bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparing Donor Site Morbidity for Autologous Breast Reconstruction: Thigh vs. Abdomen
Authors: Lee Z-Hye , Chu Carrie K. , Asaad Malke , Liu Jessie , Selber Jesse C. , Butler Charles E. , Largo Rene D. 
Published: March 2022

Background:
Although abdominally-based free flaps have long been the gold standard, the profunda artery perforator (PAP) flap has emerged as an important alternative option for autologous breast reconstruction. The aim of this study was to directly compare the donor site morbidity of using the PAP versus deep inferior epigastric perforator (DIEP) free flap.

Methods:
We performed a retrospective review of patients undergoing autologous breast reconstruction using a DIEP and/or PAP flap from January 2017 to December 2020. In total, 30 PAP flap patients were matched with 60 DIEP flap patients. Outcomes included donor site wound dehiscence, length of stay, narcotic consumption, and pain scores. Patient-reported outcomes for the thigh versus abdomen were compared using questions derived from the BREAST-Q.

Results:
There was no significant difference in length of stay (P = 0.182), reoperation rates (P = 0.999), flap failure rates (P = 0.999), or donor site complications (P = 0.999). Both groups had similar mean pain scores, maximum pain scores, daily and total narcotic requirements. In comparing the thigh or abdomen as a donor site, there was no difference in frequency of negative symptoms (difficulty with daily activities, discomfort, tightness, and negative impact on ability to work) or satisfaction scores as related to their appearance in and out of clothing and the appearance of the scar.

Conclusions:
The thigh and abdomen are both suitable donor sites for autologous breast reconstruction with similar flap-related and patient-reported outcomes. The ultimate decision regarding whether to use a PAP or DIEP flap for breast reconstruction should be tailored based on patient anatomy and preference.
Impact of the COVID-19 Pandemic on the Wellness of Canadian Plastic Surgery Residents
Authors: Wong Chloe R. , Moltaji Syena , Cross Karen , Wanzel Kyle R. 
Published: March 2022

Background:
On top of preexisting burnout, depression, and anxiety among trainees, the COVID-19 pandemic has introduced novel stressors. The objectives of this study were to determine the effects of the COVID-19 pandemic on Canadian plastic surgery residents’ practice, wellness, and overall training.

Methods:
Surveys for program directors and residents were created and disseminated to all English-speaking Canadian plastic surgery residency training programs. Survey results were pooled and presented as a percentage of responses for each question.

Results:
Response rates were 50% (n = 5/10) and 25% (n = 19/77) for program directors and residents, respectively. All program directors believed that the pandemic has a negative effect on resident wellness, 80% (n = 4/5) of which believed that their residents were coping effectively. They rated program support for resident wellness as neutral or supportive. Most programs (80%; n = 4/5) introduced strategies to support resident well-being. Most trainees (84%; n = 16/19) reported the pandemic as having a negative effect on their well-being, with approximately 50% endorsing worse emotional, social, psychological, and physical wellness, as well as feelings of burnout. Some reported difficulties coping (21%; n = 4/19). Residents felt that their wellness was supported externally by their own resilience (89%; n = 17/19), family members (74%; n = 14/19), friends (74%; n = 14/19), their partner (68%; n = 13/19), or co-residents (53%; n = 10/19). Internal support by their program was rated as neutral or negative (63%; n = 12/19).

Conclusions:
Our findings of negative effects of the COVID-19 pandemic on the wellness of Canadian plastic surgery trainees are concerning. Programs must implement appropriate identification and support strategies to improve resident well-being.
Eyebrow Position Before and After Enucleation
Authors: Custer Philip L. , Maamari Robi N. , Huecker Julia B. , Gordon Mae O. 
Published: March 2022

Purpose:
The presence of eyebrow elevation in anophthalmic patients has been used as evidence to support a proprioceptive stimulus for frontalis innervation. In this study, we examined the frequency of brow elevation before and after enucleation and reviewed additional clinical findings to determine if any were associated with eyebrow position.

Methods:
A retrospective study was performed on 134 anophthalmic patients. Demographics, measurements, and photographs were reviewed. Reference photographs were used to subjectively grade brow position and sulcus depth.

Results:
Preoperative eyebrow elevation was present in 56.2% of patients without blepharospasm from a painful eye, of who 62% had chronic visual loss. Ipsilateral ptosis (p = 0.008), deep superior sulcus (p < 0.001), and right-sided pathology (p = 0.045) were more common in patients with brow elevation. Symmetrically elevated brows were more frequent before right than left enucleation (p = 0.05). Brow position remained stable after 61.9% of procedures. While often mild, postoperative brow elevation was seen in 31.0% of patients without preoperative elevation. Deepening of the superior sulcus was more common in patients with new relative brow elevation (p = 0.031). Anophthalmic ptosis and right-left surgical side were not associated with new postoperative brow elevation.

Conclusions:
Eyebrow elevation was often present prior to enucleation and associated with an increased occurrence of ptosis, superior sulcus deepening, and right-sided pathology. Intact vision was not needed to maintain an elevated brow. Superior sulcus deepening, but not ptosis, was more common in patients developing new postoperative brow elevation. The findings support both proprioceptive and compensatory mechanisms for eyebrow elevation.
Psychogenic Ptosis
Authors: Ho Tiffany C. , Couch Steven M. , Custer Philip L. 
Published: March 2022

Purpose:
Psychogenic ptosis is a rare ophthalmic manifestation of conversion disorder. The aim of this study was to describe the clinical parameters, etiology, psychological, and clinical aspects of psychogenic ptosis.

Methods:
A retrospective case series was conducted of patients with psychogenic ptosis seen between 1990 to 2020. Medical records were reviewed for patient demographics, including psychiatric history, clinical findings, diagnostic studies, treatment, and resolution rates. A literature review was performed to identify cases of psychogenic ptosis previously published between 1990 and 2020.

Results:
Six female patients (aged 14–60 years) were diagnosed with unilateral psychogenic ptosis. Physical trauma preceded the onset of ptosis in all cases. Imaging studies had been previously obtained in all patients, none of who were correctly diagnosed at time of referral. Associated signs included concurrent brow ptosis, orbicularis oculi spasm, squint on upgaze, and variable levator function and eyelid margin measurements. Four patients had preexisting psychological conditions. Patients were primarily managed with reassurance.

Conclusions:
Psychogenic ptosis is an often delayed or misdiagnosed condition, resulting in unnecessary referrals and imaging. Psychogenic ptosis should be considered in patients with atypical findings of ptosis including ipsilateral brow depression, orbicularis oculi spasm, squint on upgaze, and variable eyelid measurements. A prior history of minor trauma and female sex were common in this series. Our experience suggests that psychogenic ptosis can often be treated with reassurance, leading to partial or complete resolution. Given the number of patients with comorbid psychiatric conditions, the authors recommend a low threshold for psychiatric or psychological evaluation.
#Oculoplastics: An Analysis of TikTok’s Top Oculoplastics Content
Authors: Cheng Tiffany , Wang Fei , Barmettler Anne 
Published: March 2022

Purpose:
To analyze the source and quality of oculoplastics-related content on TikTok, a popular social media platform.

Methods:
Twenty-five oculoplastics-related hashtags were queried. The top 20 videos for each hashtag were included. The number of views, likes, comments, and shares were recorded for each video. Each video was also categorized by the account owner and by video content characteristics. A subanalysis of the educational videos was conducted using the mDISCERN, Patient Education Materials Assessment Tool, and modified MICI scores to assess video quality, understandability and actionability, and medical accuracy, respectively.

Results:
The included 386 videos amassed 218,997,134 views, 15,033,220 likes, 148,099 comments, and 276,445 shares. Patients were the leading content creators (38.1%), followed by nonophthalmology MDs/DOs (25.6%), and oculoplastic surgeons/ophthalmologists (16.3%). Physician-created videos received more visibility than nonphysician-created videos (median of 23,600 views and 22 shares), though this did not reach statistical significance. However, oculoplastic surgeon-posted content received the lowest median views and shares. The video category that amassed the most views was “live procedure/surgeries,” followed by “educational” and “patient experience.” Subanalysis of 46 educational videos revealed physicians were the chief creators, accounting for 67.4% of all educational videos. Physician-created content demonstrated statistically significant better understandability and actionability, as measured by the Patient Education Materials Assessment Tool (p = 0.0053).

Conclusion:
Physicians play an important role in disseminating evidence-based medicine on social media. While oculoplastics-related TikTok videos are gaining traction, additional research is needed to improve the visibility of oculoplastic-surgeon posted content.
Posttraumatic Endophthalmitis Caused by Medicopsis romeroi
Authors: Garofalo Francesca , Wilcock Jonathan , Lahey Tim 
Published: March 2022

Abstract
Fungal exogenous endophthalmitis is rare. Here, we report a case of posttraumatic endophthalmitis caused by Medicopsis romeroi in a 64-year old man. After a tree branch punctured his right eye while hiking in Laos, the patient's symptoms included pain, blurry vision, limited vision of light and dark, and sensation of a foreign body. The patient was unsuccessfully treated in Thailand with itraconazole and intraocular amphotericin. Upon return to the United States, the patient underwent extensive ophthalmic surgery and voriconazole was prescribed. Fundoscopic examination showed resolution of inflammation 3 months after the surgery, but despite symptomatic improvement, severe visual deficits remained. We performed a comprehensive case review of reported cases of M. romeroi infection, revealing that M. romeroi commonly manifests as a subcutaneous infection on the extremities in immunosuppressed patients who usually resolved with antifungal and surgical therapy. Many patients living in temperate climates were reported to have a travel and/or an immigration pattern from a tropical zone. This case and review extend the clinical spectrum of Medicopsis to include ocular infections, illustrates the importance of considering rare pathogens in patients with exogenous endophthalmitis, and encourages prompt medical and surgical treatment of Medicopsis.
Number of cerebral microbleeds after intracranial/extracranial stenting and dual antiplatelet therapy
Authors: Hsu Huan-Ming , Lu Yueh-Hsun , Su I-Chang , Chan Lung 
Published: March 2022

Background:
Cerebral microbleeds (CMBs) are small (<1 cm) perivascular hemosiderin depositions. They may be visible in T2* or susceptibility-weighted magnetic resonance imaging (MRI) sequences. CMBs may indicate an increased risk of intracerebral hemorrhage (ICH) or vascular disease. Cerebral white matter changes indicate small vessel disease (SVD), which is also related to CMBs. In cerebral vascular treatment, dual antiplatelet therapy (DAPT) is routinely used after stenting. We surveyed our cerebral stenting case series for changes in the number of CMBs.

Methods:
Patients receiving extracranial or intracranial stenting between 2018 and 2020 were included. All patients received DAPT after stenting. Changes in CMBs, SVD degree, and other findings from pretreatment to follow-up MRI were recorded. Differences between stented artery supplying territory and other territories were compared.

Results:
The average age of the 75 enrolled patients was 65.37 years ± 11.53 (50 male and 25 female patients); 84 extracranial or intracranial stentings were performed. The average Fazekas scale score was 1.32 ± 0.77. Significantly more CMBs developed in the initial ≥6 CMB group than in the initial 0 and 1-5 CMB groups (7 ± 3.6 vs 0.56 ± 1.06, 1.45 ± 3.32, p < 0.001). No significant difference in increased CMBs was observed between the initial 0 and 1-5 CMB groups. Significantly more CMBs developed in the stented artery supplying territory than elsewhere (0.6 ± 0.13 vs 0.44 ± 0.17, p < 0.05). No ICH was noted in our case series.

Conclusion:
Preexisting CMB was a risk factor for the onset of new CMBs after stenting and DAPT. Poststenting and DAPT statistically increased CMBs in stented artery supplying territories at short-term follow-up.
Psychometric Testing of the Control Attitudes Scale-Revised for Patients With a Left Ventricular Assist Device
Authors: Thompson Jessica Harman , Moser Debra , Lee Christopher S. 
Published: March 2022

Background
Perceived control, an indicator of the patient's ability to cope and thrive with a chronic illness, is a common target of nursing interventions. As of 2019, more than 25 000 patients had been implanted with a left ventricular assist device (LVAD) as a treatment of advanced heart failure. Patients with an LVAD experience significant life changes that affect anxiety, depression, health-related quality of life, and, presumably, perceived control. To adequately intervene and improve perceived control, a reliable and valid measure is needed.

Objectives
The objectives of this analysis were to (1) assess item discrimination and anticipated range of scores of the Control Attitudes Scale-Revised (CAS-R), (2) assess the internal consistency and validity of the CAS-R, and (3) examine perceived control in a sample of patients with an LVAD.

Methods
Two cohorts of patients with an LVAD (n = 113) were combined to evaluate the psychometric qualities of the CAS-R. Correlations among patient-reported outcomes and perceived control were used to evaluate validity. Cronbach α was used to test internal consistency. Item response theory was used to measure item discrimination and anticipated scores. Descriptive statistics describe perceived control in the sample.

Results
Overall, the CAS-R demonstrated good internal consistency and convergent validity with other patient-reported outcomes. Using the item response theory, we saw that the CAS-R was a good predictor of lower-moderate scorers but was not good at differentiating high performers. There were several items that were poor discriminators and could be altered or discarded to create a more predictive instrument.

Conclusions
The CAS-R is a valid and reliable instrument to measure perceived control in patients who have LVAD implants; however, more work could be done to improve item-level information.
Sleep, Stress, and Symptoms Among People With Heart Failure During the COVID-19 Pandemic
Authors: O'Connell Meghan , Jeon Sangchoon , Conley Samantha , Linsky Sarah , Redeker Nancy S. 
Published: March 2022

Background
The COVID-19 pandemic raised concerns about the effects of stress on sleep and mental health, particularly among people with chronic conditions, including people with heart failure (HF).

Objective
The aim of this study was to examine changes in sleep, sleep-related cognitions, stress, anxiety, and depression among people with HF who participated in a randomized controlled trial of cognitive behavioral therapy for insomnia before the COVID-19 pandemic.

Methods
Participants self-reported sleep characteristics, symptoms, mood, and stress at baseline, 6 months after cognitive behavioral therapy for insomnia or HF self-management education (attention control), and during the pandemic.

Results
The sample included 112 participants (mean age, 63 ± 12.9 years; 47% women; 13% Black; 68% New York Heart Association class II or III). Statistically significant improvements in sleep, stress, mood, and symptoms that occurred 6 months post treatment were sustained during the pandemic.

Conclusions
Improving sleep and symptoms among people with HF may improve coping during stressful events, and cognitive behavioral therapy for insomnia may be protective.
Association Between Interdisciplinary Collaboration and Leadership Ability in Intensive Care Unit Nurses: A Cross-Sectional Study
Authors: YAMAMOTO Kanako 
Published: March 2022

ABSTRACT

Background
Interdisciplinary collaboration in the intensive care unit (ICU) is crucial for improving the quality of patient care. Furthermore, interdisciplinary team members need to establish team leadership to function effectively in solving problems. However, the influence of improving leadership ability in nurses on interdisciplinary collaboration efficacy is uncertain.

Purpose
This study was designed to clarify the relationship between nursing leadership ability and interdisciplinary collaboration.

Methods
This cross-sectional study included 3,324 nurses with > 3 years of experience working in an ICU in Japan as participants. The investigation period was from April to September 2016. The developed questionnaire addressed leadership ability (Self-Assessment Inventory of Leadership role for staff nurses) and activities and perceptions related to multidisciplinary collaboration (Collaboration and Satisfaction About Care Decisions). The questionnaires were then collected and mailed.

Results
The 2,063 valid questionnaire responses gave a valid response rate of 61%. Nursing leadership ability was found to be significantly higher in advanced practice nurses (APNs; 78.8 ± 9.5, p < .001) and nurses in higher positions (74.9 ± 8.9, p < .001) than in non-APNs. However, no differences were found in terms of ICU management systems (p = .116). In addition, higher levels of nursing leadership were associated with greater team coordination (β = .212), higher levels of interdisciplinary collaboration in the ICU (β = .196), and the perception of many medical staff members, as well as patients and family members, to be team members (β = .140) and APNs (β = .128; p < .001).

Conclusions/Implications for Practice
Improving the leadership ability of critical care nurses may impact interdisciplinary collaboration positively. Leadership ability in nurses was shown to be related to a high level of cooperation among multiple healthcare providers. To enhance leadership ability in critical care nurses, nurses must increase their level of knowledge and ability. However, examining and implementing educational methods, including the improvement of coordination ability mainly by APNs, remain a challenge.
A Survey of Combat Athletes' Rapid Weight Loss Practices and Evaluation of the Relationship With Concussion Symptom Recall
Authors: Uddin Nasir , Waldron Mark , Patterson Stephen D. , Winter Stacy , Tallent Jamie 
Published: March 2022

Objective:
There is a high incidence of concussion and frequent utilization of rapid weight loss (RWL) methods among combat sport athletes, yet the apparent similarity in symptoms experienced as a result of a concussion or RWL has not been investigated. This study surveyed combat sports athletes to investigate the differences in symptom onset and recovery between combat sports and evaluated the relationships between concussion and RWL symptoms.

Design:
Cross-sectional study.

Setting:
Data were collected through an online survey.

Participants:
One hundred thirty-two (115 male athletes and 17 female athletes) combat sport athletes.

Interventions:
Modified Sport Concussion Assessment Tool (SCAT) symptom checklist and weight-cutting questionnaire.

Main Outcome Measures:
Survey items included combat sport discipline, weight loss, medical history, weight-cutting questionnaire, and concussion and weight-cutting symptom checklists.

Results:
Strong associations (r
s = 0.6–0.7, P < 0.05) were observed between concussion and RWL symptoms. The most frequently reported symptom resolution times were 24 to 48 hours for a weight cut (WC; 59%) and 3 to 5 days for a concussion (43%), with 60% to 70% of athletes reporting a deterioration and lengthening of concussion symptoms when undergoing a WC. Most of the athletes (65%) also reported at least one WC in their career to “not go according to plan,” resulting in a lack of energy (83%) and strength/power (70%).

Conclusions:
Rapid weight loss and concussion symptoms are strongly associated, with most of the athletes reporting a deterioration of concussion symptoms during a WC. The results indicate that concussion symptoms should be monitored alongside hydration status to avoid any compound effects of prior RWL on the interpretation of concussion assessments and to avoid potential misdiagnoses among combat athletes.
Racial and Gender Disparities Among Obese Patients With Pancreatic Cancer
Authors: Twohig Patrick A. , Butt Muhammad U. , Gardner Timothy B. , Chahal Prabhleen , Sandhu Dalbir S. 
Published: March 2022

Background:
Pancreatic cancer (PC) is the third leading cause of cancer death. Obesity can increase the risk of PC by up to 50%. Studies have shown racial and gender disparities in PC, however, there is a paucity of such information in obese PC patients.

Aim:
The aim of this study was to: (1) evaluate the incidence and prevalence of obesity among PC patients in the United States over the last 15 years, and (2) determine if variation exists in the demographic of obese PC patients over the last 15 years. It is hoped that this information could be used to assist in primary prevention and early detection of PC.

Methods:
A population-based retrospective analysis in IBM Explorys, a pooled, national, deidentified database of 63 million patients from 300 hospitals in the United States. Patient populations were identified using SNOMED and ICD codes. Cochrane-Armitage testing was performed to analyze trends in obesity among PC. Subgroup analysis for gender, age, race, and mortality rate were assessed.

Results:
The percentage of obese patients with PC increased over the 15-year period (2.5% to 8.5%, P<0.0001). Rates of obesity among PC patients increased among females (P=0.0004), individuals under age 65 years (P=0.0002), and all races, but especially for African Americans (P=0.0007) and those in minority groups.

Conclusion:
Awareness of disparities in PC and applying targeted care to those at increased risk are essential to improve future outcomes, including increased health care access and recruitment in research studies for minority groups.