bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison of 1-year Follow-up Echocardiographic Outcomes of Sapien 3 Versus Evolut R Bioprosthetic Transcatheter Aortic Valves: A Single-center Retrospective Iranian Cohort Study
Authors: Sahebjam Mohammad , Zoroufian Arezou , Hajizeinali Alimohammad , Salarifar Mojtaba , Jalali Arash , Ayati Aryan , Farmanesh Mahkameh 
Published: May 2023

Objective:
The current study aimed to compare 1-year echocardiographic outcomes of the new generations of self-expanding (Evolut R) versus balloon-expandable (Sapien 3) bioprosthetic transcatheter aortic valves.

Methods:
In this study, gradients and flow velocities obtained from transthoracic Doppler-echocardiography were retrospectively collected from patients who underwent 2 new generations of transcatheter aortic valve implantation interventions with Sapien 3 and Evolut R valves. Patients underwent echocardiography before the procedure and at discharge, 6 months, and 1-year follow-up.

Results:
Of the 66 patients, 28 received Sapien 3 and 38 received Evolut R valves. Evolut R valve presented a lower mean gradient at all follow-up time points compared with Sapien 3 valves (14.4 mm Hg, 14.9 mm Hg, 15.5 mm Hg compared with 10.1 mm Hg, 11.6 mm Hg, 11.8 mm Hg, respectively; all P-values <0.001). Small valve sizes of Evolut R, including 23 and 26, had higher echocardiographic mean gradient or peak gradient at the time of discharge compared with larger valves, including sizes 29 and 34 (11.1 mm Hg and 11.2 mm Hg vs. 10.2 mm Hg, 9.1 mm Hg) and 1-year follow-up (11.0 mm Hg, 11.0 mm Hg vs. 9.9 mm Hg, 8.4 mm Hg; all P-values = 0.001). Although Sapien 3 valves demonstrated a higher peak gradient in smaller sizes at discharge (18.44 mm Hg in size 23 vs. 17.9 mm Hg, 16.5 mm Hg in size 26 and 29, respectively; P = 0.001), the peak gradients did not show a statistically significant difference in the 1-year follow-up.

Conclusions:
The current study detected significantly lower mean and peak gradients in Evolut R compared with Sapien 3 at all follow-up time points. Furthermore, smaller valve sizes were associated with significantly higher gradients at all follow-ups, regardless of the valve type.
Improving the screening process for obstructive sleep apnea in the primary care setting
Authors: Soni Sarah J. 
Published: May 2023

ABSTRACT

Background:
There is a high prevalence of obstructive sleep apnea (OSA) in the primary care setting that is underdiagnosed and underreported in 75–80% of the population. If untreated, OSA has implications for long-term cardiovascular, cerebrovascular, and metabolic health.

Local problem:
At a primary care clinic in New Jersey, patients at high risk for OSA were not being routinely screened for the condition.

Methods:
This project intended to address the administration of the STOP-Bang Questionnaire among asymptomatic high-risk patient populations with hypertension and/or obesity. In addition to determining each participant's level of risk for OSA, and in turn, facilitating referrals and diagnostic testing per a provider's discretion.

Interventions:
The STOP-Bang Questionnaire, a validated screening tool for OSA, was implemented in a primary care practice to measure levels of risk for OSA among eligible participants.

Results:
A total of 32 out of the 100 patients assessed were identified as high risk for OSA. After screening, 36 participants were referred for confirmatory testing.

Conclusions:
The STOP-Bang Questionnaire, a validated screening tool for OSA, is recommended for all asymptomatic high-risk patients, specifically for those with obesity and/or hypertension, at least annually. The use of a screening tool evaluates a level of risk, promotes detection of disease in the primary stages, delays disease progression, and improves treatment initiatives.
Excess Mortality at Veterans Health Administration Facilities During the COVID-19 Pandemic
Authors: Tenso Kertu , Strombotne Kiersten L. , Feyman Yevgeniy , Auty Samantha G. , Legler Aaron , Griffith Kevin N. 
Published: May 2023

Importance:
The COVID-19 pandemic resulted in excess mortality among the general US population and at Veterans Health Administration (VHA) facilities. It is critical to understand the characteristics of facilities that experienced the highest and lowest pandemic-related mortality to inform future mitigation efforts.

Objective:
To identify facility-level excess mortality during the pandemic and to correlate these estimates with facility characteristics and community-wide rates of COVID-19 burden.

Design:
We used pre-pandemic data to estimate mortality risk prediction models using 5-fold cross-validation and Poisson quasi-likelihood regression. We then estimated excess mortality and observed versus expected (O/E) mortality ratios by the VHA facility from March to December 2020. We examined facility-level characteristics by excess mortality quartile.

Participants:
Overall, there were 11.4 million VHA enrollees during 2016 and 2020.

Main Measures:
Facility-level O/E mortality ratios and excess all-cause mortality.

Result:
VHA-enrolled veterans experienced 52,038 excess deaths from March to December 2020, equating to 16.8% excess mortality. Facility-specific rates ranged from −5.5% to +63.7%. Facilities in the lowest quartile for excess mortality experienced fewer COVID-19 deaths (0.7–1.51, P<0.001) and cases (52.0–63.0, P=0.002) per 1,000 population compared with the highest quartile. The highest quartile facilities had more hospital beds (276.7–187.6, P=0.024) and a higher percent change in the share of visits conducted via telehealth from 2019 to 2020 (183%–133%, P<0.008).

Conclusions:
There was a large variation in mortality across VHA facilities during the pandemic, which was only partially explained by the local COVID-19 burden. Our work provides a framework for large health care systems to identify changes in facility-level mortality during a public health emergency.
Can History Change Our Future Course? Lessons From Case Managers Across Time
Authors: Moreo Kathleen , Llewellyn Anne , Sands Judith , Luttrell Jody , Prince Melanie , Owen Mindy 
Published: May 2023

Purpose/Objectives:
History can tell us a lot. Through the lens of case management history, we can appreciate how our practice has evolved and what have been the sticking points along the way. We can better understand how our practice became knitted into the fabric of the health care system, and why we apply certain functions and processes of case management across different practice settings. Historical lessons captured by national case management organizations or found in the literature can help us think about how to improve the future, as well as the care we deliver today. Higher education is another good resource for honing our skills. As the complex care of patients has evolved over time, there has been growth in advanced case management education (P. Stark, 2020). Yet, not everyone has access to formal education.

Primary Practice Settings(s):
Practical knowledge gained from the experiences of other case managers is not only free but also valuable. When we are exposed to the practical experiences and advice of seasoned case managers, we create an opportunity for knowledge sharing and reverse mentoring, which can result in leadership development (S. Powell, 2013). This article provides a historical glance into the evolution of today's case management practice, as well as provides salient lessons and advice from senior case managers who share practical tips and stories for tomorrow's case management leaders. Mentors share their career-long experiences in hospital case management, rehabilitation case management, pediatric case management, military case management, and hospice case management.

Findings/Conclusions:
Valuable lessons can be learned from reviewing case management's history that can be applied to improve current and future case management practice. Sources of information can be obtained from national organizations as well as from a review of the literature. Senior case managers who have dedicated their careers to case management can also be a vital resource, lending insights into pitfalls to avoid and best practices to implement in everyday practice.

Implications for Case Management Practice:
The case management mentors in this article have imparted the following key points to assist tomorrow's case management experts in maximizing their value:
Effectiveness of psychological interventions delivered by physiotherapists in the management of neck pain: a systematic review with meta-analysis
Authors: Farrell Scott F. , Edmunds Devon , Fletcher John , Martine Harry , Mohamed Hashem , Liimatainen Jenna , Sterling Michele 
Published: May 2023

Abstract
Physiotherapists are increasingly using psychological treatments for musculoskeletal conditions. We assessed the effects of physiotherapist-delivered psychological interventions on pain, disability, and quality of life in neck pain. We evaluated quality of intervention reporting. We searched databases for randomized controlled trials (RCTs) comprising individuals with acute or chronic whiplash-associated disorder (WAD) or nontraumatic neck pain (NTNP), comparing physiotherapist-delivered psychological interventions to standard care or no treatment. Data were extracted regarding study characteristics and outcomes. Standardised mean difference (SMD) was calculated by random-effects meta-analysis. We evaluated certainty of evidence using Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) and intervention reporting using TIDieR. Fourteen RCTs (18 articles—4 detail additional outcome/follow-up data) were included comprising 2028 patients, examining acute WAD (n = 4), subacute/mixed NTNP (n = 3), chronic WAD (n = 2), and chronic NTNP (n = 5). Treatment effects on pain favoured psychological interventions in chronic NTNP at short-term (SMD −0.40 [95% CI −0.73, −0.07]), medium-term (SMD −0.29 [95% CI −0.57, 0.00]), and long-term (SMD −0.32 [95% CI −0.60, −0.05]) follow-up. For disability, effects favoured psychological interventions in acute WAD at short-term follow-up (SMD −0.39 [95% CI −0.72, −0.07]) and chronic NTNP at short-term (SMD −0.53 [95% CI −0.91, −0.15]), medium-term (SMD −0.49 [95% CI −0.77, −0.21]), and long-term (SMD −0.60 [95% CI −0.94, −0.26]) follow-up. GRADE ratings were typically moderate, and intervention reporting often lacked provision of trial materials and procedural descriptions. Psychological interventions delivered by physiotherapists were more effective than standard physiotherapy for chronic NTNP (small-to-medium effects) and, in the short term, acute WAD.
Wise-Pattern versus Transverse Pattern Mastectomy in Two-Stage Implant-Based Breast Reconstruction: A Propensity Score-Matched Analysis
Authors: Escandón Joseph M. , Butterfield James A. , Christiano Jose G. , Gooch Jessica C. , Olzinski Ann Therese , Prieto Peter A. , Skinner Kristin A. , Langstein Howard N. , Manrique Oscar J. 
Published: May 2023

Background:
The wise pattern adapted to the mastectomy incisions has become a valuable asset for breast reconstruction in patients with large and ptotic breasts. Herein, we compared the time for exchange, time to initiate postmastectomy radiotherapy (PMRT) and complications rate between reconstructions performed with wise pattern versus a transverse incision pattern.

Methods:
We retrospectively reviewed the record of patients who underwent immediate two-stage implant-based reconstruction (IBBR) between January 2011 and December 2020. Two cohorts were compared according to the incision pattern: wise versus transverse incision pattern. Complications were compared after propensity score matching.

Results:
We initially analyzed 393 two-stage immediate IBBR in 239 patients, 91 (23.2%) in the wise-pattern group and 302 (76.8%) in the transverse pattern group. The expansion time (53 days versus 50 days, p=0.9), the time for TE-to-implant exchange (154 versus 175 days, p=0.547), and the time to initiate PMRT (144 days versus 126 days, p=0.616) were not different between groups. Before propensity score matching, the 30-day rate of wound-related complications (32% versus 10%, p<.001) and 30-day rate of wound complications requiring E/D+C procedures (20% versus 7%, p<.001) were significantly higher in the wise-pattern group. After propensity score matching, the 30-day rate of wound-related complications persisted significantly higher (25% versus 10%, p=0.03) in the wise-pattern group.

Conclusion:
The wise pattern mastectomy independently increases the incidence of wound-related complications versus only transverse patterns during two-stage IBBR, even after propensity score matching. Delayed TE placement may improve the safety profile of this procedure.
Augmented Reality Microsurgery (ARM) - Proof of Concept for a Novel Approach to Microsurgical Field Visualization in Plastic Surgery
Authors: Falola Reuben , Lombana Nicholas , Rodriguez-Unda Nelson , Mehta Ishan , Webster Nicholas , Weber Robert , Altman Andrew , Saint-Cyr Michel 
Published: May 2023

Background:
Microsurgery is conducted on tiny anatomical structures like blood vessels and nerves. Over the past few decades, little has changed in the way plastic surgeons visualize and interact with the microsurgical field. New advances in Augmented Reality (AR) technology present a novel method for microsurgical field visualization. Voice and gesture-based commands can be used in real-time to adjust the size and position of a digital screen. Surgical decision support and/or navigation may also be employed. The authors assess the use of AR in microsurgery.

Methods:
The video feed from a Leica Microsystems OHX surgical microscope was streamed to a Microsoft HoloLens2 AR headset. A fellowship-trained microsurgeon and 3 plastic surgery residents then performed a series of 4 arterial anastomoses on a chicken thigh model using the AR headset, a surgical microscope, a video microscope or “exoscope”, and surgical loupes.

Results:
The AR headset provided an unhindered view of the microsurgical field and peripheral environment. The subjects remarked on the benefits of having the virtual screen track with head movements. The ability of participants to place the microsurgical field in a tailored comfortable, ergonomic position was also noted. Points of improvement were the low image quality compared to current monitors, image latency, and the lack of depth perception.

Conclusion:
AR is useful tool that has the potential to improve microsurgical field visualization and the way surgeons interact with surgical monitors. Improvements in screen resolution, latency, and depth of field are needed.
Acellular dermal matrix cover improves skin growth during tissue expansion by affecting distribution of mechanical forces
Authors: Ledwon Joanna K. , Applebaum Sarah A. , Progri Bianka , Han Tianhong , Vignesh Oveyaa , Gutowski Kristof S. , Chang Alec B. , Reddy Narainsai K. , Tepole Adrian B. , Gosain Arun K. 
Published: May 2023

Background
Biological cover over tissue expander prostheses has been introduced to provide soft tissue support for tissue expanders during breast reconstruction. However, its impact on mechanically induced skin growth remains unknown. This study will investigate the hypothesis that covering the tissue expander with acellular dermal matrix (ADM) affects mechanotransduction without compromising the efficacy of tissue expansion.

Methods
Tissue expansion, with and without use of ADM, was performed on a porcine model. The tissue expanders were inflated twice with 45 ml of saline and the full-thickness skin biopsies were harvested from expanded and control unexpanded skin one week and 8 weeks after the final inflation. Histological evaluation, immunohistochemistry staining, and gene expression analysis were performed. Skin growth and total deformation were evaluated using isogeometric analysis (IGA).

Results
Our results demonstrate that utilization of ADM as a biological cover during tissue expansion does not impede mechanotransduction that lead to skin growth and blood vessel formation. IGA revealed similar total deformation and growth of expanded skin with and without a biological cover, confirming that its use does not inhibit mechanically induced skin growth. In addition, we found that use of an ADM cover results in more uniform distribution of mechanical forces applied by the tissue expander.

Conclusions
These results suggest that ADM improves mechanically induced skin growth during tissue expansion by facilitating a more uniform distribution of mechanical forces applied by the tissue expander. Therefore, the use of a biological cover has potential to improve outcomes in tissue expansion-based reconstruction.

Clinical Relevance Statement.
Utilization of ADM during tissue expansion results in more uniform distribution of mechanical forces applied by the tissue expander and might improve clinical outcomes in patients undergoing breast reconstruction.
Early Complications in Prepectoral Breast Reconstructions with and without Acellular Dermal Matrix: A Preliminary Analysis of Outcomes
Authors: Plotsker Ethan L. , Graziano Francis D. , Rubenstein Robyn N. , Haglich Kathryn , Allen Robert J. , Coriddi Michelle R. , Dayan Joseph H. , Poulton Richard , McKernan Cayla , Mehrara Babak J. , Matros Evan , Disa Joseph J. , Nelson Jonas A. 
Published: May 2023

BACKGROUND:
Prepectoral tissue expander (TE) placement for two-stage postmastectomy reconstruction is usually performed in conjunction with insertion of acellular dermal matrix (ADM). However, the effects of ADM use on TE loss or other early complications remain unknown. Therefore, the aim of this study was to compare early postoperative complications in patients who underwent prepectoral breast implant reconstruction with or without ADM use.

METHODS:
We performed a retrospective cohort study of all patients at our institution who underwent prepectoral breast reconstruction from January 2018 to June 2021. The primary outcome was TE loss within 90 days of surgery; secondary outcomes included other complications including infection, TE exposure, mastectomy skin flap necrosis requiring revision, and seroma.

RESULTS:
Data on 714 patients with 1,225 TEs (1,060 with ADM, 165 without) were analyzed. Baseline demographics did not differ by ADM use, though mastectomy breast tissue weight was higher in patients without ADM (750.3 g vs. 540.8 g, p < 0.001). Rates of TE loss were similar in reconstructions with (3.8 percent) ADM and without (6.7 percent; p = 0.09). We also did not find differences in the rates of secondary outcomes between cohorts.

CONCLUSIONS:
ADM use had no statistically significant effect on early complication rates among patients undergoing breast reconstruction with prepectoral TEs. Still, we were underpowered and data trended toward statistical significance, so larger studies are required in the future. Additional research and randomized studies should focus on larger cohorts and examine long-term complications such as capsular contracture and implant malposition.
Symmetrical breast surgery: balancing procedures versus prophylactic mastectomy and immediate reconstruction
Authors: Bitoiu Brendon , Grigor Emma , Hardy Jacob , Zeitouni Camille , Arnaout Angel , Zhang Jing 
Published: May 2023

Background:
Various techniques for management of the contralateral breast exist in patients with unilateral breast cancer including contralateral prophylactic mastectomy with immediate breast reconstruction (PMIBR), or symmetrisation techniques including augmentation, reduction, or mastopexy. The purpose of this prospective cohort study was to evaluate and compare complications and patient-reported satisfaction of patients with contralateral PMIBR versus having symmetrisation procedures.

Methods:
A 7-year, single institution, prospectively maintained data base was reviewed. Patient-reported BREAST-Q were obtained at baseline, 3-months, and 12-months prospectively. Post-operative complications, oncologic outcomes and BREAST-Q scores were compared.

Results:
249 patients were included, 93 (37%) of which had contralateral PMIBR and 156 (63%) which had contralateral symmetrisation. The patients who underwent PMIBR were younger and had less co-morbidities compared to patients with symmetrisation. Rates of major and minor complications were similar apart from higher rates of minor wound dehiscence in the PMIBR group. When comparing mean change at 12 months follow up to pre-operative results, there was a significant decrease in the physical well-being of chest in the symmetrisation compared to PMIBR group (2.94 vs. -5.69, p=0.042). There were no significant differences in mean breast satisfaction, psychosocial well-being, and non-significant decreases in sexual well-being between groups.

Conclusion:
Patients with unilateral breast cancer who underwent immediate contralateral breast management, with either contralateral PMIBR or symmetrisation techniques, demonstrated similar profiles of major complications and good overall satisfaction except one physical well-being domain. Management of the contralateral breast with symmetrisation may provide similar outcomes compared to PMIBR, which often is considered not necessary in patients without specific indications.
“Robot-assisted Capsulectomy with Immediate Reimplantation in Breast Reconstruction”
Authors: Oh So Min , Han Woo Yeon , Eom Jin Sup , Kim Eun Key , Han Hyun Ho 
Published: May 2023

Summary:
Recent reports have introduced robotic breast surgery for immediate breast reconstruction with an implant. However, relevant reports of robot-assisted breast reconstruction including capsulectomy are limited. Although capsulectomy lowers risk of capsular contracture and thus contributes to better aesthetic outcomes, total capsulectomy may have complications such as injury to axillary structures or chest wall and overlying skin devascularization. To minimize the risk of injury, the authors used a robotic system employing Da-vinci SP for total capsulectomy, which has freely movable arms and clear magnified 3D vision. Furthermore, compared with conventional procedures, robotic surgery has the critical advantage of minimal incision and concealed scars, contributing to positive patient aesthetic outcomes. Thus, this study suggests that robot-assisted capsulectomy is technically feasible and reliably guarantees patient safety during breast reconstruction with immediate reimplantation.