bluuebunny/crossref_metadata_2025_split huggingface dataset:
Risk Factors for Compromised Surgical Resection: A Nationwide Propensity Score-Matched Study on Laparoscopic and Open Resection for Colonic Cancer
Authors: Vogelsang Rasmus P. , Klein Mads F. , Gögenur Ismail 
Published: March 2019

BACKGROUND:
High-quality surgical resection of colonic cancer, including dissection along the embryologic mesocolic plane, translates into improved long-term oncological outcomes.

OBJECTIVE:
This study aimed to identify risk factors for compromised specimen quality and to evaluate the specimen quality of patients undergoing laparoscopic and open resection for colonic cancer.

DESIGN:
This is a retrospective observational study.

SETTINGS:
This database study is based on the prospective national Danish Colorectal Cancer Database including patients undergoing intended curative elective colonic cancer surgery from January 1, 2010 through December 2013.

PATIENTS:
A total of 5143 patients (1602 open resections; 3541 laparoscopic resections) with colonic cancer were included.

MAIN OUTCOME MEASURES:
Risk factors for poor resection quality were identified through uni- and multivariate logistic regression analysis. The surgical approach was assessed by propensity score-matched regression analysis. Poor resection quality was defined as resections in the muscularis plane accompanied by R0 resection, or resections in any resection plane accompanied by R1 resection.

RESULTS:
Overall, 4415 (85.8%) of the resections were considered good and 728 (14.2%) were considered poor. After multivariate analysis, neoadjuvant oncological treatment, advanced tumor stage (T3-4), advancing N stage (N1-2), open tumor perforation, and open surgery significantly increased the risk of poor resection quality. In a propensity score-matched sample (n = 1508 matched pairs), matched for age, sex, ASA score, BMI, neoadjuvant treatment, tumor stage, and tumor location, open resection was still associated with a higher risk of poor resection quality compared with laparoscopic resection (OR, 1.4; 95% CI, 1.1–1.8; p = 0.002).

LIMITATIONS:
Retrospective design was a limitation of this study.

CONCLUSIONS:
In this nationwide propensity score-matched database study, laparoscopic resection was associated with a higher probability of good resection quality compared with open resection for colonic cancer. Risk factors for compromised specimen quality were neoadjuvant oncological treatment, locally advanced tumor stage (T3-4), advanced N stage (N1-2), open tumor perforation, and open surgery. See Video Abstract at http://links.lww.com/DCR/A830.
Diagnosis and Management of Lynch Syndrome
Authors: Hajirawala Luv , Barton Jeffrey S. 
Published: March 2019

Case Summary:
A 56-year-old man with a history of hypertension and hyperlipidemia was referred by gastroenterology for bleeding per rectum. Because of a family history of colon cancer, he had several prior colonoscopies, most recently 3 years ago, without evidence of pathology. His mother was diagnosed with colon cancer in her mid-40s. His current colonoscopy demonstrated a 2.4 × 1.5 cm cecal adenocarcinoma. Staging workup revealed no evidence of metastatic disease. Because of the patient’s family history, the specimen was further evaluated and found to have high microsatellite instability (MSI-H). The patient was referred to a genetic counselor and found to have a germline pathogenic variant in MSH6 on gene panel testing. The patient did not have a family history of any extracolonic malignancies.
The patient underwent an uncomplicated laparoscopic total abdominal colectomy with ileorectal anastomosis, which revealed a T2N0Mx adenocarcinoma with abundant peritumoral lymphocytes. He was discharged on postoperative day 2, and recuperated appropriately from surgery. Follow-up surveillance proctoscopy showed no evidence of disease. His sole offspring, a 25-year-old man, was negative for a pathogenic variant in MSH6 and had no polyps on colonoscopy. His siblings did demonstrate a pathogenic variant in MSH6 and are currently opting for annual surveillance colonoscopy.
Multiplanar Assembly Mammaplasty Based on the Divine Proportion
Authors: Pereira Filho Osvaldo , BIns Ely Jorge , Lee Kuang Hee , Paulo Elizabeth Machado , Granemann Alfredo Spautz 
Published: March 2019

Background:
The study sought to plan mastopexy and breast reduction according to the principle of the divine proportion, represented by the letter phi, via the convergent assembly of multiple layers to create the new breast. This strategy is based on the constancy of the submammary fold and the orientation of the vertex of a V-shaped triangle opening at approximately 60° at the umbilicus, with each branch opening in the direction of the acromioclavicular joint.

Methods:
The strategy was prospectively investigated in 265 patients (n = 530 breasts). The mean patient age was 36 years. The follow-up ranged from 6 months to 3 years.

Results:
A total of 220 patients (83%) received a good score (1–4) according to Strasser grading. Complications were few, but included delayed healing with minimal scar ulceration in 19 patients (7%), asymmetry in 16 (6%), and partial nipple necrosis in 4 (1.5%).

Conclusions:
This approach adds precision to mammaplasty, reduces the laxity in the axillary region, promotes bulk in the upper pole, and eases nipple–areola complex elevation.
Five Financial Pearls for Medical Students, Residents, and Young Surgeons
Authors: Poppler Louis H. , Sharma Ketan , Buck Donald W. , Myckatyn Terence M. 
Published: March 2019

Background:
Finances impact every aspect of our daily lives. Despite this, they are rarely discussed in medical school or surgical training. Consequently, more than half the medical students we interview report no formal teaching about personal finance. The purpose of this article was to present 5 topics every graduating medical student, resident, and young surgeon should understand to start the path to financial independence.

Methods:
We synthesized recommendations and data from several books on financial literacy, blogs on the topic, and the personal experiences of the 4 authors.

Results:
The following 5 topics were identified as critical for young surgeons: learn about and manage your own finances, consider the financial implications of your career choices, make a plan to pay off your student loans, make a budget and stick to it, and think carefully before buying property. Central to these 5 lessons is the idea that starting to invest and save early is essential to taking advantage of interest and capital gains. We also demonstrate pay and cost differences in 5 regions of the country and outline the 2 main pathways one can take to repaying their student loans.

Conclusions:
Financial literacy is an important aspect of being an effective surgeon. With minimal effort, you can take these 5 steps now toward financial freedom. Doing so will improve your sense of control over your financial life and decrease anxiety about the unknown.
Extended L-Framework: An Innovative Technique for Reconstruction of Low Nasal Dorsum by Autogenous Costal Cartilage Graft
Authors: Aboul Wafa Ahmed Mabrouk 
Published: March 2019

Background:
Congenital, iatrogenic, and traumatic etiologies can produce a deficient nasal dorsum requiring dorsal augmentation. Traditional techniques for dorsal augmentation as onlay dorsal graft, cantilever graft, or conventional L-framework usually have less stability and produce a rigid lobule if the single unit framework extends to the tip. Because of abundant volume and relative ease of harvest and carving, the autogenous rib cartilage has been considered the graft of choice for dorsal nasal augmentation when structural support is necessary and sufficient septal cartilage is not available.

Methods:
Eighteen patients with congenital, iatrogenic, and posttraumatic low nasal dorsum were reconstructed with the extended L-cartilage framework over the past 3 years with an average postoperative follow-up of 15 months. The framework was reconstructed from 3 carved cartilaginous pieces. If needed, columellar strut, spreader, and tip grafts were also provided.

Results:
All the 18 patients were generally satisfied with the cosmetic and functional outcomes at around 1-year follow-up. The nasal projection and dorsal aesthetic lines were pleasing and maintained over a prolonged postoperative follow-up period. There was free natural movement of the lobular part of the nose. No major complications were encountered.

Conclusions:
Consistent, reproducible results were achieved with using the extended L-framework in primary and secondary rhinoplasty and in posttraumatic dorsal nasal deformities as well. This technique has different advantages over the conventional techniques as the extended framework is more anatomical, preserves pliability of the lobule, maintains stability without any means of fixation, and offers good control of aesthetic needs.
The Shame–Blame Game: Is It Still Necessary? A National Survey of Shame-based Teaching Practice in Canadian Plastic Surgery Programs
Authors: Boehm Kaitlin S. , McGuire Connor , Boudreau Colton , Jenkins Danielle , Samargandi Osama A. , Al-Youha Sarah , Tang David 
Published: March 2019

Background:
As understanding of poor physician mental health and burnout strengthens, it is becoming important to identify factors that detract from wellbeing. Shame-based learning (SBL) is detrimental to psychological health and can contribute to burnout, substance abuse and suicide. This study endeavoured to quantify the unknown prevalence and effects of SBL in Canadian plastic surgery programs.

Methods:
An electronic survey was sent to all attending surgeons and trainee (residents and fellows) members of the Canadian Society of Plastic Surgeons. SBL was assessed using a validated questionnaire. Data was analyzed using descriptive statistics and thematic analysis.

Results:
98 responses (14.7%) comprising of 63 attending surgeons and 36 trainees were received. The majority of attending surgeons (78 percent) and trainees (67%) have been shamed. Fourteen percent of trainees and 9% of attending surgeons felt that SBL is necessary. The most common event provoking shaming for trainees was wrong answers (56%) and for attending surgeons was disagreement in clinical care (21%). For both groups, shamers were in positions of authority. The most common effect of SBL in trainees was a loss of self-confidence (53%), compared to no negative effect in attending surgeons (49 percent). Thirty-nine percent of trainees dealt with shaming events with support from fellow trainees (39 percent), while attending surgeons kept it to themselves (40 percent).

Conclusion:
SBL is present in Canadian plastic surgery residency programs and has numerous detrimental effects. To foster better mental health, residency programs should identify ongoing SBL and make efforts to transition to healthier feedback strategies.
The Lipo-Body Lift: Operative Technique
Authors: Bertheuil Nicolas , Chaput Benoit , Bergeat Damien , Morvan Christophe , Mocquard Camille , Watier Eric 
Published: March 2019

Summary:
Bariatric surgery induces massive weight loss, which results in global and complex skin deformities. Lower body lift procedure has become the gold standard for lower trunk reconstruction. The authors describe in this video the lipo-body lift technique in detail. The video is divided into 4 parts: part 1, indications and preoperative markings; part 2, posterior contouring; part 3, anterior contouring; and part 4, preoperative and postoperative results. Patient selection and technical key points of the technique are discussed. The lipo-body lift method is an important component of reconstructive strategies and should be widely offered to patients who experienced massive weight loss.
RECLASSIFICATION OF FUNDUS AUTOFLUORESCENCE PATTERNS SURROUNDING GEOGRAPHIC ATROPHY BASED ON PROGRESSION RATE
Authors: Shen Liangbo L. , Liu Feimei , Nardini Holly Grossetta , Del Priore Lucian V. 
Published: March 2019

Purpose:
To reclassify fundus autofluorescence (FAF) patterns around geographic atrophy (GA) based on GA progression rates.

Methods:
MEDLINE, EMBASE, Cochrane Library, Clinicaltrials.gov, and PubMed were searched for studies reporting GA progression rates among different FAF patterns, such as “None,” “Focal,” “Banded,” “Patchy,” “Diffuse Nontrickling,” and “Diffuse Trickling.” The GA radius growth rate among different FAF patterns was compared, and a GA growth function for each group was derived. To account for the patients' different entry times, a horizontal translation factor was introduced to shift each data subset from “time after enrollment” to “duration of GA.”

Results:
Seven studies with 496 eyes were included. Based on GA radius growth rates, the six FAF patterns were clustered into four groups with a high correlation coefficient within each group: Group 1, None, 0.061 mm/year (r2 = 0.996), Group 2, Focal, 0.105 mm/year (r2 = 0.987), Group 3, Banded, Patchy, and Diffuse Nontrickling, 0.149 mm/year (r2 = 0.993), and Group 4, “Diffuse Trickling, 0.245 mm/year (r2 = 0.997).

Conclusion:
This meta-analysis suggested that the six FAF patterns can be coalesced into four groups based on lesion progression rates. Simplification of the reclassified FAF patterns may shed light on the GA natural history and assist in the design of clinical trials.
Open-Source Three-Dimensional Printable Infant Clubfoot Brace
Authors: Savonen Benjamin , Gershenson John , Bow Jennifer K. , Pearce Joshua M. 
Published: March 2019

ABSTRACTIntroductionOpen-source, self-replicating rapid prototypers (RepRaps) have radically reduced the costs of three-dimensional (3D) printing while expanding its access. Three-dimensional printing's model of distributed manufacturing can produce medical technologies at significantly reduced costs. We investigate this potential by evaluating the viability of an open-source 3D printable infant clubfoot brace.Materials and MethodsStarting with a list of key features present in currently available clubfoot braces, a 3D-printed clubfoot brace was developed in free and open-source CAD software (FreeCAD) to enable future customization. Polylactic acid, a biodegradable and recyclable bioplastic, was selected among the various commercial 3D printable materials based on strength and cost.ResultsThe results show that the open-source clubfoot brace matches or surpasses the physical features and mechanical degrees of freedom of all commercial- and nonprofit-developed brace designs while substantially reducing the costs of the braces to hospitals and families.ConclusionsThe 3D-printed brace has the features of commercially available braces while significantly reducing the cost, making this clubfoot brace particularly appropriate for use in developing countries. In addition, the results indicated that this model of distributed manufacturing of medical technology is technically and economically appropriate through much of the Global South.
Addressing adverse childhood experiences in diverse racial and ethnic settings: a review
Authors: Wang Yingna , Nerwen Renana , Gabris Carla 
Published: March 2019

Purpose of review
This article reviews the current literature on adverse childhood experiences (ACEs) with particular focus on racial and ethnic factors.

Recent findings
Limited research exists with respect to ACEs and certain racial and ethnic groups. In this article, we highlight the unique challenges specific populations may face in their lives. Further research on ACEs in these and other racial and ethnic groups is needed to help clinicians contextualize their cases in the clinical setting.

Summary
As the US population continues to diversify, it is pivotal that clinicians and researchers understand some of the challenges faced by different racial and ethnic populations and demonstrate more sensitivity to patient needs. Clinicians who are sensitive to an individual's history of ACEs would be expected to have a better understanding of his/her patient's predilection to specific mental health issues.
Psychometric Testing of Errors of Care Omission Survey: A New Tool on Patient Safety in Primary Care
Authors: Poghosyan Lusine , Norful Allison A. , Ghaffari Affan , Liu Jianfang 
Published: March 2019

Objective
The aim of the study was to evaluate the psychometric properties of a newly developed survey tool measuring omissions in primary care.

Methods
The Errors of Care Omission Survey (ECOS) is the only known tool to measure critical omissions (“errors”) in primary care from the perspectives of primary care providers (PCPs), both physicians and nurse practitioners. The tool has 31 items grouped into the following four subscales: Self-Management Support, Follow-up, Emotional Health Support, and Care Integration. A cross-sectional survey design was used to mail the tool to PCPs and 582 PCPs in one state in the U.S. completed and returned the survey. Exploratory factor analysis with target rotation was carried out. Internal consistency reliability of identified subscales was investigated.

Results
Four factors emerged representing domains of omissions in primary care. The original Follow-up and Care Integration subscales were retained. The items on Self-Management Support and Emotional Health Support subscales loaded differently on two factors, which were labeled Patient Self-Management and Family Engagement subscales, suggesting that conceptually PCPs separate patient and family involvement in patient care. Seven poorly performing or redundant items were removed. The remaining 24 items measure patient self-management, family engagement, follow-up, and care integration domains of omissions in primary care. The ECOS subscales have acceptable internal consistency reliability with Cronbach’s α ranging from 0.90 to 0.97.

Conclusions
The ECOS can be used in primary care to identify critical omissions, so actions can be taken by clinicians and administrators to prevent them before they result in patient harm. Further testing of the ECOS is recommended with diverse samples.
Lymphoscintigraphic Evaluation of Systemic Tracer Uptake in Patients With Primary Lymphedema
Authors: Goss Jeremy A. , Maclellan Reid A. , Greene Arin K. 
Published: March 2019

Background
Lymphoscintigraphy is used to confirm the diagnosis of lymphedema. One end point for the test is to ensure a patent thoracic duct by uptake of tracer in the organs. The purpose of this study was to evaluate transit of radiolabeled colloid to the organs to gain insight into the etiopathophysiology of primary lymphedema.

Methods
Patients treated in our Lymphedema Program between 2009 and 2018 were reviewed. Only subjects with bilateral lower extremity primary lymphedema were included (individuals with unilateral leg lymphedema were excluded because the tracer will reach the venous circulation and organs through the normal extremity). Disease severity and lymphoscintigraphy findings were documented.

Results
Sixty-one patients were included. Ten subjects had no radiolabeled tracer transit to the inguinal lymph nodes on lymphoscintigraphy. However, 8 of these individuals had tracer uptake to the liver, kidney, and/or bladder, illustrating clearance of tracer into the systemic venous circulation. All 8 patients had infant-onset primary lymphedema and mild disease. The 2 patients who did not have clearance of tracer to the systemic venous circulation developed lymphedema in adolescence and had clinically moderate or severe disease.

Conclusions
Patients with primary lower extremity lymphedema often have pathways for lymph fluid to reach the venous circulation other than through the inguinal nodes and thoracic duct. Documentation of systemic tracer uptake during lymphoscintigraphy to confirm a patent thoracic duct has limited clinical significance in subjects with primary disease of the legs.
The value of failure to rescue in determining hospital quality for pediatric trauma
Authors: Rosenfeld Eric H. , Zhang Wei , Johnson Brittany , Shah Sohail R. , Vogel Adam M. , Naik-Mathuria Bindi 
Published: March 2019

BACKGROUND
In adult trauma patients, high- and low-mortality trauma hospitals have similar rates of major complications but differ based on failure to rescue (mortality following a major complication), which has become a marker of hospital quality. The aim of this study is to examine whether failure to rescue is also an appropriate hospital quality indicator in pediatric trauma.

METHODS
Children younger than 15 years were identified in the 2007 to 2014 National Trauma Databank research data sets. Hospitals were classified as a high, average or low mortality based on risk-adjusted observed-to-expected in-hospital mortality ratios using the modified Trauma Mortality Probability Model. Regression modeling was used to explore the impact of hospital quality ranking on the incidence of major complications and failure to rescue.

RESULTS
Of 125,057 children, 31,600 were treated at low-mortality outlier hospitals, and 7,014 at high-mortality outlier hospitals. Low-mortality hospitals had a lower rate of major complications compared with high-mortality hospitals (0.5% [low] vs. 0.8% [high]; adjusted odds ratio [OR], 0.71; 95% confidence interval [CI], 0.61–0.83; p < 0.01) and a lower failure-to-rescue rate (17.6% [low] vs. 24.1% [high]; adjusted OR, 0.53 [high; 95% CI 0.34–0.83; p < 0.01]). When patients who died within 48 hours were excluded, low-mortality hospitals had a lower complication rate (OR, 0.81; 95% CI, 0.68, 0.96; p = 0.02), but similar failure-to-rescue rate compared to high-mortality hospitals. There was no correlation between trauma verification level and hospital mortality status based on the model.

CONCLUSION
For pediatric trauma patients, mortality is more strongly associated with major complication rate than with failure to rescue. Thus, failure to rescue does not appear to be the key driver of hospital quality in this population as it does in the adult trauma population.

LEVEL OF EVIDENCE
Prognostic and epidemiological, level III.