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American Journal of Otolaryngology 2024To compare clinical outcomes in patients with and without history of tobacco use who underwent Zenker's diverticulotomy (ZD).
OBJECTIVE
To compare clinical outcomes in patients with and without history of tobacco use who underwent Zenker's diverticulotomy (ZD).
STUDY DESIGN
Single institution retrospective review.
SETTING
Tertiary care academic hospital.
METHODS
A retrospective review of patients who underwent ZD via an open stapler, rigid endoscopic CO2 laser, stapler or harmonic scalpel, and flexible endoscopic technique from January 2006 to December 2020 was performed. Data were abstracted for patient demographics, diverticular features, and rates of adverse events and symptomatic recurrence.
RESULTS
Out of 424 patients, 146 (34.4 %) had a history of tobacco use: 126 (29.7 %) were former smokers, and 20 (4.7 %) were active smokers. In univariable cross-sectional analyses, the likelihood of postoperative bleeding, perforation, emergency department visits, unplanned readmission, or recurrence did not demonstrate an association with tobacco use history even after adjustment for age, sex, and surgical approach. Similarly, in Cox Proportional Hazards regression, tobacco use was not associated with an increased risk of recurrence, even after correcting for age, sex, and type of surgery. The median time to recurrence observed in our cohort was 11.5 years amongst non-smokers, 8.7 years amongst former smokers, and 1.2 years amongst active smokers (p = 0.94).
CONCLUSIONS
There were no significant differences in post-operative adverse events or frequency of recurrence of ZD between active, former, and non-smokers. Although underpowered and not statistically significant, median time to recurrence appears to be shorter in smokers when compared with former and non-smokers following surgery.
Topics: Humans; Zenker Diverticulum; Male; Female; Retrospective Studies; Aged; Middle Aged; Recurrence; Treatment Outcome; Postoperative Complications; Tobacco Use; Cross-Sectional Studies
PubMed: 38574513
DOI: 10.1016/j.amjoto.2024.104261 -
AANA Journal Apr 2024Certified registered nurse anesthetists (CRNAs) who are responsible for airway management, may lack adequate continuing education for emergency front of neck access...
Certified registered nurse anesthetists (CRNAs) who are responsible for airway management, may lack adequate continuing education for emergency front of neck access (EFONA), an advanced skill necessary in situations when a patient cannot be intubated and cannot be oxygenated (CICO). The purpose of this study was to improve CRNA knowledge and confidence when performing a scalpel-bougie cricothyrotomy for EFONA in a CICO event through the implementation of a spaced learning intervention. Thirteen CRNAs at a 160-bed community hospital participated in a 3-week educational intervention. Week 1: online preintervention survey followed by an educational video. Week 2: video review and skills component practiced on a cricothyrotomy trainer. Week 3: skills component practiced on a cricothyrotomy trainer followed by postintervention survey. This was a single-arm study and Wilcoxon sign ranked tests and a paired t-test were utilized to monitor for change in CRNA knowledge, confidence, and skill in performing EFONA. Implementation of a 3-week spaced learning program for educating CRNAs to perform a scalpel-bougie cricothyrotomy significantly increased CRNA knowledge, confidence, and skill when performing EFONA. Utilizing a spaced learning program may therefore improve provider skills, resulting in optimized patient care during a CICO event, leading to improved patient safety and outcomes.
Topics: Humans; Nurse Anesthetists; RNA, Complementary; Education, Continuing; Airway Management; Hospitals, Community
PubMed: 38564211
DOI: No ID Found -
Journal of Pharmacopuncture Mar 2024Phlebotomy, a therapeutic method of bloodletting typically performed using a needle, has a traditional technique known as "Fasd." In this method, blood is extracted by...
Phlebotomy, a therapeutic method of bloodletting typically performed using a needle, has a traditional technique known as "Fasd." In this method, blood is extracted by creating a longitudinal incision on a vein (3-5 mm) with a surgical scalpel blade, usually blade No. 11. Due to the incision in the vessel wall, establishing hemostasis is more challenging compared to conventional methods. Hemostasis is usually achieved within minutes after Fasd. We present a case highlighting an uncommon yet significant complication of traditional phlebotomy. A 55-year-old man with no prior medical conditions underwent traditional phlebotomy at an academic traditional medicine clinic. Senior MD-PhD students in Iranian Traditional Medicine, under professor supervision, performed Fasd. A sterile scalpel blade No. 11 was used to create a longitudinal incision of approximately 4 mm on the patient's median basilic vein in the right hand. After removing 400 cc of blood, a pressure dressing was applied to the incision site. Despite attempts such as hand elevation, ice pack application, prolonged direct pressure, and tight elastic bandaging, bleeding from the incision persisted. After an hour of supportive therapy, hemostasis was eventually achieved within a few minutes using burnt cotton dressing (a traditional method for blood hemostasis). Following intravenous hydration, the patient was discharged in stable condition and reported no issues during the one-month follow-up. The traditional phlebotomy (Fasd) carries the risk of serious complications, including uncontrolled and prolonged bleeding. Further research on the efficacy and safety of burnt cotton dressing for controlling hemostasis is recommended.
PubMed: 38560341
DOI: 10.3831/KPI.2024.27.1.47 -
Annals of Plastic Surgery Apr 2024Following the integration of the electronic health record (EHR) into the healthcare system, concern has grown regarding EHR use on physician well-being. For surgical...
BACKGROUND
Following the integration of the electronic health record (EHR) into the healthcare system, concern has grown regarding EHR use on physician well-being. For surgical residents, time spent on the EHR increases the burden of a demanding, hourly restricted schedule and detracts from time spent honing surgical skills. To better characterize these burdens, we sought to describe EHR utilization patterns for plastic surgery residents.
METHODS
Integrated plastic surgery resident EHR utilization from March 2019 to March 2020 was extracted via Cerner Analytics at a tertiary academic medical center. Time spent in the EHR on-duty (0600-1759) and off-duty (1800-0559) in the form of chart review, orders, documentation, and patient discovery was analyzed. Statistical analysis was performed in the form of independent t tests and Analysis of Variance (ANOVA).
RESULTS
Twelve plastic surgery residents spent a daily average of 94 ± 84 minutes on the EHR, one-third of which was spent off-duty. Juniors (postgraduate years 1-3) spent 123 ± 99 minutes versus seniors (postgraduate years 4-6) who spent 61 ± 49 minutes (P < 0.01). Seniors spent 19% of time on the EHR off-duty, compared with 37% for juniors (P < 0.01). Chart review comprised the majority (42%) of EHR usage, followed by patient discovery (22%), orders (14%), documentation (12%), other (6%), and messaging (1%). Seniors spent more time on patient discovery (25% vs 21%, P < 0.001), while juniors spent more time performing chart review (48% vs 36%, P = 0.19).
CONCLUSION
Integrated plastic surgery residents average 1.5 hours on the EHR daily. Junior residents spend 1 hour more per day on the EHR, including more time off-duty and more time performing chart review. These added hours may play a role in duty hour violations and detract from obtaining operative skill sets.
Topics: Humans; Internship and Residency; Electronic Health Records; Surgery, Plastic; Time Factors; Computers
PubMed: 38556688
DOI: 10.1097/SAP.0000000000003863 -
Anaesthesia and Intensive Care May 2024At the Royal Perth Hospital, we have been developing and teaching a can't intubate, can't oxygenate (CICO) rescue algorithm for over 19 years, based on live animal...
At the Royal Perth Hospital, we have been developing and teaching a can't intubate, can't oxygenate (CICO) rescue algorithm for over 19 years, based on live animal simulation. The algorithm involves a 'cannula-first' approach, with jet oxygenation and progression to scalpel techniques if required in a stepwise fashion. There is little reported experience of this approach to the CICO scenario in humans. We present eight cases in which a cannula-first Royal Perth Hospital approach was successfully implemented during an airway crisis. We recommend that institutions teach and practice this approach; we believe it is effective, safe and minimally invasive when undertaken by clinicians who have been trained in it and have immediate access to the requisite equipment. The equipment is low cost, comprising a 14G Insyte cannula, saline, 5 ml syringe and a Rapid-O2. Training can be provided using low-fidelity manikins or part-task trainers.
Topics: Humans; Algorithms; Cannula; Intubation, Intratracheal
PubMed: 38546511
DOI: 10.1177/0310057X231214548 -
Plant Disease Mar 2024Members of Botryosphaeria s.l. have an extensive history as cankering pathogens of stressed and declining oak trees in the eastern United States (Ferreira et al. 2021)....
Members of Botryosphaeria s.l. have an extensive history as cankering pathogens of stressed and declining oak trees in the eastern United States (Ferreira et al. 2021). The host range, distribution, and virulence among two closely related species, Diplodia corticola and D. gallae, remains unclear (Brazee et al. 2023). On 15 August 2023, a survey was conducted at a declining natural hardwood site in Shenandoah County, Virginia (GPS coordinates 38.922089, -78.606125). One mature Quercus coccinea tree that displayed scorched leaf margins and branch dieback was felled and a cankered branch from the crown was sampled (Fig. 1A and B). A 4-mm piece of necrotic tissue was selected from the margin of the canker, disinfected with 2.5% NaOCl, again with 70% ethanol, and air-dried before being placed on half-strength acidified PDA medium (pH 4.8) and incubated in the dark at 22 ± 2°C. After 5 days, four colonies were transferred to full-strength PDA medium and incubated in the dark at 22 ± 2°C. After 10 days, all four colonies displayed thick, gray, floccose mycelium and pigmented hyphae (Fig. 1C). Mycelia was harvested from 10-day-old colonies with a sterile pin and DNA was extracted using a Qiagen DNeasy Plant Pro Kit (Germantown, MD) according to the manufacturer's instructions. A fragment of the internal transcribed spacer (ITS) and translation elongation factor 1-α (tef1) loci were amplified using ITS4/ITS5 (White et al. 1990) and EF1-728F/EF1-986R (Carbone and Kohn 1999) primer sets, respectively. The PCR amplicons were purified with ExoSap-IT (Affymetrix, Santa Clara, CA) and sequenced at Eurofins (Louisville, KY).&xa0; The raw nucleotide sequences were analyzed using Geneious 11.1.5 software (Biomatters, Auckland, NZ). All four colonies had identical ITS sequences. A 523 and 276-bp fragment of the ITS and tef1 loci, respectively, from isolate R1.2 was deposited into the GenBank database (accessions OR934498 and OR961039). A dataset of 43 strains consisting of 38,658 characters was aligned using MAFFT v7.49 (Katoh et al. 2013), and a concatenated ITS + tef1 maximum likelihood phylogenetic tree (1000 bootstraps) was built with PhyML 3.0 (Guindon et al. 2010) using the GTR substitution model. Isolate R1.2 was grouped with isolates of D. gallae although the species failed to form a well-supported clade (BS = 67) due to intraspecific variation (Fig. 1D). Koch's postulates were fulfilled by inoculating five healthy, containerized Q. coccinea trees (average stem caliper 5.3 cm) with isolate R1.2, with five plants as controls. After disinfecting the bark with 70% ethanol, a 0.5 mm section of the bark was removed 13 cm above the soil line with a sterile scalpel, and a 0.5 mm agar plug taken from the edge of a 10-day-old PDA culture was placed in the wound with the mycelium facing the cambial tissue, sealed with Parafilm, and maintained at 22 ± 4°C. The same procedure was performed on the control plants using sterile PDA plugs. After five weeks the bark was removed, and all five stems treated with R1.2 had necrotic lesions with a mean linear growth ([length+width]/2) of 9.2 ± 2.72 mm from the edge of the wound, which was significantly larger (P = 0.003) than the controls (1 ± 0.66 mm; Fig. 1E - L). Necrotic stem tissue was sampled as previously described, and the isolate recovered was confirmed as D. gallae based on morphology and 100% ITS sequence homology to isolate R1.2. D. gallae was not recovered from the control plants. In the United States, D. gallae has been isolated from Q. rubra and Q. velutina twig cankers in Maine, Massachusetts, New Hampshire, New York, and Vermont (Brazee et al. 2023). This is the first report of the species in Virginia causing branch cankers on Q. coccinea.
PubMed: 38537141
DOI: 10.1094/PDIS-12-23-2781-PDN -
PloS One 2024Only 34% of Canadian surgeons in 2022 were female. The protracted length of surgical residency training, concerns regarding infertility, and increased rates of...
INTRODUCTION
Only 34% of Canadian surgeons in 2022 were female. The protracted length of surgical residency training, concerns regarding infertility, and increased rates of obstetrical complications have been shown to contribute to the disproportionate lack of females in surgical specialties.
METHODS
A novel online survey was sent to all surgical residents in Canada. Respondents were asked about perceptions of pregnancy and parenthood during surgical training, and parents were asked about parental leave, accommodations they received, and pregnancy complications. Chi squared tests were used to compare opinions of male and female residents.
RESULTS
A total of 272/2,419 (11.2%) responses were obtained, with a high response from females (61.8%) and orthopaedic residents (29.0%). There were 56 women reporting 76 pregnancy events during training, 62.5% of which had complications. Notably, 27.3% of men and 86.7% of women 'agreed' or 'strongly agreed' that surgeons have higher pregnancy complication rates than the general population (p<0.001). Men were much less likely to believe that pregnant residents should be offered modified duties (74.2% of men, 90.0% of women, p = 0.003). Women were much more likely to experience significant stigma or bias due to their status as a parent (43% of women, 0% of men, p<0.001). Women reported negative comments from others at a higher rate (58.5% of women, 40.7% of men, p = 0.013). Women believe there is negative stigma attached to being pregnant during training (62.7% of women, 42.7% of men, p = 0.01). The limitations of our study include a small sample size and response bias.
CONCLUSION
Challenges and negative perceptions exist around pregnancy and parenthood in surgical residency, which disproportionately affect women trainees.
Topics: Pregnancy; Humans; Male; Female; Internship and Residency; Canada; Surveys and Questionnaires; Surgeons; Orthopedics
PubMed: 38536844
DOI: 10.1371/journal.pone.0301190 -
Journal of Orthopaedic Surgery and... Mar 2024Isolated gastrocnemius contracture has been associated with more than 30 lower limb disorders, including plantar heel pain/plantar fasciitis, Achilles tendinosis,...
BACKGROUND
Isolated gastrocnemius contracture has been associated with more than 30 lower limb disorders, including plantar heel pain/plantar fasciitis, Achilles tendinosis, equinus foot, adult flatfoot, and metatarsalgia. Although many techniques are available for gastrocnemius recession, potential anesthetic, cosmetic, and wound-related complications can lead to patient dissatisfaction. Open and endoscopic recession techniques usually require epidural or general anesthesia, exsanguination of the lower extremities and stitches and can damage the sural nerve, which is not under the complete control of the surgeon at all stages of the procedure. The purpose of this study is to evaluate the clinical results of a surgical technique for gastrocnemius lengthening with a needle, as previously described in cadaver specimens.
METHODS AND RESULTS
We performed a prospective study of ultrasound-guided gastrocnemius tendon lengthening in level II using a needle in 24 cases (19 patients) of gastrocnemius contracture. The study population comprised 12 males and 7 females. Mean age was 41 years (18-64). All but 5 recessions were bilateral and occurred simultaneously. The indication for the procedure was gastrocnemius contracture; although the patients also presented other conditions such as non-insertional Achilles tendinopathy in 6 patients (2 were bilateral), insertional Achilles calcifying enthesitis in 4 (1 was bilateral), metatarsalgia in 4, flexible flat foot in 1 and plantar fasciitis in 5 (2 were bilateral). The inclusion criteria were the failure of a previous conservative protocol, that the Silfverskiöld test was positive, and that the pathology suffered by the patient was within the indications for surgical lengthening of the patients and were described in the scientific literature. The exclusion criteria were that the inclusion criteria were not met, and patients with surgical risk ASA 3 or more and children. In these patients, although possible, it is preferable to perform the procedure in the operating room with monitoring, as well as in children since they could be agitated during the procedure at the office. We used the beveled tip of an Abbocath needle as a surgical scalpel. All patients underwent recession of the gastrocnemius tendon, as in an incomplete Strayer release. We evaluated pre- and postoperative dorsiflexion, outcomes, and procedural pain (based on a visual analog scale and the American Orthopedic Foot and Ankle Society scores), as well as potential complications. No damage was done to the sural bundle.
RESULTS
Ankle dorsiflexion increased on average by 17.89°. The average postoperative visual analog score for pain before surgery was 5.78, 5.53 in the first week, 1.89 at 1 month, and 0.26 at 3 months, decreasing to 0.11 at 9 months. The mean postoperative American Orthopedic Foot and Ankle Society Ankle-Hindfoot score the average was 50.52 before surgery, 43.42 at 1 week, 72.37 at 1 month, 87.37 at 3 months, and 90.79 at 9 months.
CONCLUSION
Ultrasound-guided needle lengthening of the gastrocnemius tendon is a novel, safe, and effective technique that enables the surgeon to check all the structures clearly, thus minimizing the risk of neurovascular damage. The results are encouraging, and the advantages of this approach include absence of a wound and no need for stitches. Recovery is fast and relatively painless. A specific advantage of ultrasound-guided needle lengthening of the gastrocnemius tendon is the fact that it can be performed in a specialist's office, with a very basic instrument set and local anesthesia, thus reducing expenses.
Topics: Adult; Male; Female; Child; Humans; Achilles Tendon; Prospective Studies; Fasciitis, Plantar; Tendinopathy; Muscle, Skeletal; Contracture; Ultrasonography, Interventional; Metatarsalgia
PubMed: 38532430
DOI: 10.1186/s13018-024-04685-0 -
Nanotechnology Apr 2024We introduce a new scanning probe microscopy (SPM) concept called reverse tip sample scanning probe microscopy (RTS SPM), where the tip and sample positions are reversed...
We introduce a new scanning probe microscopy (SPM) concept called reverse tip sample scanning probe microscopy (RTS SPM), where the tip and sample positions are reversed as compared to traditional SPM. The main benefit of RTS SPM over the standard SPM configuration is that it allows for simple and fast tip changes. This overcomes two major limitations of SPM which are slow data acquisition and a strong dependency of the data on the tip condition. A probe chip with thousands of sharp integrated tips is the basis of our concept. We have developed a nanofabrication protocol for Si based probe chips and their functionalization with metal and diamond coatings, evaluated our probe chips for various RTS SPM applications (multi-tip imaging, SPM tomography, and correlative SPM), and showed the high potential of the RTS SPM concept.
PubMed: 38522105
DOI: 10.1088/1361-6528/ad3744 -
Case Reports in Dentistry 2024Peripheral ossifying fibroma (POF) is a benign swelling of the gingival connective tissue commonly associated with dental biofilm and biofilm-retentive dental...
Peripheral ossifying fibroma (POF) is a benign swelling of the gingival connective tissue commonly associated with dental biofilm and biofilm-retentive dental appliances. In the present case report, we described three cases of POF with different clinical presentations and treatment approaches. The treatment consisted of the removal of supra- and subgingival calculus, followed by a flap surgery with excision of the entire lesion ensuring the inclusion of the periosteal bed. The first patient developed POF during her pregnancy that remained clinically noticeable postpartum. The second case represented a rare case of POF appearing on the palatal aspect of the anterior maxilla of an African American male. The third case represented POF that developed on the mandible, and contrary to the first two cases, it was excised using a diode laser and not a scalpel blade. All patients showed uneventful healing during follow-up appointments; however, poor patient compliance did not allow for evaluation of long-term healing responses and possible recurrence of the lesion. Within the limitations of this clinical report, it is evident that the periodontal surgical approach was effective in managing POF with stable short-term clinical outcomes.
PubMed: 38501031
DOI: 10.1155/2024/3683561