bluuebunny/crossref_metadata_2025_split huggingface dataset:
Analysis of Olfaction after Bilateral Nasoseptal Rescue Flap Transsphenoidal Approach with Olfactory Mucosal Preservation
Authors: Griffiths Chester F. , Barkhoudarian Garni , Cutler Aaron , Duong Huy T. , Karimi Kian , Doyle Olivia , Carrau Ricardo , Kelly Daniel F. 
Published: July 2019

ObjectiveTo ascertain the impact of septal olfactory strip preservation and bilateral rescue flap elevation on the incidence of olfactory dysfunction.Study DesignCase series with chart review of patients undergoing endoscopic endonasal skull base surgery (2012‐2014).SettingProvidence Saint John’s Health Center and John Wayne Cancer Institute.Subjects and MethodsThe incidences of postoperative epistaxis, hyposmia, and anosmia were analyzed using the Brief Smell Identification Test (B‐SIT), which was completed in 110 of the 165 patients.ResultsSeventy‐eight patients required extended approaches. Bilateral nasoseptal rescue flaps were elevated in 144 patients (87.3%) and pedicled nasoseptal or middle turbinate flaps in 21 patients (12.7%). The neurovascular pedicles were preserved in all patients, and there were no episodes of postoperative arterial epistaxis. Normal olfaction was noted in 95 patients (86%), with new hyposmia noted in 5 patients (5.5%). Within the rescue flap cohort, new hyposmia occurred in 6.3% (P <. 01) of patients, balanced by improvement of olfaction in 43% of patients with preoperative dysfunction (overall pre‐ and postoperative olfactory function: 85% vs 86%). Patients with pedicled nasoseptal flaps did not have new hyposmia, with a net improvement of olfaction (71% vs 86%, P =. 07). No patients experienced new anosmia. There was no difference between flap type within either subgroup.ConclusionsSuperior olfactory strip preservation during elevation of reconstructive flaps preserves olfactory function and maintains adequate surgical exposure. In addition, rescue flaps have significantly diminished the rate of arterial postoperative epistaxis while maintaining the ability to harvest nasoseptal flaps for future reconstruction.
Image‐Guided Mastoidectomy with a Cooperatively Controlled ENT Microsurgery Robot
Authors: Razavi Christopher R. , Wilkening Paul R. , Yin Rui , Barber Samuel R. , Taylor Russell H. , Carey John P. , Creighton Francis X. 
Published: July 2019

Mastoidectomy is a common surgical procedure within otology. Despite being inherently well suited for implementation of robotic assistance, there are no commercially available robotic systems that have demonstrated utility in aiding with this procedure. This article describes a robotic technique for image‐guided mastoidectomy with an experimental cooperatively controlled robotic system developed for use within otolaryngology–head and neck surgery. It has the ability to facilitate enhanced operative precision with dampening of tremor in simulated surgical tasks. Its kinematic design is such that the location of the attached surgical instrument is known with a high degree of fidelity at all times. This facilitates image registration and subsequent definition of virtual fixtures, which demarcate surgical workspace boundaries and prevent motion into undesired areas. In this preliminary feasibility study, we demonstrate the clinical utility of this system to facilitate performance of a cortical mastoidectomy by a novice surgeon in 5 identical temporal bone models with a mean time of 221 ± 35 seconds.
A Standardized Care Pathway following Mandibular Distraction in Infants Less Than 3 Months of Age
Authors: Leu Grace R. , Scott Andrew R. 
Published: July 2019

ObjectivesTo assess for differences in postoperative care following mandibular distraction osteogenesis (MDO) in infants before and after implementation of a standardized protocol.Study DesignRetrospective chart review.SettingUrban tertiary pediatric hospital.Subjects and MethodsThe inpatient charts of infants who underwent MDO before 90 days of age were assessed for metrics such as postoperative length of stay (LOS), duration of mechanical ventilation, and the choice and duration of sedating medications.ResultsOver a 6‐year period, 16 patients met inclusion criteria. The first 4 consecutive patients were managed at the discretion of the critical care staff. The remaining 12 infants were managed with a planned 4‐ to 6‐day period of postoperative intubation, during which a standard protocol determined the choice, dosage, and duration of sedating medications. The mean age was similar between groups (preprotocol: mean, 26.5 days; protocol: mean, 20.3 days; P =. 51). The mean postoperative LOS was 13.3 days less among infants managed with the protocol (P =. 06), and the mean number of midazolam boluses was fewer among protocol patients (P <. 01). A more consistent postoperative LOS, duration of mechanical ventilation, and exposure to sedating medications was observed among protocol subjects (P <. 01). The LOS for 2 patients in the preprotocol group was extended due to iatrogenic withdrawal syndrome. There were no instances of accidental extubation or anoxia in either group.ConclusionsAmong infants undergoing MDO, standardizing postoperative airway and sedation practices may offer a more predictable postoperative course as compared with a case‐by‐case management philosophy.
Does Attending Surgeon Presence at the Preinduction Briefing Improve Operating Room Efficiency?
Authors: Saxena Rajeev C. , Whipple Mark E. , Neradilek Moni B. , Solomon Stuart , Fong Christine T. , Nair Bala G. , Lang John D. 
Published: July 2019

ObjectiveTo examine if attending surgeon presence at the preinduction briefing is associated with a shorter time to incision.Study DesignRetrospective cohort study and survey.SettingTertiary academic medical center.Subjects and MethodsA retrospective cohort study was conducted of 22,857 operations by 141 attending surgeons across 12 specialties between August 3, 2016, and June 21, 2018. The independent variable was attending surgeon presence at the preinduction briefing. Linear regression models compared time from room entry to incision overall, by service line, and by surgeon. We hypothesized a shorter time to incision when the attending surgeon was present and a larger effect for cases with complex surgical equipment or positioning. A survey was administered to evaluate attending surgeons’ perceptions of the briefing, with a response rate of 68% (64 of 94 attending surgeons).ResultsCases for which the attending surgeon was present at the preinduction briefing had a statistically significant yet operationally minor reduction in mean time to incision when compared with cases when the attending surgeon was absent. After covariate adjustment, the mean time to incision was associated with an efficiency gain of 1.8 ± 0.5 minutes (mean ± SD; P <. 001). There were no statistically significant differences in the subgroups of complex surgical equipment and complex positioning or in secondary analysis comparing service lines. The surgeon was the strongest confounding variable. Survey results demonstrated mild support: 55% of attending surgeons highly prioritized attending the preinduction briefing.ConclusionAttending surgeon presence at the preinduction briefing has only a minor effect on efficiency as measured by time to incision.
Incidence and Significance of Hypermetabolic PET‐CT Findings in Unilateral TVF Motion Impairment
Authors: Stanisce Luke , Renzi Timothy , Paripati Nikita , Ahmad Nadir , Spalla Thomas C. , Roth Howard L. , Koshkareva Yekaterina 
Published: July 2019

ObjectiveTo determine the incidence and significance of asymmetric hypermetabolic laryngeal findings on positron emission tomography–computed tomography (PET‐CT) in patients with unilateral true vocal fold (TVF) motion abnormalities.Study DesignRetrospective cohort.SettingSingle‐center tertiary care institution.Subjects and MethodsThe medical records of patients with unilateral TVF motion abnormalities were reviewed. The incidence of normal and asymmetric hypermetabolic laryngeal findings was calculated in patients who underwent PET‐CT and laryngeal examination, operative laryngoscopy with biopsy, or injection medialization laryngoplasty.ResultsA total of 135 patients with unilateral TVF motion abnormalities underwent PET‐CT. After exclusion of patients who completed new or surveillance imaging for a laryngeal neoplasm (n = 27), asymmetric hypermetabolic findings in the larynx were noted in 21 (19%) cases: 13 (12%) on the contralateral side of the impaired TVF, 8 (7%) on the ipsilateral side. Two (25%) patients with ipsilateral hypermetabolism had concerning subsequent fiberoptic laryngeal examinations prompting operative biopsy. There was no evidence of inflammatory or neoplastic disease in all patients with contralateral hypermetabolic findings. Fifteen patients completed PET‐CT scans after injection medialization procedures; 6 (40%) displayed avidity ipsilateral to the side of the injection. The median time from injection to scan was 27 days, as opposed to 193 days in the unremarkable scans (P =. 011).ConclusionContralateral hypermetabolism in patients with unilateral TVF motion abnormalities may represent a false‐positive finding. Ipsilateral hypermetabolic uptake without recent fold instrumentation warrants prompt diagnostic evaluation.
Preoperative detection of colorectal liver metastases: DWI alone or combined with MDCT is no substitute for Gd-EOB-DTPA-enhanced MRI
Authors: Schulz Anselm , Joelsen-Hatlehol Eivind Selstø , Brudvik Kristoffer Watten , Aasand Kjersti Karoline , Hanekamp Bettina , Viktil Ellen , Johansen Cathrine K , Dormagen Johann Baptist 
Published: July 2019

Background Magnetic resonance imaging (MRI) with hepatocyte specific contrast has the highest sensitivity for colorectal liver metastases but comes at high costs and long examination times. Purpose To evaluate if preoperative detection of colorectal liver metastases with less resource-consuming diffusion-weighted imaging (DWI) alone or in combination with multidetector computed tomography (MDCT) can compete with gadolinium-etoxybenzyl-diethylenetriaminepentaacetic acid (Gd-EOB-DTPA)-enhanced MRI. Material and Methods Forty-four patients with 123 colorectal liver metastases received MDCT and Gd-EOB-DTPA-enhanced MRI including DWI before liver resection for colorectal liver metastases. Five image sets were evaluated by two radiologists. The DWI set consisted of DWI, ADC map, coronal, axial T2-weighted single-shot sequences. The DWI-T2F set contained additionally respiratory-triggered T2-weighted TSE-SPIR sequences. The MDCT set consisted of four-phase MDCT, the MDCT-DWI set also contained DWI. The CE-MRI set contained all MRI sequences including Gd-EOB-DTPA. Reference standards was histopathology and follow-up. Results CE-MRI set had highest sensitivity ( P ≤ 0.013) with 95% compared to 72%, 73%, 73%, and 87% the for DWI set, DWI-T2W-FS set, MDCT set, and MDCT-DWI set, respectively. The CE-MRI set had the highest sensitivity ( P≤0.012) for colorectal liver metastases <10 mm with 87% compared to 55%, 52%, 23%, and 58% for the DWI set, DWI-T2W-FS set, MDCT set, and MDCT-DWI set, respectively. The MDCT-DWI set improved sensitivity overall and in size-dependent subgroup analyses compared to the MDCT set ( P ≤ 0.031). The MDCT-DWI set showed the highest specificity of 98% followed by 98%, 98%, 95%, and 88% for the DWI set, DWI-T2W-FS set, MDCT set, and CE-MRI set, respectively. Conclusion The less resource and time-consuming DWI sets are inferior to Gd-EOB-DTPA-enhanced MRI for the detection of colorectal liver metastases. Gd-EOB-DTPA-enhanced MRI with its excellent sensitivity should be the preferred preoperative modality when meticulous lesion identification is essential. Combination of DWI with MDCT improved significantly sensitivity compared to each modality alone.
Surgeon Ability to Appropriately Address the Calcified Cartilage Layer: An In Vitro Study of Arthroscopic and Open Techniques
Authors: Yanke Adam B. , Lee Andrew S. , Karas Vasili , Abrams Geoffrey , Riccio Mark L. , Verma Nikhil N. , Bach Bernard R. , Cole Brian J. 
Published: July 2019

Background: Microfracture is a commonly utilized cartilage restoration technique for articular cartilage defects. While the removal of the calcified cartilage layer (CCL) has been shown to be critical with in vivo models, little is known with regard to surgeon reliability to adequately perform the technique. Purpose: To evaluate surgeon reliability in removing the CCL utilizing open and arthroscopic techniques. Study Design: Controlled laboratory study. Methods: Eleven cadaveric knees were utilized to create four 12-mm diameter defects in the anterior and posterior medial femoral condyles. Eleven fellowship-trained surgeons were asked to perform the following procedures: remove the CCL open, retain the CCL open, remove the CCL arthroscopically, and retain the CCL arthroscopically. Samples underwent histologic staining and analysis with 3-dimensional micro–computed tomography. The latter was used to calculate the percentage of the CCL that was removed or retained across the entire defect. Results: When surgeons were asked to retain the CCL arthroscopically, 48% ± 41% (mean ± SD) remained. When surgeons were asked to remove the CCL arthroscopically, 24% ± 35% remained. There was no statistical difference between these groups ( P > .05). When the CCL was retained during open preparation, 60% ± 39% remained. During attempts to remove the CCL in an open manner, 19% ± 28% remained. There was a significant difference in the amount of CCL remaining between the open removal and open retaining groups ( P = .03). There were no significant differences in the percentage of CCL remaining between the open and arthroscopic preservation groups and between the open and arthroscopic removal groups. Conclusion/Clinical Relevance: This study highlights the significant variability in surgeon ability to reliably retain or remove the CCL. However, there appears to be improved ability of surgeons to more reliably remove or retain the CCL in an open fashion as compared with the arthroscopic approach.
Association Between a Rule Change to Reduce Home Plate Collisions and Mild Traumatic Brain Injury and Other Injuries in Professional Baseball Players
Authors: Green Gary , D’Angelo John , Coyles Jon , Penny Ian , Golfinos John G. , Valadka Alex 
Published: July 2019

Background: Improved player safety is an important goal of professional baseball. Prevention of mild traumatic brain injury (concussion) is an area of emphasis because of the potential for long-term as well as short-term sequelae. Hypothesis: A rule change can lower the incidence of concussions and other injuries in professional baseball. Study Design: Cohort study; Level of evidence, 3. Methods: This study included a retrospective review of data entered concurrently into professional baseball’s electronic medical record system. All minor and major league teams are required to use this system. All injuries are captured by creation of a new record in the system at the time of the injury. All active minor and major league players from 2011 to 2017 were included. The 30 major league clubs have 1200 roster players and play 162 games per season. The approximately 200 minor league clubs have about 7500 active players and play 56 to 144 games annually that combine for approximately 330,000 athlete-exposures per season. Before the 2014 season, Major League Baseball, in conjunction with its players association, instituted a rule limiting home plate collisions between base runners and catchers that applied to both Major League Baseball and Minor League Baseball. All concussions and other injuries at home plate from 2011 to 2017 were analyzed by mechanism and player position. Results: From 2011 to 2013, an annual mean of 100 injuries occurred from home plate collisions in the minor and major leagues, resulting in a mean loss of 2148 days annually. After the rule change, there was a mean 55 home plate collision injuries with 936 days lost per season ( P < .0001 for injuries and days lost). A mean 11 concussions attributed to these collisions occurred annually in the minor and major leagues before the rule change, as compared with 2.3 per year after ( P = .0029). There were no major league concussions from these collisions after the rule change. The mean annual number of days missed because of concussions at home plate dropped from 276 before 2014 to 36 per year after 2014 ( P = .0001). Conclusion: This rule change was associated with significant reductions in the numbers of concussions and other injuries caused by collisions at home plate as well as significant decreases in time lost from play.
Ethical leadership, nursing error and error reporting from the nurses’ perspective
Authors: Barkhordari-Sharifabad Maasoumeh , Mirjalili Narges-Sadat 
Published: July 2019

Background: Nursing errors endanger patient safety, and error reporting helps identify errors and system vulnerabilities. Nursing managers play a key role in preventing nursing errors by using leadership skills. One of the leadership approaches is ethical leadership. Aim: This study determined the level of ethical leadership from the nurses’ perspective and its effect on nursing error and error reporting in teaching hospitals affiliated to Shahid Sadoughi University of Medical Sciences, Yazd, Iran. Research design: This was a cross-sectional descriptive study. Participants and research context: A total of 171 nurses working in medical-surgical wards were selected through random sampling. Data collection was carried out using “ethical leadership in nursing, nursing errors and error reporting” questionnaires. Data were analyzed with SPSS20 using descriptive and analytical statistics. Ethical considerations: This study was approved by the Ethics Committee for Medical Research. Ethical considerations such as completing informed consent form, ensuring confidentiality of information, explaining research objectives, and voluntary participation were observed in the present study. Findings: The results showed that the level of nursing managers’ ethical leadership was moderate from the nurses’ point of view. The highest and the lowest levels were related to the power-sharing and task-oriented dimensions, respectively. There was a significant relationship between nursing managers’ level of ethical leadership with error rates and error reporting. Conclusion: The development of ethical leadership approach in nursing managers reduces error rate and increases error reporting. Programs designed to promote such approach in nursing managers at all levels can help reduce the level of error rate and maintain patient safety.
Is There a Correlation Between Nasolabial Appearance and Dentoalveolar Relationships in Patients With Repaired Unilateral Cleft Lip and Palate?
Authors: Lee Tara V. N. , Ireland Anthony J. , Atack Nikki E. , Deacon Scott A. , Jones Timothy E. M. , Matharu Jason , Wills Andrew , Al-Ghatam Rana , Richard Bruce M. , Ness Andy R. , Sandy Jonathan R. 
Published: July 2019

Objective: To determine whether a relationship exists between the aesthetic scores given to photographic records of the nasolabial region of patients with repaired unilateral cleft lip and palate (UCLP) and the 5-Year Olds’ Index scores of study models for the same participants. Design: Retrospective study. Setting: University of Bristol Dental Hospital, United Kingdom. Participants: Patients with nonsyndromic UCLP previously enrolled in the Cleft Care UK (CCUK) Study. Methods: The CCUK participants, who had both study models and photographs (frontal and worm’s eye view), were identified and their records retrieved. These were rated by 2 consultants and 2 senior registrars in orthodontics. The 5-Year Olds’ Index was used to score the study models, and at a separate sitting, a 5-point Likert scale was used to score the cropped frontal and worm’s eye view photographs of the same children. The results were analyzed using intraclass correlation coefficients and Cohen κ. Main Outcome Measures: Correlation between the aesthetic scores of the photographic views and the concordant 5-Year Olds’ Index scores of the study models. Results: The intraclass correlation coefficient scores showed very poor agreement between the photographic views and their concordant study models. The level of inter- and intra-rater reliability was strongest when scoring the study models. Conclusions: There was no agreement between the scores given to various photographic views and their corresponding study models. Scoring the study models using the 5-Year Olds’ Index was the most reliable outcome measure for this age-group.
An Anatomic and Clinical Study of the Innervation of the Dorsal Midfoot Capsule
Authors: Shi Glenn G. , Williams Meredith A. , Whalen Joseph L. , Wilke Benjamin K. , C. Kraus Jonathan 
Published: July 2019

Background: Dorsal pain from osteoarthritic midfoot joints is thought to be relayed by branches of the medial and lateral plantar, sural, saphenous, and deep peroneal nerves (DPN). However, there is no consensus on the actual number or pathways of the nervous branches for midfoot joint capsular innervation. This study examined the DPN’s terminal branches at the midfoot joint capsules through anatomic dissection and confirmation of their significance in a clinical case series of patients with midfoot pain relief after DPN block. Methods: Eleven cadaveric lower leg specimens, 6 left and 5 right, were dissected using operative loupe magnification. We preserved the terminal branches and recorded their paths and branching patterns. Joint capsular innervations were individually noted. To confirm our hypothesis of significant dorsal midfoot joint capsular innervation by the DPN, we also performed an institutional review board–approved retrospective chart review of 37 patients with painful dorsal midfoot osteoarthritis who underwent diagnostic local anesthetic injection block of the DPN. The percentage of temporary pain relief after the injection was recorded. Results: Terminal innervation of the DPN branches showed distribution of the second and third tarsometatarsal joints in all specimens. Inconsistent innervation of the naviculocuneiform (9/11), fourth (7/11), first (6/11), and fifth (4/11) tarsometatarsal and calcaneocuboid joints (1/11) were observed. The retrospective review of pain relief in patients with dorsal midfoot pain due to arthritis after diagnostic injection demonstrated a mean of 92.1% improvement. Conclusion: Innervation of the dorsal midfoot joint capsule appears to follow a consistent distribution across 3 joints: second and third tarsometatarsal joints and the naviculocuneiform joint. Acute relief of dorsal midfoot arthritic pain after diagnostic injection suggests that dorsal midfoot nociceptive pain is at least partly transmitted by the DPN. Level of Evidence: Level IV, case series.