bluuebunny/crossref_metadata_2025_split huggingface dataset:
Assessing Organizational Supports for Evidence-Based Decision Making in Local Public Health Departments in the United States: Development and Psychometric Properties of a New Measure
Authors: Mazzucca Stephanie , Parks Renee G. , Tabak Rachel G. , Allen Peg , Dobbins Maureen , Stamatakis Katherine A. , Brownson Ross C. 
Published: January 2019

Context:
Fostering evidence-based decision making (EBDM) within local public health departments and among local health department (LHD) practitioners is crucial for the successful translation of research into public health practice to prevent and control chronic disease.

Objective:
The purpose of this study was to identify organizational supports for EBDM within LHDs and determine psychometric properties of a measure of organizational supports for EBDM in LHDs.

Design:
Cross-sectional, observation study.

Setting:
Local public health departments in the United States.

Participants:
Local health department practitioners (N = 376) across the United States participated in the study.

Main Outcome Measures:
Local health department practitioners completed a survey containing 27 items about organizational supports for EBDM. Most items were adapted from previously developed surveys, and input from researchers and practitioners guided survey development. Confirmatory factor analysis was used to test and refine the psychometric properties of the measure.

Results:
The final solution included 6 factors of 22 items: awareness of EBDM (3 items), capacity for EBDM (7 items), resources availability (3 items), evaluation capacity (3 items), EBDM climate cultivation (3 items), and partnerships to support EBDM (3 items). This factor solution achieved acceptable fit (eg, Comparative Fit Index = 0.965). Logistic regression models showed positive relationships between the 6 factors and the number of evidence-based interventions delivered.

Conclusions:
This study identified important organizational supports for EBDM within LHDs. Results of this study can be used to understand and enhance organizational processes and structures to support EBDM to improve LHD performance and population health. Strong measures are important for understanding how LHDs support EBDM, evaluating interventions to improve LHD capacity, and to guide programmatic and policy efforts within LHDs.
Novel Agents in Multiple Myeloma
Authors: Szalat Raphaël , Munshi Nikhil C. 
Published: January 2019

Abstract
The therapeutic landscape of multiple myeloma (MM) has dramatically changed in the last 15 years with the advent of immunomodulatory drugs and proteasome inhibitors. However, majority of MM patients relapse, and new therapies are needed. Various agents with diverse mechanisms of action and distinct targets, including cellular therapies, monoclonal antibodies, and small molecules, are currently under investigation. In this review, we report novel drugs recently approved or under advanced investigation that will likely be incorporated in the future as new standard for MM treatment, focusing on their mechanisms of action, cellular targets, and stage of development.
Cost-Effectiveness Analysis of Virtual Surgical Planning in Mandibular Reconstruction
Authors: Fatima Aaisha , Hackman Trevor G. , Wood Jeyhan S. 
Published: January 2019

Background:
Because of the complex nature of osteocutaneous free flap mandibular reconstruction, modern technologies such as virtual surgical planning have become popularized to refine the procedure. Compared with usual care, virtual surgical planning has been suggested to reduce operative time and improve accuracy of outcomes. The aim of this study was to examine the cost-effectiveness of virtual surgical planning versus usual care in mandibular reconstruction.

Methods:
A decision-analytic model was constructed to comparatively understand cost-effectiveness of virtual surgical planning and usual care treatments based on additional costs of virtual surgical planning, and costs attributed to probabilities of postoperative complications. Model structure was informed through qualitative clinical interviews from the University of North Carolina, and supported through University of North Carolina clinical data and literature. Costs and complication probabilities were estimated from the literature. Sensitivity analyses of all uncertain model parameters were performed, and distributional parameters were selected based on best practices.

Results:
Results of base-case analysis indicated that virtual surgical planning was more costly by a difference of $7099 per person and did not reduce the risk of complications or flap loss. Virtual surgical planning cases had an increased incidence of flap loss by 0.6 percent and an increased incidence of mandibular infection by 6.5 percent.

Conclusions:
Virtual surgical planning has upfront expenses that do not necessarily translate into downstream reduction in complications or improved outcomes. Clinical decision-makers would benefit from future research to identify thresholds whereby virtual surgical planning may result in more cost-savings for particular types of patients.
Management of High-Output Chyle Leak after Harvesting of Vascularized Supraclavicular Lymph Nodes
Authors: Teven Chad M. , Hunter Cedric L. , Chang David W. 
Published: January 2019

Summary:
Vascularized lymph node transfer is a physiologic microsurgical technique used for the treatment of lymphedema. As vascularized lymph node transfer is becoming more common, it is essential that one is aware of all potential complications associated with vascularized lymph node transfer and know how to avoid and manage them when they do occur. The authors recently encountered a complication after supraclavicular vascularized lymph node transfer that has not been previously reported. A patient developed a recalcitrant high-output (>500 ml/day) chyle leak in the neck donor site after supraclavicular vascularized lymph node transfer harvest. In this article, the authors share their experience with massive chyle leak and review the management strategies of how to effectively avoid and treat this potentially dangerous complication. This review of a previously unreported complication of supraclavicular vascularized lymph node transfer is timely and important, as this procedure is increasingly being offered to patients, and surgeons performing these procedures should be familiar with effectively managing this potentially dangerous complication.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, V.
A Virtual Surgical Planning Algorithm for Delayed Maxillomandibular Reconstruction
Authors: Stranix John T. , Stern Carrie S. , Rensberger Michael , Ganly Ian , Boyle Jay O. , Allen Robert J. , Disa Joseph J. , Mehrara Babak J. , Garfein Evan S. , Matros Evan 
Published: January 2019

Background:
The absence of a tumor specimen from which to obtain measurements at the time of delayed maxillomandibular reconstruction introduces degrees of uncertainty, creating the need for substantial intraoperative guesswork by the surgeon. Using the virtual surgical planning environment, the size and shape of missing bony elements is determined, effectively “recreating the defect” in advance of the surgery. Three virtual surgical planning techniques assist the reconstructive surgeon: patient-specific modeling, mirroring the normal contralateral side, and scaled normative data. To facilitate delayed reconstruction a hierarchical algorithm using virtual surgical planning techniques was developed.

Methods:
Delayed maxillomandibular virtual surgical planning reconstructions were identified from 2009 to 2016. Demographics, modeling techniques, and surgical characteristics were analyzed.

Results:
Sixteen reconstructions were performed for osteoradionecrosis with displacement (50.0 percent) or oncologic defects (37.5 percent). Most patients had prior surgery (81.3 percent) and preoperative radiation therapy (81.3 percent); four had failed prior reconstructions. The following delayed virtual surgical planning techniques were used: patient-specific modeling based on previous imaging (43.8 percent), mirroring normal contralateral anatomy (37.5 percent), and scaled normative data (18.8 percent). Normative and mirrored reconstructions were designed to restore normal anatomy; however, most patient-specific virtual surgical planning designs (71.4 percent) required nonanatomical reconstructions to accommodate soft-tissue limitations and to avoid the need for a second flap. One partial flap loss required a second free flap, and one total flap failure occurred. Hardware exposure was the most common minor complication, followed by infection, dehiscence, and sinus tract formation.

Conclusions:
Virtual surgical planning has inherent advantages in delayed reconstruction when compared to traditional flap shaping techniques. An algorithmic approach based on available imaging and remaining native anatomy enables accurate reconstructive planning followed by flap transfer without the need for intraoperative guesswork.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
Symmetric Philtral Column Repair for Unilateral Cleft Lip
Authors: Madaree Anil 
Published: January 2019

Background:
When treating a patient with a unilateral cleft lip, the goal is to try and achieve a result that is the least perceivable at conversational distance. The result should be a balanced and symmetric lip with scars that are hidden or are placed in natural anatomical lines. Several methods have been described to repair the lip. The most popular repairs at present are the rotation-advancement or its modifications and the various versions of the straight-line repair.

Methods:
In the author’s unit, a method has evolved entitled the symmetric philtral column repair. In this method, the author attempts to achieve a philtral column that mirrors the philtral column on the normal side, producing a balanced appearing lip. This method has been used for the past 14 years in over 500 patients.

Results:
The results have been satisfying, with a lip revision rate of 6 percent.

Conclusions:
The symmetric philtral column repair of a unilateral cleft lip is an effective and safe repair. The repair is easy to understand and produces results that minimize the stigmata of a cleft lip deformity.
Long-Term Functional Upper-Extremity Outcomes in Adults with Apert Syndrome
Authors: Taghinia Amir H. , Yorlets Rachel R. , Doyle Michael , Labow Brian I. , Upton Joseph 
Published: January 2019

Background:
The goal of this study was to determine upper-extremity function and health-related quality of life in a cohort of adults with Apert syndrome.

Methods:
Twenty-two adults with Apert syndrome completed the Disabilities of the Arm, Shoulder, and Hand survey; the 36-Item Short-Form Health Survey; and a semistructured interview. One surgeon administered the Jebsen Hand Function Test and measured sensation, joint motion, and strength.

Results:
Median Disabilities of the Arm, Shoulder, and Hand score was 16.9, which indicated slightly greater disability than the population norm of 10.1. Median 36-Item Short-Form Health Survey scores were 54.5 for mental health and 57.0 for physical health—both more favorable than population norms. Total Jebsen Hand Function Test scores for dominant hand were 69.2 seconds for men and 64.7 seconds for women versus 37.8 seconds for population norms of both sexes. More complex syndactyly resulted in worse metacarpophalangeal joint motion but no significant difference in Disabilities of the Arm, Shoulder, and Hand; 36-Item Short-Form Health Survey; or other functional results. There was no difference in self-reported outcomes between patients with four (n = 8) versus five digits (n = 14) in each hand.

Conclusions:
In this cohort of adults with Apert syndrome, self-reported assessment of disability was more favorable than measured functional data would suggest. Despite significant functional deficits, the participants in this study had adapted remarkably well.
Patient Attitudes Toward Telemedicine-Delivered Cardiac Rehabilitation
Authors: Grover David B. , Alexander Jeffrey L. 
Published: January 2019

Abstract

Background
Telemedicine-delivered cardiac rehabilitation (telemedicine-CR) provides an alternative pathway for patients who are unable to participate in conventional CR. Little is known regarding the relationships among potential participants’ perceptions of barriers to CR participation, interest in telemedicine-CR, and self-efficacy beliefs toward the use of telemedicine. The purpose of this study was to identify if associations exist between these variables.

Methods
A quantitative, correlational survey study was conducted using the Cardiac Rehabilitation Barriers Scale and a survey examining interest in and self-efficacy for telemedicine technologies. Eighty-three patients were invited to participate.

Results
Twenty surveys (24%) were returned. Significant correlations were identified between interest in telemedicine-CR and self-efficacy beliefs for the use of live video links, r
s(14) = .510, p = .044, and the Cardiac Rehabilitation Barriers Scale Comorbidity subscale, r
s(18) = −.469, p = .037.

Conclusions
Higher self-efficacy for the use of video chat and fewer perceived comorbidity barriers were associated with greater interest in telemedicine-CR.
Using Volume-Based Tube Feeding to Increase Nutrient Delivery in Patients on a Rehabilitation Unit
Authors: Kinikin JaNae , Phillipp Rita , Altamirano Christine 
Published: January 2019

Abstract

Purpose
The purpose of this study was to determine whether volume-based tube feeding (VBTF) increased nutrient delivery to patients in a rehabilitation unit.

Design
A cohort study with a prospective group and a historical control group was used as the study design.

Methods
The intervention was VBTF, a change from the standard hourly rate-based enteral nutrition. Data were collected on 70 rehabilitation patients. Data on the control group (n = 35) were collected through retrospective chart review of rate-based tube-fed patients. Data on the VBTF intervention group (n = 35) were collected prospectively after implementation of VBTF in the inpatient medical rehabilitation unit at University of Utah Health.

Findings
The results showed patients in the VBTF group received 82% of their prescribed feed whereas rate-based patients received 70%.

Clinical Relevance
VBTF appears to increase the amount of nutrition inpatient medical rehabilitation patients receive, which may help with the intensive therapy sessions these patients must undergo.
Quadruple Perforator Flaps for Primary Closure of Large Myelomeningoceles
Authors: Rankin Timothy M. , Wormer Blair A. , Tokin Christopher , Kaoutzanis Christodoulos , Al Kassis Salam , Wellons John C. , Braun Stephane 
Published: January 2019

Introduction
Myelomeningocele is the most common open neural tube defect. A quadruple rotation-VY advancement flap (butterfly flap) was recently reported for closure of large myelomeningocele defects; however, no series has been reproduced to evaluate this technique. The objective of this study was to describe our experience with this technique.

Materials and Methods
We reviewed all infants born with large myelomeningocele defects who underwent butterfly flap closure over a 2-year period. Demographics, defect size, operative details, and complications were used to generate descriptive statistics.

Results
From June 2015 to January 2018, 7 infants met inclusion criteria. Mean defect width was 52% ± 0.11 of the back, representing 21% ± 0.09 of the total back area. Only 1 child had central breakdown. All patients had some peripheral skin dehiscence that occurred on postoperative day 12 ± 7, and these were treated with outpatient wound care. Four patients returned to the operating room for dehiscence electively. There were no incidences of total flap loss. There were no cases of meningitis or myelomeningocele dehiscence. All patients had successful closure of their myelomeningocele without the use of skin grafts.

Conclusions
The butterfly flap is able to close large myelomeningocele defects and has the potential to improve contour. There are minor wound-healing complications, but in the rare event of central dehiscence, quadruple rotation-VY advancement flaps can be re-advanced. In all cases, a large myelomeningocele was successfully reconstructed with robust full-thickness flaps, and there was no need for skin grafting of donor sites.
Cosmetically Challenging Congenital Melanocytic Nevi
Authors: Fahradyan Artur , Wolfswinkel Erik M. , Tsuha Michaela , Reinisch John F. , Magee William , Hammoudeh Jeffrey A. , Urata Mark M. , Howell Lori K. 
Published: January 2019

Background
Congenital melanocytic nevi (CMN) have a 1% to 5% lifetime risk for malignant transformation, with 50% of transformations occurring before the age of 5 years.
The aim of this study is to assess the risk of melanoma development in pediatric patients with facial CMN involving the eyebrows, eyelid margins, and nasal alae where a margin of CMN was not excised to preserve these structures.

Methods
A retrospective chart review of all pediatric patients with CMN from 1986 to 2014 was performed to review demographic information, diagnosis, and number of surgeries. Patients' clinical photographs were evaluated for residual nevi after completion of the treatment.

Results
More than 950 medical charts of patients with CMN of the face area were reviewed. We identified 32 patients (13; 41% male) that met the study criteria with pathology-confirmed diagnosis of facial CMN with an average age of 4.4 years (3.3 months–15.8 years) at the time of initial surgery. The CMNs were classified into small (1; 3%), medium (14; 44%), large (14; 44%), and giant (3; 9%) based on their projected adult sizes. No patients developed melanoma within the small residual lesions left over the eyebrows and eyelids and inside nostrils at an average follow-up time of 5.6 (1.0–14.4) years and average age of 9.6 (1.8–19.2) years at the time of last follow-up.

Conclusions
Although a lifelong risk of malignant transformation of the residual CMN cannot be concluded, our results found no transformation in follow-up visits at an average age beyond the highest risk of melanoma development in childhood. We feel that leaving residual lesions on the face in areas of important anatomic structures for better cosmetic outcome is an acceptable risk.
“No-Touch” Enhancement Significantly Reduces the Risk of Infection-Related Failure in Immediate Breast Reconstruction
Authors: Wilson Henry B. 
Published: January 2019

Purpose
Infection rates in prosthetic breast reconstruction after mastectomy vary widely, ranging from 1% to 35%, with meta-analyses reporting average infection rates of greater than 5%. This infection rate of greater than 5% is unfortunate for one of today's most commonly performed plastic surgical procedures. In an attempt to reduce infectious events, the author developed a “no-touch” protocol for performing breast reconstruction with tissue expanders and acellular dermis (ADM). This approach utilizes a transparent barrier drape and self-retaining retractor system patterned after similar orthopedic and urologic techniques that have proven to significantly reduce infection of implanted prostheses. Our preliminary results published in 2015 showed a significant improvement in infection rates. With this study, we assess the impact of the no-touch technique on a much larger number of patients.

Methods
Institutional review board approval was granted for a retrospective study of patients who underwent immediate breast reconstruction with tissue expanders and ADM from 2010 to 2017 by the author. Reconstructions prior to the institution of a no-touch protocol in 2014 were compared with those after the enhancement was instituted. A minimum of 60 days' follow-up was used to assess surgical complications. Demographic and outcome data were analyzed.

Results
Immediate breast reconstruction with tissue expanders and ADM was performed on 133 patients (217 breasts) from 2010 to 2017. Sixty-nine patients (113 breasts) underwent reconstruction from 2010 to 2014 utilizing the traditional technique, and 64 patients (104 breasts) underwent reconstruction from 2014 to 2017 using the new no-touch enhancement applied by the author. Patients in both groups had similar demographics and comorbidity profiles. The only other technique variable besides the addition of no-touch was the trend toward the use of larger sizes of ADM in the later group (164 vs 108 cm2). The rate of infection-related reconstructive failure dropped from 11.5% (13/113) to 1.9% (2/104) (P = 0.0054) after institution of the no-touch protocol.

Conclusions
Institution of a specific no-touch protocol to immediate breast reconstruction with tissue expanders and ADM lowered the risk of reconstructive failure due to infection 6-fold—11.5% to 1.9%. Comparative studies from other surgeons are encouraged.
A Study to Evaluate Change in Ventricular Volume Obtained by Cranial Distraction for Craniosynostosis
Authors: Hashmi Asra , Davis Greta , Zaldana Michelle , Vinocur Daniel , Cahill Gabrielle L. , Brandel Michael G. , Lance Samuel , Meltzer Hal S. , Gosman Amanda A. 
Published: January 2019

Background
The aims of the current analysis were to study the change in ventricular volume (VV) obtained with cranial distraction in patients with craniosynostosis and compare it with the change in total intracranial volume (ICV) and brain volume.

Methods
After institutional review board approval, a retrospective review was performed on patients undergoing cranial distraction over a 5-year period. GE Healthcare AdW 4.3 volume assessment software was utilized to calculate preoperative and postdistraction ICV, VV, and whole-brain volume. Data were also collected on patient demographics, age at the time of distraction, time spent in distraction and consolidation, and length of stay. t Tests were used for comparison.

Results
Twenty-three patients met our inclusion criteria. Forty-eight percent of patients (n = 11) had right-sided cranial distraction, 30% (n = 7) had bilateral distraction, and 22% of patients (n = 5) had left-sided distraction. At the preoperative stage, mean head circumference was 42.5 ± 4.7 cm, mean ICV was 810.1 ± 27 cm3, mean non-VV (NVV) was 796.2 ± 268 cm3, and mean VV was 13.9 ± 9 cm3. After a mean of 27.4 mm of distraction, occurring over a mean of 26 days and consolidation period of 149 days, a second computed tomography scan was obtained. Mean postdistraction head circumference was 49.1 ± 3.9 cm, mean ICV was 1074.1 ± 203 cm3, mean NVV was 1053.5 ± 197 cm3, and VV was 20.6 ± 14 cm3. Mean % increase in ICV at this stage was 47.4%; mean % NVV increase was 48.5% as opposed to 60.3% increase in VV.

Conclusions
Cranial distraction is known to effectively increase ICV. Our study suggests that the effect of this volumetric increase is much more pronounced on the VV compared with the brain volume. Further studies are underway to investigate whether this short-term marked increase in VV is sustained over a long-term period.