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Recent Research Articles from JPS Health Network

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Updated: 47 min 9 sec ago

Ultrasound in COVID-19: a timeline of ultrasound findings in relation to CT.

Sun, 04/26/2020 - 06:26
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Ultrasound in COVID-19: a timeline of ultrasound findings in relation to CT.

Clin Radiol. 2020 Apr 18;:

Authors: Fiala MJ

PMID: 32331781 [PubMed - as supplied by publisher]

Fetal Aneuploidy: Screening and Diagnostic Testing.

Thu, 04/16/2020 - 05:45

Fetal Aneuploidy: Screening and Diagnostic Testing.

Am Fam Physician. 2020 Apr 15;101(8):481-488

Authors: LeFevre NM, Sundermeyer RL

Abstract
Aneuploidy is the presence of one or more extra chromosomes or the absence of one or more chromosomes. The risk of fetal aneuploidy rises with increasing maternal age. Because fetal aneuploidy can affect any pregnancy, all pregnant women should be offered screening. First-trimester combined screening performed between 10 and 13 weeks' gestation detects 82% to 87% of trisomy 21 (Down syndrome) cases. Second-trimester serum quadruple screening performed between 15 and 22 weeks' gestation detects 81% of trisomy 21 cases. Combinations of these tests include integrated or serum integrated, stepwise sequential, and contingent sequential screenings, all of which improve detection rates compared with each test alone. Fetal cell-free DNA testing (noninvasive prenatal testing) performed at or after 10 weeks' gestation detects more than 99% of trisomy 21 cases, with a lower false-positive rate than traditional first- or second-trimester screening methods. Fetal cell-free DNA testing has similar detection rates in high- and low-risk populations but has lower positive predictive values in younger women. It may be performed as primary screening or as a follow-up test to abnormal findings on first- or second-trimester screenings. Second-trimester ultrasonography has limited utility in aneuploidy screening in women who have already been screened with a first- or second-trimester serum test. Diagnostic tests following a positive screening result include chorionic villus sampling performed between 10 and 13 weeks' gestation or amniocentesis performed after 15 weeks' gestation.

PMID: 32293844 [PubMed - as supplied by publisher]

Breastfeeding practices among childhood cancer survivors.

Thu, 04/16/2020 - 05:45
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Breastfeeding practices among childhood cancer survivors.

J Cancer Surviv. 2020 Apr 14;:

Authors: Ogg S, Klosky JL, Chemaitilly W, Srivastava DK, Wang M, Carney G, Ojha R, Robison LL, Cox CL, Hudson MM

Abstract
PURPOSE: This cross-sectional study compared breastfeeding outcomes among childhood cancer survivors to those of women in the general population and evaluated whether breastfeeding is adversely affected by cancer treatment or endocrine-related late effects.
METHODS: A self-reported survey ascertained breastfeeding practices and incorporated items from the questionnaires used in the Infant Feeding Practices Study II (IFPS II) to allow comparison with the general population. Among 710 eligible survivors, 472 (66%) responded. The participants were predominantly non-Hispanic White (84%), married (73%), and had some college or less (60%). The mean maternal age at the time of birth of the first child after cancer treatment was 24 years (SD 24.3 ± 4.8).
RESULTS: Fewer survivors planned to breastfeed than did IFPS II controls (67% vs. 82%, P < .0001), and fewer survivors initiated breastfeeding (66% vs. 85%, P < .0001). The median breastfeeding duration was shorter among survivors, with early undesired weaning occurring sooner in the survivor group (1.4 months, interquartile range (IQR) 0.5-3.5 months) than in the IFPS II group (2.7 months, IQR 0.9-5.4 months). A higher proportion of survivors reported an unfavorable breastfeeding experience (19% vs. 7.5%, P < .0001) and early, undesired weaning (57.5%, 95% CI 51-64) than did IFPS II participants (45.2%, 95% CI 44-47, P = .0164). Among survivors who expressed intention and chose to breastfeed, 46% endorsed disrupted lactation related to physiologic problems with high risk in those overweight/obese.
CONCLUSIONS: Survivors are at risk of negative breastfeeding experiences; however, lactation outcomes were not significantly associated with cancer diagnosis, treatments, or endocrine complications.
IMPLICATIONS FOR CANCER SURVIVORS: Prior research has not examined the association of cancer treatments and clinically validated late effects with lactation outcomes in a clinically diverse childhood cancer survivor cohort. Findings from this study suggest that childhood cancer survivors, especially those who are overweight/obese, are at risk of having negative breastfeeding experiences. Early undesired weaning, physiologic problems related to lactation and misconceptions about breastfeeding, especially fears of passing on cancer through breastmilk, highlight the need for counseling and specialized support to optimize lactation outcomes in this vulnerable population.

PMID: 32291564 [PubMed - as supplied by publisher]

Empirical comparison of approaches for odds ratios to risk ratio transformations in meta-analyses of randomized controlled trials with common outcomes.

Thu, 04/09/2020 - 07:53
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Empirical comparison of approaches for odds ratios to risk ratio transformations in meta-analyses of randomized controlled trials with common outcomes.

Ann Epidemiol. 2020 Mar 26;:

Authors: Chu TC, Ojha RP, VanderWeele TJ

PMID: 32265076 [PubMed - as supplied by publisher]

Prolonged Steroid Dependence in Adult Patients With Glioma.

Fri, 04/03/2020 - 07:10
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Prolonged Steroid Dependence in Adult Patients With Glioma.

Anticancer Res. 2020 Apr;40(4):2059-2064

Authors: Mantilla EC, Abramowitz J, Dan TU, Pan E

Abstract
BACKGROUND/AIM: Prolonged use of glucocorticoids (GC) in glioma treatment can lead to adrenal insufficiency (AI) and subsequent steroid dependence due to suppression of the hypothalamic-pituitary-adrenal (HPA) axis. This is challenging to diagnose due to its nonspecific clinical symptoms erroneously ascribed to treatment. This study aimed to evaluate the risk factors predisposing patients with gliomas to develop AI.
PATIENTS AND METHODS: Charts in the neuro-oncology clinic from July 2018 to March 2019 were reviewed. Inclusion criteria included >18 y/o with WHO Grade II-IV gliomas, and secondary AI. Demographic profile, tumor characteristics, and treatment profile were compared.
RESULTS: The majority of patients were started on high dose dexamethasone at >8 mg daily, and were on dexamethasone for 4-8 months. The minimum dose needed to prevent symptoms was 0.5 mg to 2 mg daily. The majority received standard radiation doses ranging from 54-60 Gy. Most patients had radiation exposure to the HPA axis within the prescription isodose levels.
CONCLUSION: Prolonged steroid dependency can result from chronic GC use in patients with glioma. Dose and duration of GC are risk factors for its development. Radiation exposure to the HPA axis may also be a contributing factor.

PMID: 32234897 [PubMed - in process]

Experience With "Jaw in a Day" Technique.

Wed, 04/01/2020 - 08:01
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Experience With "Jaw in a Day" Technique.

J Craniofac Surg. 2020 Mar 27;:

Authors: Sukato DC, Hammer D, Wang W, Shokri T, Williams F, Ducic Y

Abstract
The "Jaw in a Day" (JIAD) technique, first described by Levine and colleagues, establishes immediate functional occlusion through a single-stage maxillomandibular reconstruction with concurrent implant placement and provisional prosthesis delivery. In this study, the authors describe 2 cases exemplifying the reconstructive principles of JIAD. One patient underwent mandibular reconstruction with the JIAD technique and another patient underwent JIAD with an optimized rapid sequence computer-aided design and computer-aided manufacturing (CAD-CAM) for composite maxillomandibular reconstruction. Immediate implant-borne prosthesis was fixated and all implants osseointegrated into the neomandible. Although the authors' patient outcomes are consistent with the literature, the published reports of JIAD remain limited, and further studies are required to assess the long-term functional and aesthetic outcomes as well as cost-effectiveness of this approach.

PMID: 32224781 [PubMed - as supplied by publisher]

A Biomechanical Examination of Prefabricated Total Contact Cast Kits: Relevance to Patients With Diabetic Neuropathy.

Wed, 04/01/2020 - 08:01
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A Biomechanical Examination of Prefabricated Total Contact Cast Kits: Relevance to Patients With Diabetic Neuropathy.

Int J Low Extrem Wounds. 2020 Mar 29;:1534734620914440

Authors: Ersen A, Lavery LA, Monga A, Richardson M, Schwarz B, Quiben MU, Garrett AG, Flyzik M, Wukich DK, Yavuz M

Abstract
The traditional Total Contact Cast (TCC) is considered the gold standard for treating plantar diabetic ulcers. A number of prefabricated TCC kits have been introduced, which offer a user-friendly casting process for health care providers. Our objective was to evaluate pressure reduction and gait characteristics after application of a TCC kit (TCC-EZ) and traditional TCC. Fifteen individuals (9 males, 6 females; median age of 51.5 years [range = 40.5-71.2 years]) completed 30-m walking trials while fitted with TCC-EZ and TCC in a randomized order. A pair of automated wireless photogate sensors captured time to traverse the distance and pedobarographic insoles measured and recorded plantar pressures. Paired t tests were used to compare peak pressure, gait speed, and cast weights across the 2 modalities. Peak pressure and cast weight were significantly lower in the TCC-EZ arm (169.6 ± 41.3 kPa vs 214.9 ± 63.2 kPa, P = .0048; and 1.79 ± 0.17 kg vs 2.11 ± 0.25 kg, P = .0004). Contact area and gait speed were not significantly different between the 2 modalities (140.4 ± 25.8 cm2 vs 126.9 ± 37.8 cm2, P = .0228, Cohen's d = 0.40; and 0.94 ± 0.19 m/s vs 0.83 ± 0.26 m/s, P = .0532, Cohen's d = .48). TCC-EZ was found to provide more favorable pressure distributions compared with TCC. TCC-EZ is also lighter and may be a preferred treatment modality for patients. More research is necessary to reveal the clinical effectiveness of prefabricated total contact kits.

PMID: 32223354 [PubMed - as supplied by publisher]

Cholecystectomy does not worsen progression or outcomes in non-alcoholic fatty liver disease.

Fri, 03/20/2020 - 07:43
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Cholecystectomy does not worsen progression or outcomes in non-alcoholic fatty liver disease.

Transl Gastroenterol Hepatol. 2020;5:3

Authors: Kakati D, Kumar U, Russ K, Shoreibah M, Kuo YF, Jackson B, Singal AK

Abstract
Background: Cholecystectomy is a frequently performed surgical procedure for symptomatic cholelithiasis, which is reported to be more common in patients with non-alcoholic steatohepatitis (NASH), given the common risk factors. However, the data remains unclear on the association of cholecystectomy with NASH. We performed a retrospective study to examine the association of cholecystectomy and NASH.
Methods: Medical charts of patients with steatohepatitis related liver disease at a tertiary care center from 2004 to 2011 were stratified by cholecystectomy and defined by its history and/or absence of gallbladder on ultrasonography. Logistic regression model was built for predictors of cholecystectomy. Patients with NASH were stratified based on timing of cholecystectomy. The diagnosis of NASH and timing of cholecystectomy were compared based on baseline characteristics and outcomes (liver disease complications and survival) on follow up. Kaplan-Meier curves were generated for the two group comparisons. Chi-square and unpaired t-tests were used for comparing outcomes on follow up. P value <0.05 was considered significant.
Results: Analysis of 584 patients [379 non-alcoholic fatty liver disease (NAFLD)] showed that patients with cholecystectomy (N=191) were more likely to be female (57% vs. 44%), diabetic (53% vs. 37%), have liver biopsy (43% vs. 25%) and diagnosis of NAFLD (80% vs. 58%) P<0.001 for all. NAFLD diagnosis was associated with 2.79 folds odds of cholecystectomy. Among 379 (192 cholecystectomy) NAFLD patients, cirrhosis and female gender were associated with over 2 and 1.5 folds of cholecystectomy. Of 141 patients with data on timing of cholecystectomy, 55 (39%) with cholecystectomy at or after NAFLD diagnosis vs. 86 with cholecystectomy within median of 6 years prior to NAFLD diagnosis were similar on all characteristics except on model for end-stage liver disease (MELD) score (9.2±8.4 vs. 6.4±7.1, P=0.045). Of 28 with available histology data, there were no differences on histology based on timing of cholecystectomy. On a median follow up of 5 years, timing of cholecystectomy did not impact on development of cirrhosis (74% vs. 67%, P=0.45), ascites (31% vs. 38%, P=0.76), variceal bleeding (11% vs. 16%, P=0.44), hepatic encephalopathy (22% vs. 29%, P=0.74), hepatocellular carcinoma (HCC) (15% vs. 9%, P=0.59), and patient survival (95% vs. 98%, P=0.3).
Conclusions: Cholecystectomy is associated with NAFLD diagnosis. We did not find cause and effect of cholecystectomy in the development of severity of NAFLD. Prospective studies are suggested to examine the role of cholecystectomy and bile acids in the pathogenesis of NAFLD.

PMID: 32190771 [PubMed]

Getting It Off the Ground: Key Factors Associated With Implementation of Wellness Programs.

Thu, 03/12/2020 - 06:43
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Getting It Off the Ground: Key Factors Associated With Implementation of Wellness Programs.

Fam Med. 2020 Mar;52(3):182-188

Authors: Penwell-Waines L, Cronholm PF, Brennan J, Romain A, Runyan C, Buck K, Fazio L, Grace A, Ricker M, Ross V, Schneiderhan J, Talen M

Abstract
BACKGROUND AND OBJECTIVES: Many residency programs are developing resident wellness curricula to improve resident well-being and to meet Accreditation Council for Graduate Medical Education guidelines. However, there is limited guidance on preferred curricular components and implementation. We sought to identify how specific driving factors (eg, having an identified wellness champion with a budget and protected time to develop wellness programs) impact implementation of essential elements of a resident wellness curriculum.
METHODS: We surveyed 608 family medicine residency program directors (PDs) in 2018-2019 on available resources for wellness programs, essential wellness elements being implemented, and satisfaction with wellness programming; 251 PDs provided complete responses (42.5% response rate). Linear and logistic regressions were conducted for main analyses.
RESULTS: Having an identified wellness champion, protected time, and dedicated budget for wellness were associated with greater implementation of wellness programs and PD satisfaction with wellness programming; of these, funding had the strongest association. Larger programs were implementing more wellness program components. Program setting had no association with implementation.
CONCLUSIONS: PDs in programs allocating money and/or faculty time can expect more wellness programming and greater satisfaction with how resident well-being is addressed.

PMID: 32159829 [PubMed - as supplied by publisher]

Spindle Cell Sarcoma of the Maxilla: A Rare Entity, Case Report, and Review of the Literature.

Tue, 03/10/2020 - 06:06
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Spindle Cell Sarcoma of the Maxilla: A Rare Entity, Case Report, and Review of the Literature.

J Oral Maxillofac Surg. 2020 Feb 12;:

Authors: Schwitzer D, Kim R, Williams F, Hammer D

Abstract
Spindle cell sarcoma (SCS) is a malignancy, with the most recent Surveillance, Epidemiology, and End Results (SEER) data citing a total of 250 reported cases occurring in the head and neck. Of these cases, none originated in the maxillofacial hard tissue. To the best of our knowledge, only 2 cases of primary osseous SCS of the maxillofacial region have been reported. These cases were not accounted for in the SEER data. The diagnosis of SCS requires its differentiation from other sarcomas and spindle cell neoplasms. Therefore, a comprehensive review to reinforce its inclusion in oral and maxillofacial surgeons' differential diagnosis for osseous neoplastic pathology is desired. In the present case report, we have described a maxillary SCS in a patient with an initial diagnosis of a spindle cell lesion of uncertain biologic behavior. We reviewed the data for SCS, including the epidemiologic data, diagnostic challenges, clinical and radiographic presentations, prognostic indicators, and treatment.

PMID: 32147227 [PubMed - as supplied by publisher]

Peripheral nerve repair throughout the body with processed nerve allografts: Results from a large multicenter study.

Thu, 02/27/2020 - 05:20
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Peripheral nerve repair throughout the body with processed nerve allografts: Results from a large multicenter study.

Microsurgery. 2020 Feb 26;:

Authors: Safa B, Jain S, Mihir DJ, Greenberg JA, Niacaris TR, Nydick JA, Leversedge FJ, Megee DM, Zoldos J, Rinker BD, McKee DM, MacKay BJ, Ingari JV, Nesti LJ, Cho M, Valerio IL, Kao DS, El-Sheikh Y, Weber RV, Shores JT, Styron JF, Thayer WP, Przylecki WH, Hoyen HA, Buncke GM

Abstract
BACKGROUND: Peripheral nerve damage resulting in pain, loss of sensation, or motor function may necessitate a reconstruction with a bridging material. The RANGER® Registry was designed to evaluate outcomes following nerve repair with processed nerve allograft (Avance® Nerve Graft; Axogen; Alachua, FL). Here we report on the results from the largest peripheral nerve registry to-date.
METHODS: This multicenter IRB-approved registry study collected data from patients repaired with processed nerve allograft (PNA). Sites followed their own standard of care for patient treatment and follow-up. Data were assessed for meaningful recovery, defined as ≥S3/M3 to remain consistent with previously published results, and comparisons were made to reference literature.
RESULTS: The study included 385 subjects and 624 nerve repairs. Overall, 82% meaningful recovery (MR) was achieved across sensory, mixed, and motor nerve repairs up to gaps of 70 mm. No related adverse events were reported. There were no significant differences in MR across the nerve type, age, time-to-repair, and smoking status subgroups in the upper extremity (p > .05). Significant differences were noted by the mechanism of injury subgroups between complex injures (74%) as compared to lacerations (85%) or neuroma resections (94%) (p = .03) and by gap length between the <15 mm and 50-70 mm gap subgroups, 91 and 69% MR, respectively (p = .01). Results were comparable to historical literature for nerve autograft and exceed that of conduit.
CONCLUSIONS: These findings provide clinical evidence to support the continued use of PNA up to 70 mm in sensory, mixed and motor nerve repair throughout the body and across a broad patient population.

PMID: 32101338 [PubMed - as supplied by publisher]

Validating Invalidation: Examining the Construct Validity of the Illness Invalidation Inventory among Individuals with Chronic Low Back Pain.

Wed, 02/19/2020 - 10:05

Validating Invalidation: Examining the Construct Validity of the Illness Invalidation Inventory among Individuals with Chronic Low Back Pain.

Clin J Pain. 2020 Feb 14;:

Authors: Molzof HE, Newman AK, Barnett MD, Guck A, Scott W, Sturgeon JA, Trost Z

Abstract
OBJECTIVES: The Illness Invalidation Inventory (3*I) was designed to assess individuals' perceived invalidation regarding chronic pain experiences. However, no study has yet investigated the psychometric properties of the 3*I among individuals with chronic low back pain (CLBP). Given the personal and societal impact of CLBP and the potential for invalidation associated with this condition, the current study sought to examine the psychometric properties of the 3*I among individuals with CLBP.
MATERIALS AND METHODS: Community-dwelling adults with CLBP living in the Southwestern United States (N=134) completed the 3*I. In line with previous literature, current analyses focused on the 3*I "family members" subscale. Exploratory and confirmatory factor analysis were performed on participant responses. Hierarchical linear regression analyses examined the relationship between the identified factors and participant self-reported pain severity, disability, and depression.
RESULTS: Exploratory factor analysis conducted on the 3*I "family members" subscale found two factors with high internal consistency (α>0.70) that cumulatively accounted for 49.04% of the variance in scores. Consistent with previous findings, factor loadings suggested that these factors correspond to "discounting" and "lack of understanding." Subsequent confirmatory factor analysis found that this two-factor model demonstrated good fit with the data. Greater perceived discounting by family members was associated with greater pain severity, disability, and depression.
DISCUSSION: The two-factor model of the 3*I "family members" subscale identified in the current study reflects previous findings and further extends the psychometric validity of the 3*I to a US multiethnic sample of individuals with CLBP.

PMID: 32068539 [PubMed - as supplied by publisher]

Association of ultrasound-related interruption during cardiopulmonary resuscitation with adult cardiac arrest outcomes: A video-reviewed retrospective study.

Wed, 02/19/2020 - 10:05

Association of ultrasound-related interruption during cardiopulmonary resuscitation with adult cardiac arrest outcomes: A video-reviewed retrospective study.

Resuscitation. 2020 Feb 14;:

Authors: Chou EH, Wang CH, Monfort R, Likourezos A, Wolfshohl J, Lu TC, Hsieh YL, Haines L, Dickman E, Lin J

Abstract
OBJECTIVES: To determine the association of focused transthoracic echocardiography (ECHO) related interruption during cardiopulmonary resuscitation (CPR) with patient outcomes in the Emergency Department (ED).
METHODS: This was a retrospective, single center, cohort study, conducted in an urban community teaching ED. Eligible study subjects were adult patients in the ED with sustained cardiac arrest. Exclusion criteria include traumatic cardiac arrest and age less than 18. All resuscitations were video recorded and were subsequently reviewed by 2 study investigators. The no-flow time from chest compression interruption was analyzed using video review and separated into ECHO-related and non-ECHOrelated. Our primary outcome was patient survival to hospital discharge and the secondary outcome was the rate of return of spontaneous circulation (ROSC). Multivariate logistic regression analyses were performed to examine the associations between independent variables and outcomes.
RESULTS: From January 2016 to May 2017, a total of 210 patients were included for final analysis. The median total no-flow time observed on video was 99.5 seconds (IQR: 54.0-160.0 seconds). Among these, a median of 26.5 seconds (IQR: 0.0-59.0 seconds) was ECHO-related and a median of 60.5 seconds (IQR: 34.0-101.9) was non-ECHO-related. The ECHO-related noflow time between 77 and 122 seconds (OR: 7.31, 95% confidence interval [CI]: 1.59-33.59; p-value = 0.01) and ECHO-related interruption≦2 times (OR: 8.22, 95% CI: 1.51-44.64; p-value = 0.01) were positively associated with survival to hospital discharge. ECHO-related interruption≦2 times (OR: 5.55, 95% CI: 2.44-12.61; p-value <0.001) was also positively associated with ROSC.
CONCLUSION: Short ECHO-related interruption during CPR was positively associated with ROSC and survival to hospital discharge. While ECHO can be a valuable diagnostic tool during CPR, the no-flow time associated with ECHO should be minimized.

PMID: 32068026 [PubMed - as supplied by publisher]

Two-step predictive model for early detection of emergency department patients with prolonged stay and its management implications.

Tue, 02/18/2020 - 18:10
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Two-step predictive model for early detection of emergency department patients with prolonged stay and its management implications.

Am J Emerg Med. 2020 Jan 30;:

Authors: d'Etienne JP, Zhou Y, Kan C, Shaikh S, Ho AF, Suley E, Blustein EC, Schrader CD, Zenarosa NR, Wang H

Abstract
OBJECTIVE: To develop a novel model for predicting Emergency Department (ED) prolonged length of stay (LOS) patients upon triage completion, and further investigate the benefit of a targeted intervention for patients with prolonged ED LOS.
MATERIALS AND METHODS: A two-step model to predict patients with prolonged ED LOS (>16 h) was constructed. This model was initially used to predict ED resource usage and was subsequently adapted to predict patient ED LOS based on the number of ED resources using binary logistic regressions and was validated internally with accuracy. Finally, a discrete event simulation was used to move patients with predicted prolonged ED LOS directly to a virtual Clinical Decision Unit (CDU). The changes of ED crowding status (Overcrowding, Crowding, and Not-Crowding) and savings of ED bed-hour equivalents were estimated as the measures of the efficacy of this intervention.
RESULTS: We screened a total of 123,975 patient visits with final enrollment of 110,471 patient visits. The overall accuracy of the final model predicting prolonged patient LOS was 67.8%. The C-index of this model ranges from 0.72 to 0.82. By implementing the proposed intervention, the simulation showed a 12% (1044/8760) reduction of ED overcrowded status - an equivalent savings of 129.3 ED bed-hours per day.
CONCLUSIONS: Early prediction of prolonged ED LOS patients and subsequent (simulated) early CDU transfer could lead to more efficiently utilization of ED resources and improved efficacy of ED operations. This study provides evidence to support the implementation of this novel intervention into real healthcare practice.

PMID: 32063427 [PubMed - as supplied by publisher]

Authors' Reply to "Working Together to Heal Our Physician Well-Being Crisis".

Thu, 02/13/2020 - 06:33
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Authors' Reply to "Working Together to Heal Our Physician Well-Being Crisis".

Fam Med. 2020 Feb;52(2):153-154

Authors: Penwell-Waines L, Schneiderhan J, Ross V, Grace A, Buck K, Brennan J

PMID: 32050277 [PubMed - in process]

Productivity, efficiency, and overall performance comparisons between attendings working solo versus attendings working with residents staffing models in an emergency department: A Large-Scale Retrospective Observational Study.

Thu, 02/06/2020 - 05:19

Productivity, efficiency, and overall performance comparisons between attendings working solo versus attendings working with residents staffing models in an emergency department: A Large-Scale Retrospective Observational Study.

PLoS One. 2020;15(2):e0228719

Authors: Robinson RD, Dib S, Mclarty D, Shaikh S, Cheeti R, Zhou Y, Ghasemi Y, Rahman M, Schrader CD, Wang H

Abstract
BACKGROUND AND OBJECTIVE: Attending physician productivity and efficiency can be affected when working simultaneously with Residents. To gain a better understanding of this effect, we aim to compare productivity, efficiency, and overall performance differences among Attendings working solo versus working with Residents in an Emergency Department (ED).
METHODS: Data were extracted from the electronic medical records of all patients seen by ED Attendings and/or Residents during the period July 1, 2014 through June 30, 2017. Attending productivity was measured based on the number of new patients enrolled per hour per provider. Attending efficiency was measured based on the provider-to-disposition time (PDT). Attending overall performance was measured by Attending Performance Index (API). Furthermore, Attending productivity, efficiency, and overall performance metrics were compared between Attendings working solo and Attendings working with Residents. The comparisons were analyzed after adjusting for confounders via propensity score matching.
RESULTS: A total of 15 Attendings and 266 Residents managing 111,145 patient encounters over the study period were analyzed. The mean (standard deviation) of Attending productivity and efficiency were 2.9 (1.6) new patients per hour and 2.7 (1.8) hours per patient for Attendings working solo, in comparison to 3.3 (1.9) and 3.0 (2.0) for Attendings working with Residents. When paired with Residents, the API decreased for those Attendings who had a higher API when working solo (average API dropped from 0.21 to 0.19), whereas API increased for those who had a lower API when working solo (average API increased from 0.13 to 0.16).
CONCLUSION: In comparison to the Attending working solo staffing model, increased productivity with decreased efficiency occurred among Attendings when working with Residents. The overall performance of Attendings when working with Residents varied inversely against their performance when working solo.

PMID: 32023302 [PubMed - in process]

Paramedian Forehead Flap.

Wed, 02/05/2020 - 16:25
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Paramedian Forehead Flap.

Atlas Oral Maxillofac Surg Clin North Am. 2020 Mar;28(1):23-28

Authors: Hammer D, Williams F, Kim R

PMID: 32008706 [PubMed - in process]

Muscular architecture of the popliteus muscle and the basic science implications.

Mon, 01/20/2020 - 05:38

Muscular architecture of the popliteus muscle and the basic science implications.

Knee. 2020 Jan 15;:

Authors: Wood A, Boren M, Dodgen T, Wagner R, Patterson RM

Abstract
BACKGROUND: The function of the popliteus muscle is largely treated as a static stabilizer and has a lack of basic muscular architectural data to enable study of its dynamic function. A large volume of literature supports its static function and the essential need for reconstruction in the posterolateral knee when injured to restore knee stability.
HYPOTHESIS/PURPOSE: We hypothesize that the popliteus muscle is more significant as a dynamic presence in the knee.
METHODS: A collection of popliteus architectural data was collected from 28 cadaver specimens (mean (SD) 76 years (11)). Physiological cross-sectional area of the popliteus and semimembranosus muscles were calculated from muscle volume and fiber length to power future muscle force prediction models. Posterior knee muscle trajectories were measured with respect to the longitudinal axis of the tibia. A 2-tailed T test was performed.
RESULTS: Significant differences between males and females were found for both the popliteus (p = 1.1E-05) and semimembranosus (p = 2.0E-05) muscle volumes. Significant differences between males and females were also found in PCSA for the popliteus (p = 0.005) and semimembranosus (p = 4.1E-05) muscles. There were no significant differences in fiber length, overall muscle length (with tendon removed), age, and orientation.
CONCLUSION: Further consideration should be given to include the popliteus muscle as a dynamic entity in the knee given its mechanical properties, trajectory, and prior biomechanical evidence showing when and how it is activated. The present study provides data that may shape future directions of research and treatment with regard to posterolateral corner injuries and ligamentous balancing of the knee.

PMID: 31954610 [PubMed - as supplied by publisher]

Kinematic Analysis of Combined Suture-Button and Suture Anchor Augment Constructs for Ankle Syndesmosis Injuries.

Fri, 01/17/2020 - 05:50
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Kinematic Analysis of Combined Suture-Button and Suture Anchor Augment Constructs for Ankle Syndesmosis Injuries.

Foot Ankle Int. 2020 Jan 15;:1071100719898181

Authors: Wood AR, Arshad SA, Kim H, Stewart D

Abstract
BACKGROUND: Syndesmosis injuries are common, with up to 25% of all ankle injuries being reported to involve an associated syndesmosis injury. These injuries are typically treated with cortical screw fixation or suture-button implants when indicated, but the addition of a suture anchor augment implant has yet to be evaluated. The purpose of this study was to evaluate the ability of a suture anchor augment to add sagittal plane translational and transverse plane rotational constraint to suture-button constructs with syndesmosis injuries. We hypothesized that the suture anchor augment oriented in parallel with the fibers of an injured anterior-inferior tibiofibular ligament (AITFL) in addition to a suture-button construct would achieve physiological motion and stability at the syndesmosis through increased rotational and translational constraint of the fibula.
METHODS: Eleven fresh-frozen cadaver ankles were stressed in external rotation using a custom-made ankle rig. Each ankle had simultaneous recording of ultrasound video, 6 degrees-of-freedom kinematics of the fibula and tibia, and torque as the ankle was stressed by an examiner. The ankles were tested in 6 different states: native uninjured; injured with interosseous ligament and AITFL sectioned; 1× suture button; 2× suture buttons, divergent; 1× suture anchor augment with 2× suture buttons, divergent; and 1× suture anchor augment with 1× suture buttons.
RESULTS: Only the suture anchor augment + 2× suture buttons and suture anchor augment + 1× suture-button constructs were found to be significantly different from the injured state (P = .0003, P = .002) with mean external rotation of the fibula.
CONCLUSION: Overall, the most important finding of this study was that the addition of a suture anchor augment to suture-button constructs provided a mechanism to increase external rotational constraint of the fibula.
CLINICAL RELEVANCE: This study provides a mechanistic understanding of how the combined suture-button and suture anchor augment construct provides an anatomically similar reconstruction of constraints found in the native ankle. However, none of the constructs examined in this study were able to fully restore physiologic motion.

PMID: 31941352 [PubMed - as supplied by publisher]

Gender differences in diversion among non-medical users of prescription opioids and sedatives.

Wed, 01/15/2020 - 06:30

Gender differences in diversion among non-medical users of prescription opioids and sedatives.

Am J Drug Alcohol Abuse. 2020 Jan 14;:1-8

Authors: Milani SA, Lloyd SL, Serdarevic M, Cottler LB, Striley CW

Abstract
Background: Non-medical use of prescription drugs is a major public health concern in the United States. Prescription opioids and sedatives are among the most widely abused drugs and their combined use can be lethal. Increasingly rigid prescribing guidelines may contribute to the changing context of opioid use and increase drug diversion.Objective: To examine gender differences in diversion of prescription opioids and sedatives among non-medical prescription opioid and sedative polysubstance users. We hypothesize that men will be more likely than women to engage in incoming diversion.Methods: Data from the Prescription Drug Abuse, Misuse, and Dependence Study, a cross-sectional study focused on prescription drug users, were analyzed. Non-medical use was defined as use of a drug that was not prescribed or use in a way other than prescribed. Individuals who reported past 12-month non-medical opioid and sedative use were included; diversion was defined as incoming (obtaining drugs from a source other than a health professional) and outgoing (giving away/selling/trading prescription drugs).Results: Among the 198 polysubstance users, 41.4% were female. Men were 2.85 times as likely as women to report incoming diversion (95% CI: 1.21-6.72). Women were more likely to obtain opioids from a healthcare professional; men were more likely to obtain sedatives from a roommate, coworker, or friend. Over half of men and women reported outgoing diversion opioids or sedatives.Conclusion: Drug diversion highlights an important point of intervention. Current prevention efforts that target prescribers should be expanded to include users and diversion activities; these interventions should be gender-specific.

PMID: 31935131 [PubMed - as supplied by publisher]

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