bluuebunny/crossref_metadata_2025_split huggingface dataset:
Trends in Physician Payments for Breast Reconstruction
Authors: Sheckter Clifford C. , Yi Day , Panchal Hina J. , Razdan Shantanu N. , Pusic Andrea L. , McCarthy Colleen M. , Cordeiro Peter G. , Disa Joseph J. , Mehrara Babak , Matros Evan 
Published: March 2018

Background:
Prosthetic breast reconstruction rates have risen in the United States, whereas autologous techniques have stagnated. Meanwhile, single-institution data demonstrate that physician payments for prosthetic reconstruction are rising, while payments for autologous techniques are unchanged. This study aims to assess payment trends and variation for tissue expander and free flap breast reconstruction.

Methods:
The Blue Health Intelligence database was queried from 2009 to 2013, identifying women with claims for breast reconstruction. Trends in the incidence of surgery and physician reimbursement were characterized by method and year using regression models.

Results:
There were 21,259 episodes of breast reconstruction, with a significant rise in tissue expander cases (incidence rate ratio, 1.09; p < 0.001) and an unchanged incidence of free flap cases (incidence rate ratio, 1.02; p = 0.222). Bilateral tissue expander cases reimbursed 1.32 times more than unilateral tissue expanders, whereas bilateral free flaps reimbursed 1.61 times more than unilateral variants. The total growth in adjusted tissue expander mean payments was 6.5 percent (from $2232 to $2378) compared with −1.8 percent (from $3858 to $3788) for free flaps. Linear modeling showed significant increases for tissue expander reimbursements only. Surgeon payments varied more for free flaps (the 25th to 75th percentile interquartile range was $2243 for free flaps versus $987 for tissue expanders).

Conclusions:
The incidence of tissue expander cases and reimbursements rose over a period where the incidence of free flap cases and reimbursements plateaued. Reasons for stagnation in free flaps are unclear; however, the opportunity cost of performing this procedure may incentivize the alternative technique. Greater payment variation in autologous reconstruction suggests the opportunity for negotiation with payers.
An Update on the Safety and Efficacy of Outpatient Plastic Surgery: A Review of 26,032 Consecutive Cases
Authors: Rohrich Rod J. , Mendez Bernardino M. , Afrooz Paul N. 
Published: March 2018

Background:
Outpatient surgery offers many advantages, including cost-containment, privacy, and convenience. However, patient safety must take precedence over these benefits. Limited well-designed studies exist in the plastic surgery literature on patient safety in the outpatient setting, particularly those that identify risk factors for adverse outcomes.

Methods:
A retrospective review was performed on 26,032 consecutive cases completed by board-certified plastic surgeons at an accredited outpatient surgical center between 1995 and 2017. All cases were reviewed for potential morbidity and mortality events, and variables were analyzed to determine potential risk factors for postoperative complications and inpatient admission.

Results:
A total of 26,032 cases were performed over a 23-year period. There were a total of 203 complications (0.78 percent). Compared with the control population, the 12 patients (0.05 percent) that sustained venous thromboembolic events demonstrated higher body mass indexes (p < 0.01), greater lipoaspirate amounts (p = 0.04), longer operative times (p < 0.01), and were more likely to have undergone a combined procedure (p < 0.01). In addition, the 22 patients (0.08 percent) that were transferred to inpatient facilities demonstrated greater body mass index (p < 0.01) and longer operative times (p = 0.01).

Conclusions:
Plastic surgery is safe to perform in an accredited outpatient facility for a majority of patients. According to the authors’ data, postoperative monitoring in a nursing facility should be considered for the following high-risk patients: those with a body mass index greater than 30 kg/m2, operative times greater than 4 hours, lipoaspirate volumes greater than 3 liters, and those undergoing combined procedures.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Risk, III.
Predictors for Unfavorable Projection of the Constructed Auricle following Ear Elevation Surgery in Microtia Reconstruction
Authors: Lee Kyeong-Tae , Oh Kap Sung 
Published: March 2018

Background:
Nagata’s two-stage technique for microtia reconstruction using autologous costal cartilage consists of the implantation of a fabricated cartilage framework and the elevation of the constructed auricle. Achieving long-lasting, sufficient projection of the auricle is a goal of second-stage surgery; however, unfavorable outcomes have been seen in some patients, with suboptimal long-term elevation. The present study aimed to investigate prognostic factors that might contribute to adverse outcomes following the ear elevation operation.

Methods:
Outcomes of patients with congenital microtia who underwent auricular reconstruction with a modified Nagata technique between January of 2007 and June of 2015 were reviewed. Unfavorable elevation was defined as cases with an auriculocephalic angle less than 20 degrees or with a shallow auricular sulcus requiring revision operations. Univariate and multivariate analyses were conducted to identify independent predictors for the unfavorable elevation.

Results:
A total of 309 patients representing 323 cases were analyzed with a median follow-up period of 26 months. The mean age of the patients was 15.1 years. The majority of cases had lobule-type microtia. Hemifacial microsomia was present in 114 cases. Canalplasty was performed in 117 cases before the auricular elevation. Unfavorable elevation was observed in 72 cases (22.3 percent). Multivariate analyses showed that the presence of hemifacial microsomia and performance of canalplasty less than or equal to 12 months before the ear elevation operation were independent risk factors for the unfavorable elevation.

Conclusion:
Several preoperative factors, including combined anomalies and operative timing and sequences, might influence the outcomes of the ear elevation operation.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Risk, III.
Incidence of Cranial Base Suture Fusion in Infants with Craniosynostosis
Authors: Mazzaferro Daniel M. , Naran Sanjay , Wes Ari M. , Runyan Christopher M. , Vossough Arastoo , Bartlett Scott P. , Taylor Jesse A. 
Published: March 2018

Background:
Cranial base sutures are important drivers of both facial and cranial growth. The purpose of this study was to compare the incidence and location of cranial base suture fusion among three groups: nonaffected controls, patients with nonsyndromic craniosynostosis, and patients with syndromic craniosynostosis.

Methods:
Patients and computed tomographic scans were accrued from the authors’ prospective craniofacial database. Computed tomographic scans were graded on the frequency of cranial vault and cranial base suture/synchondrosis fusion (0, open; 1, partially/completely fused) by an attending craniofacial surgeon and neuroradiologist. Statistical comparisons were conducted on location and rates of fusion, age, and diagnosis.

Results:
One hundred forty patients met inclusion criteria: 55 syndromic, 64 nonsyndromic, and 21 controls. Average age at computed tomography of syndromic patients (3.6 ± 3.1 months) was younger than that of nonsyndromic patients (5.4 ± 3.1 months; p = 0.001) and control subjects (5.1 ± 3.2 months; p = 0.058). Syndromic craniosynostotic patients had over three times as many cranial base minor sutures fused (2.2 ± 2.5) as nonsyndromic craniosynostosis patients (0.7 ± 1.2; p < 0.001) and controls (0.4 ± 0.8; p = 0.002), whose rates of fusion were statistically equivalent (p = 0.342). Syndromic craniosynostosis patients had a greater frequency of cranial base suture fusion in the coronal branches, squamosal arch, and posterior intraoccipital synchondrosis (p < 0.05).

Conclusions:
Patients with syndromic craniosynostosis have higher rates of cranial base suture fusion in infancy, especially in the coronal arches, and this may have significant implications for both cranial and facial growth. In contrast, patients with nonsyndromic craniosynostosis have similar rates and sites of cranial base suture fusion as controls. Interestingly, there is a low, “normal,” rate of cranial base suture/synchondrosis closure in infancy, the implications of which are unknown.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Risk, III.
Learning from an Unsuccessful Study Idea: Reflection and Application of Innovative Techniques to Prevent Future Failures
Authors: Fujihara Yuki , Saito Taichi , Huetteman Helen E. , Sterbenz Jennifer M. , Chung Kevin C. 
Published: March 2018

Summary:
A well-organized, thoughtful study design is essential for creating an impactful study. However, pressures promoting high output from researchers can lead to rushed study proposals that overlook critical weaknesses in the study design that can affect the validity of the conclusions. Researchers can benefit from thorough review of past failed proposals when crafting new research ideas. Conceptual frameworks and root cause analysis are two innovative techniques that can be used during study development to identify flaws and prevent study failures. In addition, conceptual frameworks and root cause analysis can be combined to complement each other to provide both a big picture and detailed view of a study proposal. This article describes these two common analytical methods and provides an example of how they can be used to evaluate and improve a study design by critically examining a previous failed research idea.
A New Composite Eyeball-Periorbital Transplantation Model in Humans: An Anatomical Study in Preparation for Eyeball Transplantation
Authors: Siemionow Maria , Bozkurt Mehmet , Zor Fatih , Kulahci Yalcin , Uygur Safak , Ozturk Can , Djohan Risal , Papay Frank 
Published: March 2018

Background:
Vascularized composite allotransplantation offers a new hope for restoration of orbital content and perhaps vision. The aim of this study was to introduce a new composite eyeball-periorbital transplantation model in fresh cadavers in preparation for composite eyeball allotransplantation in humans.

Methods:
The composite eyeball-periorbital transplantation flap borders included the inferior border, outlined by the infraorbital rim; the medial border, created by the nasal dorsum; the lateral border, created by the lateral orbital rim; and the superior border, created by the superior part of the eyebrow. The pedicle of the flap included the facial artery, superficial temporal artery, and external jugular vein. The skin and subcutaneous tissues of the periorbital region were dissected and the bony tissue was reached. A coronal incision was performed and the frontal lobe of the brain was reached by means of frontal osteotomy. Ophthalmic and oculomotor nerves were also included in the flap. After a “box osteotomy” around the orbit, the dissection was completed. Methylene blue and indocyanine green injection (SPY Elite System) was performed to show the integrity of the vascular territories after facial flap harvest.

Results:
Adequate venous return was observed within the flap after methylene blue dye injection. Laser-assisted indocyanine green angiography identified a well-defined vascular network within the entire composite eyeball-periorbital transplantation flap.

Conclusions:
For the first time, a novel composite eyeball-periorbital transplantation model in human cadavers was introduced. Good perfusion of the flap confirmed the feasibility of composite eyeball-periorbital transplantation in the clinical setting. Although harvesting of the flap is challenging, it introduces a new option for reconstruction of the periorbital region including the eyeball.
Patient-Reported Outcome Measures Used in Gender Confirmation Surgery: A Systematic Review
Authors: Andréasson My , Georgas Konstantinos , Elander Anna , Selvaggi Gennaro 
Published: March 2018

Background:
The usefulness of patient-reported outcome measures is emphasized along with the development of patient-centered care. When implementing patient-reported outcome measures, evidence of the instrument’s validity, reliability, and responsiveness in the target population is necessary to secure accurate reporting of the patient’s experience. The aim of this study was to identify the literature in which structured patient-reported outcome measures have been used to evaluate the results of gender confirmation surgery, and to systematically evaluate the validity of these instruments.

Methods:
A systematic review of the current literature was performed to identify structured patient-reported outcome measures used to evaluate the outcome of gender confirmation surgery. The identified instruments’ validity in the transgender population was assessed for adherence to international guidelines for development and validation of health outcomes instruments.

Results:
A total of 110 instruments were identified: 64 ad hoc; six generic; 24 evaluating psychiatric, social, or psychosocial aspects; nine evaluating function but only valid in other patient groups; five ad hoc with some formal development/validation; and two specific for gender dysphoria.

Conclusions:
There is a lack of patient-reported outcome measures that are valid for the transgender population and concurrently sensitive enough to evaluate gender confirmation surgery without the influence of other gender confirming interventions. Basing research on instruments without confirmed validity decreases the validity of the study itself; thus, previous research using patient-reported outcome measures to evaluate gender confirmation surgery can be considered to have a low level of evidence. To obtain valid patient-reported outcome measures, specific for evaluating the results of gender confirmation surgery, development of new instruments or adaptation of existing instruments is needed.
Inner Scar Umbilicus: New Horizons for Vertical Abdominoplasty
Authors: Mendes Flavio H. , Viterbo Fausto , Luna Ana L. A. P. 
Published: March 2018

Background:
It is reasonable that deflated tissue in massive weight loss patients may demand not only lifting but also some extent of central body tightening, by the fleur-de-lis procedure. Although achieving nice contouring results, poor visible scars, including umbilical complications, have restricted the indications for the anterior vertical approach. The purpose of this article is to present the authors’ experience with the inner scar umbilical reconstruction, reflecting overall results in vertical abdominoplasties.

Methods:
Massive weight loss patients who underwent fleur-de-lis abdominoplasties with the inner scar umbilicus were reviewed retrospectively. The original stalk was resected along with the surgical specimen, and two marked parallel skin flaps were kept and sutured against each other into the deep medial fascia, to reconstruct the umbilical base. Additional sutures were made to approximate fat tissue immediately under and above it, enhancing a deepening effect. Conventional upper and lower vertical closure helped to establish the tridimensional shape of the new navel.

Results:
One hundred ten consecutive patients were studied, and 52 (47 percent) presented small inflammatory exudate arising from the inner suture, which resolved with conservative dry dressings. No further umbilical complications such as infection, necrosis, dehiscence, widening, or stenosis were reported, and all patients showed natural and scarless new navels with nice shapes and correct position.

Conclusions:
The inner scar umbilicus is a simple, safe, and reproducible technique, presenting low complication rates with sustainable and natural results. High-quality navel reconstruction favors the indication of vertical abdominoplasties, especially for post–bariatric surgery body contouring.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
How to Diagnose and Treat Breast Implant–Associated Anaplastic Large Cell Lymphoma
Authors: Clemens Mark W. , Brody Garry S. , Mahabir Raman C. , Miranda Roberto N. 
Published: March 2018

Learning Objectives:
After reading this article, the participant should be able to: 1. Describe the diagnostic criteria for breast implant–associated (BIA) anaplastic large cell lymphoma (ALCL). 2. Appropriately evaluate a patient with suspected BIA-ALCL, including appropriate imaging, laboratory tests, and pathologic evaluation. 3. Understand the operative treatment of BIA-ALCL, and indications for systemic chemotherapy and/or radiation therapy in advanced disease. 4. Understand treatment outcomes and prognosis based on stage of disease.

Summary:
The goal of this continuing medical education module is to present the assessment of a patient with suspected breast implant–associated anaplastic large cell lymphoma, the evaluation and diagnosis, the preoperative oncologic workup, the formation and execution of a surgical treatment plan, and the inclusion of adjunct treatments when indicated. In addition, staging and disease progression for treatment of breast implant–associated anaplastic large cell lymphoma are discussed.
Assessing Resident Safety Culture in Six Nursing Homes in Belgium
Authors: Desmedt Melissa , Petrovic Mirko , Beuckelaere Petra , Vandijck Dominique 
Published: March 2018

Objectives
The primary aim was to measure resident safety culture in six nursing homes in northern Belgium (Flanders). In addition, differences in safety culture perceptions between professions were also examined. Finally, results of the present study were compared with the Nursing Home Comparative Database from the Agency for Healthcare Research and Quality (USA).

Methods
A cross-sectional study was conducted by administering the Nursing Home Survey on Patient Safety Culture in six nursing homes in Belgium (Flanders). Each nursing home has 92 to 170 licensed nursing home beds. Data collection occurred between December 2016 and January 2017.

Results
Highest mean scores were found for “feedback and communication about incidents” (mean [SD] = 4.20 [0.58]), “overall perceptions of resident safety” (mean [SD] = 4.07 [0.52]), and “supervisor expectations and actions promoting resident safety” (mean [SD] = 4.04 [0.70]). The lowest mean score was found for “staffing” (mean [SD] = 2.99 [0.61]). In addition, managers/supervisors scored significantly higher on all resident safety dimensions, with the exception of the dimensions “teamwork” and “supervisor expectations and actions promoting resident safety.” Finally, the present study scored higher on the dimensions “teamwork,” “nonpunitive response to mistakes,” “handoffs,” “feedback and communication about incidents,” and “communication openness” than the benchmarking data from the Nursing Home Comparative Database.

Conclusions
More work is necessary to improve the safety of resident care in nursing homes, especially regarding staffing issues and turnover rates. The present research findings serve to shine a light on an often-overlooked patient population and emphasize the need to develop improvement strategies for preventing resident safety incidents in nursing homes.
Neisseria gonorrhoeae vaccine development: hope on the horizon?
Authors: Edwards Jennifer L. , Jennings Michael P. , Seib Kate L. 
Published: March 2018

Purpose of review

Neisseria gonorrhoeae is one of the most common causes of sexually transmitted infections, with an estimated more than 100 million cases of gonorrhea each year worldwide. N. gonorrhoeae has gained recent increasing attention because of the alarming rise in incidence and the widespread emergence of multidrug-resistant gonococcal strains. Vaccine development is one area of renewed interest. Herein, we review the recent advances in this area.

Recent findings
Vaccine development for N. gonorrhoeae has been problematic, but recent progress in the field has provided new hope that a gonococcal vaccine may be feasible. Several new vaccine antigens have been characterized in various models of infection. Furthermore, the first potential vaccine-induced protection against gonorrhea in humans has been reported, with decreased rates of gonorrhea described among individuals vaccinated with the Neisseria meningitidis serogroup B vaccine, MeNZB.

Summary
As antibiotic resistance continues to increase, vaccine development for N. gonorrhoeae becomes more urgent. The MeNZB vaccine is shown to have efficacy, albeit relatively low, against N. gonorrhoeae. This finding has the potential to reinvigorate research in the field of gonococcal vaccine development and will guide future studies of the antigens and mechanism(s) required for protection against gonococcal infection.
Human adenovirus infections: update and consideration of mechanisms of viral persistence
Authors: Radke Jay R. , Cook James L. 
Published: March 2018

Purpose of review
To provide an update on recent studies of human adenoviral (HAdV) infections and to explore the mechanisms of viral persistence and the role of persistent infection in disseminated disease in immunocompromised patients.

Recent findings
Human adenoviruses continue to be a problem in ophthalmology clinics and to cause periodic, limited, global outbreaks of respiratory disease. Ad14p1 remains in worldwide circulation and continues to result in miniepidemics of severe respiratory infections. New variants of Ad4 and Ad7 have emerged in both the United States and Asia. The severity of Ad4 infections in outbreaks appears to depend more on preexisting conditions in patients than on genetically determined, viral virulence factors, in contrast to limited evidence of Ad7 mutations that may convey increased viral pathogenesis. Reactivation of persistent adenovirus infection appears to be the primary source of disseminated infections in immunocompromised patients. New studies suggest that establishment of persistent infection and reactivation are related to variations in interferon-mediated control of viral replication.

Summary
Innate immune responses can create a state of adenoviral persistence, and repression of these host defenses can result in reactivation and dissemination of infection. A better definition of the molecular mechanisms of immune-mediated control of viral replication might lead to new strategies for treatment of HAdV reactivation and dissemination.
Group A Streptococcus infections in children: from virulence to clinical management
Authors: Botteaux Anne , Budnik Isolda , Smeesters Pierre R. 
Published: March 2018

Purpose of review
Recent findings have open new perspectives on group A Streptococcus (GAS) virulence understanding with special focus on the carrier stage and new hopes for an efficient vaccine against this important pathogen.

Recent findings
Understanding of carriage state, transmission and role of virulence factors in invasive infections have been recently active research fields questioning the link between carriage and infections and highlighting the potential to prevent invasive diseases. New roles for already well known virulence factors, such as Streptolysin O, M protein or NAD(+)-glycohydrolase have been discovered. Immunological studies have also shown diversity in both clinical and immunological responses toward various GAS antigens raising questions, and hopes, for the development of an efficient global vaccine candidate.

Summary
A greater understanding of GAS virulence strategies, and their associated clinical manifestations, may be obtained by shifting our research scope toward virulence determinant interactions and cooperation rather than focusing on individual virulence factor or specific strain characterization only.