the lower bound for the provable risk regardless of the sample size. In this case study, we developed and discussed the minimum provable risk considering the uncertainty in background risk for hypothetical populations by referring to recent Japanese statistical information to grasp the extent of the minimum provable risk. Risk of fatal diseases due to radiation exposure, which has recently been the focus of radiological protection, was also examined by comparative assessment of the minimum provable risk for cancer and circulatory diseases. It was estimated that the minimum provable risk for circulatory disease mortality was much greater than that for cancer mortality, approximately five to seven times larger; circulatory disease mortality is more difficult to prove as a radiation risk than cancer mortality under the conditions used in this case study.
Characteristics of Children With Invasive Pneumococcal Disease After the Introduction of the 13-valent Pneumococcal Conjugate Vaccine in England and Wales, 2010–2016
Authors: Makwana Ashley , Sheppard Carmen , Borrow Ray , Fry Norman , Andrews Nick J. , Ladhani Shamez N. 
Published: June 2018

Background:
In England and Wales, replacement of childhood 7-valent pneumococcal conjugate vaccine (PCV7) with a 13-valent vaccine (PCV13) in 2010 was associated with a significant reduction in PCV13-serotype invasive pneumococcal disease (IPD), with a small increase in IPD due to non-vaccine serotypes. Here, we describe the clinical presentation, comorbidity prevalence, serotype distribution and outcomes of childhood IPD during the first 6 years after PCV13 introduction.

Methods:
Public Health England conducts enhanced IPD surveillance in England and Wales, with detailed information requested from general practitioners for all cases in children <5 years of age. Invasive isolates are routinely serotyped at the Public Health England reference laboratory.

Results:
From April 2010 to March 2016, 1280 IPD episodes were confirmed in 1255 children 3–59 months of age; 84.3% (1059/1255) isolates were serotyped. Clinical presentation with meningitis was most prevalent in 3- to 11-month olds (45.8%, 209/456) and lower respiratory tract infection in 24- to 59-month olds (46.7%, 133/285). Overall, 259 (20.6%) children had 292 comorbidities, particularly immunosuppression (31.6%, 92/292). Twenty-one children (1.8%) had recurrent IPD. The case fatality rate was 5.1% (64/1255; 95% confidence interval [CI]: 3.9%–6.5%) and independently associated with meningitis (aOR 3.53; 95% CI: 1.62–7.70) and presence of comorbidity (aOR, 2.41; 95% CI: 1.25–4.64). In 2015/2016, PCV13 serotypes were responsible for 10.8% (25/232) of serotyped cases; the most prevalent non-PCV13 serotypes were 12F (18%), 10A (12%), 23B (10%), 33F (10%), 15B/C (10%) and 8 (8%).

Conclusions:
Most childhood IPD cases are now due to non-PCV13 serotypes. A higher proportion of children with IPD have underlying comorbidity, but, reassuringly, the risk of recurrent IPD or death remains low.
Nurse Practitioner Triage of the Neurosurgical Patient: A Patient-Centered Care Delivery Model
Authors: Miniard Jody L. , Ballman Kathleen 
Published: June 2018

ABSTRACT

Background: Nurse practitioners (NPs) are helping to bridge the gap not only in primary care but also in specialty practice. In an outpatient, neurosurgical spinal clinic in the midwest, patient volume exceeded provider availability, and to rectify this problem, a proposal for an NP triage system and an NP-led spinal clinic was presented. Purpose: The aim of this project was to use NPs to facilitate patient triage in an outpatient neurosurgical practice to expedite patients’ access to care and ultimately improve patient satisfaction, outcomes, and healthcare expenditure. Methods: A prospective comparison study was conducted in which NP patient triaging involved surgeons and NPs simultaneously reviewing patient cases over a 1-month period, with a total number of reviews equaling 100 reviews per NP, for a grand total of 200 test reviews. Data were analyzed for a comparison of NP and surgeon input, in reference to patient diagnosis and appropriate NP referral for surgical consultation. Institutional review board approval was sought and granted. Results: Nurse practitioner and surgeon diagnoses were congruent 100% of the time. Patients triaged were correctly referred to the clinic for surgical consultation, with a sensitivity of 95.7% (95% confidence interval, 90.8%–98.4%) and a specificity of 73.8% (95% confidence interval, 60.9%–84.2%). Discussion: Utilization of NPs to facilitate triage and treatment of the outpatient neurosurgical spine patient is a sustainable patient-centered care delivery model that leads to improvements in access and ensures exceptional quality outcomes.
The Current Limitations and Future Direction of Instrument Design for Totally Endoscopic Ear Surgery: a Needs Analysis Survey
Authors: Swarup Arushri , le Nobel Gavin J. , Andrysek Jan , James Adrian L. 
Published: June 2018

Objective:
This study aimed to identify limitations and challenges associated with existing instruments and techniques used in totally endoscopic ear surgery (TEES).

Background:
Otologic instruments, traditionally developed for two-handed surgery with operating microscopes, are not necessarily optimized for the TEES environment. Better understanding of technical challenges and the limitations of current instrumentation may allow advances in instrument design for TEES surgery.

Methods:
This cross-sectional study employed a mixed-methods nine-question survey that was distributed internationally to surgeons with an interest in TEES. Respondents were asked to classify their TEES experience and instrumentation used, rate their need for better instrumentation to address six TEES-related challenges using visual analog scales, and comment on how to modify or develop new instrumentation.

Results:
With 51 respondents, we quantified a need for better instruments to address the following 6 potential TEES challenges ordered from greatest to least need: 1) reaching structures visualized by the endoscope, 2) dissection and removal of cholesteatoma, 3) cutting and/or removing bone, 4) bleeding control, 5) keeping the endoscope lens clean, 6) moving and positioning a graft into the intended place. The majority of surgeons perceive a need for improved instrumentation to address each challenge. Challenges 1) and 2) were associated with significantly greater need than the others (p < 0.05, Wilcoxon method for nonparametric pairwise comparisons).

Conclusion:
In addition to highlighting and quantifying some of the common TEES challenges, these findings provide valuable insight into the design requirements for developing improved surgical instrumentation and techniques.
Prevalence of Obstructive Sleep Apnea (OSA) in Spontaneous Cerebrospinal Fluid (CSF) Leaks: A Prospective Cohort Study
Authors: Rabbani Cyrus C. , Saltagi Mohamad Z. , Manchanda Shalini K. , Yates Charles W. , Nelson Rick F. 
Published: June 2018

Objective:
To determine the prevalence of obstructive sleep apnea (OSA) in a prospective cohort of patients with spontaneous CSF (sCSF) leaks of the temporal bone.

Study Design:
Prospective cohort study.

Setting:
Tertiary referral center.

Patients:
Consecutive sCSF leak patients (21) over a 3-year period. Four patients presented with a history of OSA and 17 patients were prospectively offered polysomnogram (PSG) testing during the initial clinic encounter.

Intervention:
Level I PSG. Main Outcome Measures: Patient characteristics (age, sex, body mass index), apnea hypopnea index (AHI), presence of snoring, and presence of hypoxia (oxygen saturation <88% for >5 min). OSA was defined as mild (AHI ≥5 and <15/h), moderate (AHI ≥15 and <30/h), and severe (AHI ≥30/h).

Results:
The prevalence of OSA in sCSF leak patients is 83.3%. PSG studies were performed on 18 of the 21 patients. There were 15 women and 6 men with an average age (standard deviation) of 56.3 (11.2) years and an average body mass index of 35.3 (7.7) kg/m2. Objectively, the AHI ranged from mild to severe (range = 5.7–92, median = 19.8). Snoring was present in 61% of patients and hypoxia was present in 39% of patients. sCSF leak patients with OSA were significantly older than sCSF leak patients without OSA (56.7 [8.3] versus 42.7 [14.5] yr, p = 0.03).

Conclusions:
OSA is highly prevalent among patients with sCSF leaks. All patients with sCSF leaks should undergo formal PSG testing. Future studies are needed to determine the role of OSA in the development of sCSF leaks.
Lateral Semicircular Canal Pressures During Cochlear Implant Electrode Insertion: a Possible Mechanism for Postoperative Vestibular Loss
Authors: Banakis Hartl Renee M. , Greene Nathaniel T. , Jenkins Herman A. , Cass Stephen P. , Tollin Daniel J. 
Published: June 2018

Hypothesis:
Insertion of cochlear implant electrodes generates transient pressure spikes within the vestibular labyrinth equivalent to high-intensity acoustic stimuli.

Background:
Though cochlear implant (CI) surgery is regarded as having low risk of impacting the vestibular system, several studies have documented changes in vestibular function after implantation. The mechanism of these changes is not understood. We have previously established that large, potentially damaging pressure transients can be generated in the cochlea during electrode insertion, but whether pressure transients occur within the vestibular labyrinth has yet to be determined. Here, we quantify the exposure of the vestibular system to potentially damaging pressure transients during CI surgery.

Methods:
Five human cadaveric heads were prepared with an extended facial recess and implanted sequentially with eight different CI electrode styles via a round window approach. Fiber-optic sensors measured intralabyrinthine pressures in scala vestibuli, scala tympani, and the lateral semicircular canal during insertions.

Results:
Electrode insertion produced a range of high-intensity pressure spikes simultaneously in the cochlea and lateral semicircular canal with all electrodes tested. Pressure transients recorded were found to be significantly higher in the vestibular labyrinth than the cochlea and occurred at peak levels known to cause acoustic trauma.

Conclusion:
Insertion of CI electrodes can produce transients in intralabyrinthine fluid pressure levels equivalent to high-intensity, impulsive acoustic stimuli. Results from this investigation affirm the importance of atraumatic surgical techniques and suggest that in addition to the cochlea, the vestibular system is potentially exposed to damaging fluid pressure waves during cochlear implantation.
Does a “Fundal Fluid Cap” Predict Successful Hearing Preservation in Vestibular Schwannoma Resections Via the Middle Cranial Fossa Approach?
Authors: Sun Daniel Q. , Kung Raymond W. , Hansen Marlan R. , Gantz Bruce J. 
Published: June 2018

Objective:
To determine the association between radiographic cerebrospinal fluid (CSF) cap in the lateral internal auditory canal (IAC) and likelihood of successful hearing preservation in middle cranial fossa (MCF) vestibular schwannoma (VS) surgery.

Study Design:
Retrospective chart review.

Setting:
Academic tertiary referral center.

Patients:
One hundred thirty-eight consecutive patients (mean age/standard deviation, SD, 50/11 yr) who underwent MCF VS resection.

Interventions:
MCF VS excision.

Main Outcome Measures:
Size of fundal fluid cap on preoperative magnetic resonance imaging (MRI), pre- and postoperative pure-tone average (PTA), and word recognition score (WRS).

Results:
Mean tumor and fundal fluid sizes were 9.7 mm (SD, 3.9 mm) and 2.8 mm (SD, 1.7 mm), respectively. On bivariate analysis, fundal fluid size was associated with larger tumor size (p = 0.005) but not changes in postoperative PTA (p = 0.45) or WRS (p = 0.17). When fundal fluid size was stratified as none (<1 mm), small (≥1 mm and <4 mm), and large (≥4 mm), no significant differences were seen in rates of hearing preservation. Using multivariate linear regression models adjusting for patient age, sex, tumor nerve of origin, neurofibromatosis type II status, and preoperative PTA and WRS, superior vestibular nerve tumor origin but not increasing fundal fluid size was associated with preserved postoperative PTA or WRS.

Conclusions:
Presence or size of CSF fluid cap may not be a reliable prognostic indicator for hearing preservation in MCF VS resection, with important implications for patient counseling.