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Facial Plastic Surgery Clinics of North... May 2020Contemporary hair transplant surgery creates natural appearing transplanted hair. The procedure is performed as an outpatient under local anesthesia. Donor harvesting... (Review)
Review
Contemporary hair transplant surgery creates natural appearing transplanted hair. The procedure is performed as an outpatient under local anesthesia. Donor harvesting can be performed by either elliptical donor harvesting or follicular unit extraction. An experience surgical team is needed for a high-quality, efficient procedure. Robotic hair transplantation allows precise and efficient removal of follicular units. The robot allows for minimally invasive surgery. Robotic hair transplantation is an important tool for hair transplant surgeons, but does not replace appropriate candidate selection, hairline design, and the judgment of where to place and not place transplanted hair for optimal short- and long-term results.
Topics: Alopecia; Hair Follicle; Humans; Patient Selection; Robotic Surgical Procedures; Skin Transplantation; Tissue and Organ Harvesting
PubMed: 32312506
DOI: 10.1016/j.fsc.2020.01.011 -
Biometrics Sep 2023Rerandomization discards assignments with covariates unbalanced in the treatment and control groups to improve estimation and inference efficiency. However, the...
Rerandomization discards assignments with covariates unbalanced in the treatment and control groups to improve estimation and inference efficiency. However, the acceptance-rejection sampling method used in rerandomization is computationally inefficient. As a result, it is time-consuming for rerandomization to draw numerous independent assignments, which are necessary for performing Fisher randomization tests and constructing randomization-based confidence intervals. To address this problem, we propose a pair-switching rerandomization (PSRR) method to draw balanced assignments efficiently. We obtain the unbiasedness and variance reduction of the difference-in-means estimator and show that the Fisher randomization tests are valid under PSRR. Moreover, we propose an exact approach to invert Fisher randomization tests to confidence intervals, which is faster than the existing methods. In addition, our method is applicable to both nonsequentially and sequentially randomized experiments. We conduct comprehensive simulation studies to compare the finite-sample performance of the proposed method with that of classical rerandomization. Simulation results indicate that PSRR leads to comparable power of Fisher randomization tests and is 3-23 times faster than classical rerandomization. Finally, we apply the PSRR method to analyze two clinical trial datasets, both of which demonstrate the advantages of our method.
Topics: Research Design; Computer Simulation; Sample Size
PubMed: 35758335
DOI: 10.1111/biom.13712 -
Physical Medicine and Rehabilitation... Nov 2020Performing artists are a unique subset of athletes. With the highly repetitive nature of performance training, emphasis on proper technique, ergonomics, and preventive... (Review)
Review
Performing artists are a unique subset of athletes. With the highly repetitive nature of performance training, emphasis on proper technique, ergonomics, and preventive cross-training is vital, as many injuries are due to overuse or poor technique. There are novel medical concerns in performers, including ENT problems, mental health concerns and substance use risks. While music is central to performances, it is also a treatment modality to address cognitive, sensory, and motor dysfunctions in certain neurological conditions. Due to this wide array of issues, it is imperative to understand the specific needs and risks of performers to provide optimal medical care.
Topics: Athletic Injuries; Cumulative Trauma Disorders; Dancing; Humans; Movement Disorders; Musculoskeletal Diseases; Music; Rehabilitation
PubMed: 32981582
DOI: 10.1016/j.pmr.2020.08.001 -
Minerva Chirurgica Oct 2019Sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), and one anastomosis gastric bypass (OAGB) are the commonest bariatric procedures performed worldwide. The... (Review)
Review
INTRODUCTION
Sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), and one anastomosis gastric bypass (OAGB) are the commonest bariatric procedures performed worldwide. The purpose of this review was to analyze comparative data on these three procedures to aid patient and procedure selection for patients seeking bariatric and metabolic surgery (BMS).
EVIDENCE ACQUISITION
We examined published English language scientific literature available on PubMed for data comparing SG, RYGB, and OAGB for various groups of patients.
EVIDENCE SYNTHESIS
There are a number of variables that can influence patient and procedure selection for individuals seeking BMS. High-quality data comparing each of these procedures for every patient subgroup, for each possible outcome measure is lacking. It is, therefore, not currently possible to make strict recommendations regarding patient and procedure selection. At the same time, the multidisciplinary teams should understand that risks of surgery may simply be too high for some patients - such as those suffering from end-stage organ disease and those suffering from mega obesity (BMI ≥70 kg/m2). Surgery should only be offered to such high-risk groups in dedicated centers with appropriate expertise. For other patients, surgeons should carefully consider the pros and cons of each procedure, their own experience, and patient preferences before deciding the most appropriate BMS procedure for them.
CONCLUSIONS
This review examines various factors influencing patient and procedure selection in bariatric surgery. Authors feel it is currently not possible to make strict recommendations and surgeons should carefully discuss the pros and cons of bariatric surgery and that of various options available in their practice with the patients before making a final recommendation.
Topics: Gastrectomy; Gastric Bypass; Humans; Obesity, Morbid; Patient Selection
PubMed: 31359745
DOI: 10.23736/S0026-4733.19.08121-5 -
Medizinische Klinik, Intensivmedizin... Oct 2022Extracorporeal cardiopulmonary resuscitation (eCPR) is the implementation of extracorporeal membrane oxygenation (ECMO) in selected patients with cardiac arrest and may... (Review)
Review
Extracorporeal cardiopulmonary resuscitation (eCPR) is the implementation of extracorporeal membrane oxygenation (ECMO) in selected patients with cardiac arrest and may be considered when conventional CPR efforts fail, as written in the latest international guidelines. eCPR is a complex intervention that requires a highly trained team, specialized equipment, and multidisciplinary support within a healthcare system and it has the risk of several life-threatening complications. However, there are no randomized, controlled studies on eCPR, and valid predictors of benefit and outcome are lacking. Therefore, optimal timing, patient selection, location and method of implementation vary across centers. As utilization of eCPR has increased in recent years and more centers begin to perform eCPR, considerable uncertainties exist in the prehospital setting as well as in the emergency room. However, structured communication and clearly defined processes are essential especially at the interface between prehospital rescue teams and the eCPR team to achieve the highest possible benefit for cardiac arrest patients using eCPR. This article presents an algorithm for structured, evidence-based logistic considerations, patient selection, and implementation of eCPR as well as early care after establishment of extracorporeal life support (ECLS) which are mainly based on the German national recommendations for eCPR of DGIIN, DGK, DGTHG, DGfK, DGNI, DGAI, DIVI and GRC published in 2019 as well as the S3 guideline "Use of extracorporeal circulation (ECLS/ECMO) for cardiac and circulatory failure" and local standard operating procedures of the authors.
Topics: Cardiopulmonary Resuscitation; Emergency Service, Hospital; Extracorporeal Membrane Oxygenation; Heart Arrest; Humans; Out-of-Hospital Cardiac Arrest; Patient Selection; Retrospective Studies
PubMed: 33835193
DOI: 10.1007/s00063-021-00796-2 -
Transfusion and Apheresis Science :... Oct 2023Significant advances in procedural information displayed by current apheresis machines have been made, but analyses of cell collection efficiency (CE) still rely on...
Significant advances in procedural information displayed by current apheresis machines have been made, but analyses of cell collection efficiency (CE) still rely on calculations done by apheresis professionals. Accordingly, understanding CE equations can support the optimization of apheresis techniques and identification of incidents that could impact the procedure's effectiveness. This report summarizes classical and novel CE analyses applied to apheresis exemplified by an actual case of hematopoietic progenitor cell collection. In addition to the apheresis yield and most common CE and CE formulas, we present the instantaneous and corrected CE, fold enrichment, collection throughput, collection rate and its variants, average inlet rate, classical and adjusted captured cells, recruitment pool, recruitment factor, recruitment coefficient, blood component loss, predictive apheresis yield, and performance ratio calculations. Moreover, the mathematical relationship between these CE equations is also shown, which can be helpful in many apheresis procedures.
Topics: Humans; Leukapheresis; Blood Component Removal; Hematopoietic Stem Cells; Antigens, CD34
PubMed: 37438245
DOI: 10.1016/j.transci.2023.103758 -
Current Opinion in Anaesthesiology Dec 2020This article describes the processes for identifying high-risk patients at the time of ambulatory procedure scheduling, enabling the implementation of multidisciplinary... (Review)
Review
PURPOSE OF REVIEW
This article describes the processes for identifying high-risk patients at the time of ambulatory procedure scheduling, enabling the implementation of multidisciplinary collaborative pathways for prehabilitation and optimization, allowing for risk mitigation and improvement in outcomes. This review is particularly relevant because of the current proliferation of ambulatory surgery with more complex procedures being performed on an outpatient basis on patients who may be American Society of Anesthesiologists Physical Status 3 or greater.
RECENT FINDINGS
Increased longevity and rising prevalence of obesity have resulted in patients with a wide variety of comorbidities presenting for complex ambulatory procedures with the expectation of rapid recovery and same-day discharge to home. Recent literature highlights the importance of patient preparation, value-based healthcare, patient outcomes, and the role of anesthesiologists as perioperative physicians.
SUMMARY
The focus of this article is on general principles and establishment of best practices based on current evidence and a brief description of anesthetic management of specific comorbidities. This review will provide guidance to the practicing anesthesiologist on identifying, stratifying, optimizing, and managing high-risk patients in the ambulatory setting.
Topics: Ambulatory Surgical Procedures; Humans; Outpatients; Patient Selection; Perioperative Care; Physicians; Preoperative Care; Risk Assessment; Risk Factors
PubMed: 33093300
DOI: 10.1097/ACO.0000000000000919 -
Expert Review of Cardiovascular Therapy Dec 2019: Transcatheter tricuspid valve (TV) procedures emerged as an alternative to surgery for symptomatic high-risk patients with severe tricuspid regurgitation.: A... (Review)
Review
: Transcatheter tricuspid valve (TV) procedures emerged as an alternative to surgery for symptomatic high-risk patients with severe tricuspid regurgitation.: A literature search was performed using PubMed. Authors review clinical evidence in this field, the imaging features and the developments in TV transcatheter technologies. Currently, transcatheter devices for TV procedures can be allocated into four main groups: 1) those ones targeting leaflet malcoaptation, 2) those addressing annular dilatation, 3) those performing heterotopic valve implantation and 4) those onesaccomplishing a complete transcatheter replacement of the valve.: Actually, encouraging results are provided by initial experience in the field of transcatheter TV procedures. However, this field remains full of challenges that faced could lead to better results and prognosis for the patients. The next steps in this emerging field will need to focus on accurate patient selection, an early patient referral and on studies comparable and providing long-term data.
Topics: Cardiac Catheterization; Heart Valve Prosthesis Implantation; Humans; Patient Selection; Treatment Outcome; Tricuspid Valve; Tricuspid Valve Insufficiency
PubMed: 31795771
DOI: 10.1080/14779072.2019.1699056 -
Progress in Cardiovascular Diseases 2019Transcatheter therapy with the MitraClip system (Abbott Structural, Menlo Park, CA) is the most commonly used transcatheter therapy for patients with tricuspid... (Review)
Review
Transcatheter therapy with the MitraClip system (Abbott Structural, Menlo Park, CA) is the most commonly used transcatheter therapy for patients with tricuspid regurgitation, with over 1000 cases performed worldwide. The procedure is an off-label approach that requires meticulous attention to anatomical features obtained via comprehensive echocardiography and, in some cases, using cardiac computed tomography. Herein, we describe patient selection, procedural performance, and clinical outcomes of this therapy.
Topics: Cardiac Catheterization; Echocardiography; Equipment Design; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; Patient Selection; Severity of Illness Index; Treatment Outcome; Tricuspid Valve; Tricuspid Valve Insufficiency
PubMed: 31655080
DOI: 10.1016/j.pcad.2019.10.001 -
Pharmaceutical Statistics 2023We introduce a new two-sample inference procedure to assess the relative performance of two groups over time. Our model-free method does not assume proportional hazards,...
We introduce a new two-sample inference procedure to assess the relative performance of two groups over time. Our model-free method does not assume proportional hazards, making it suitable for scenarios where nonproportional hazards may exist. Our procedure includes a diagnostic tau plot to identify changes in hazard timing and a formal inference procedure. The tau-based measures we develop are clinically meaningful and provide interpretable estimands to summarize the treatment effect over time. Our proposed statistic is a U-statistic and exhibits a martingale structure, allowing us to construct confidence intervals and perform hypothesis testing. Our approach is robust with respect to the censoring distribution. We also demonstrate how our method can be applied for sensitivity analysis in scenarios with missing tail information due to insufficient follow-up. Without censoring, Kendall's tau estimator we propose reduces to the Wilcoxon-Mann-Whitney statistic. We evaluate our method using simulations to compare its performance with the restricted mean survival time and log-rank statistics. We also apply our approach to data from several published oncology clinical trials where nonproportional hazards may exist.
Topics: Humans; Proportional Hazards Models; Neoplasms; Medical Oncology; Research Design; Survival Analysis
PubMed: 37429738
DOI: 10.1002/pst.2324