Inclusion of Social and Structural Determinants of Health to Advance Understanding of their Influence on the Biology of Chronic Disease.

Social Determinants of Health (SDOH) consider social, political, and economic factors that contribute to health disparities in patients and populations. The most common health-related SDOH exposures are food and housing insecurity, financial instability, transportation needs, low levels of education, and psychosocial stress. These domains describe risks that can impact health outcomes more than health care.

Turning Feed-forward and Feedback Processes on Patient-reported Data into Intelligent Action and Informed Decision-making: Case Studies and Principles.

Introduction: The collection of patient-reported outcomes (PROs) in routine clinical practice provides opportunities to "feed-forward" the patient's perspective to his/her clinical team to inform planning and management. This data can also be aggregated to "feedback" population-level analytics that can inform treatment decision-making, predictive modeling, population-based care, and system-level quality improvement efforts.

Methods Aiding Interpretation And Acting On Results: Three case studies demonstrate a number of system-level features which aid effective PRO interpretation: (1) feed-forward and feedback information flows; (2) score interpretation aids; (3) cascading measurement; (4) registry-enabled learning health care systems; and (5) the maturational development of information systems.

Implementation of Patient-Reported Outcomes in Routine Medical Care.

There is increasing interest to integrate collection of patient-reported outcomes (PROs) in routine practice to enhance clinical care. Multiple studies show that systematic monitoring of patients using PROs improves patient-clinician communication, clinician awareness of symptoms, symptom management, patient satisfaction, quality of life, and overall survival. The general approach includes a brief electronic survey, administered via the Web or an app or an automated telephone system, with alerts to clinicians for concerning or worsening issues.

Breast Cancer and Reconstruction: Normative Data for Interpreting the BREAST-Q.

Background: The BREAST-Q is a patient-reported outcome instrument used to evaluate outcomes in patients undergoing breast cancer surgery and reconstruction. Normative values for the BREAST-Q breast cancer modules have not been established, limiting data interpretation.

Methods: Participants were recruited by means of the Army of Women, an online community of women (with and without breast cancer), to complete Mastectomy, Breast Conserving Therapy, and Reconstruction preoperative BREAST-Q scales.

Normative Data for Interpreting the BREAST-Q: Augmentation.

Background: The BREAST-Q is a rigorously developed, well-validated, patient-reported outcome instrument with a module designed for evaluating breast augmentation outcomes. However, there are no published normative BREAST-Q scores, limiting interpretation.

Methods: Normative data were generated for the BREAST-Q Augmentation module by means of the Army of Women, an online community of women (with and without breast cancer) engaged in breast-cancer related research.

Understanding the Health Burden of Macromastia: Normative Data for the BREAST-Q Reduction Module.

Background: The BREAST-Q Reduction module evaluates outcomes in reduction mammaplasty. However, there are currently no published normative scores, limiting the interpretation of BREAST-Q data.

Methods: The BREAST-Q Reduction module was administered via the Army of Women, an online community of women (with and without breast cancer) engaged in breast-cancer related research.

Benefits and Risks of Prophylaxis for Deep Venous Thrombosis and Pulmonary Embolus in Plastic Surgery: A Systematic Review and Meta-Analysis of Controlled Trials and Consensus Conference.

Unlabelled: The goal of this consensus conference, sponsored by the American Association of Plastic Surgeons, was to perform a systematic review and meta-analysis of controlled trials to examine both the benefits and risks of venous thromboembolism prophylaxis in plastic surgery patients. The panel sought to assess the safety and effectiveness of recognized venous thromboembolism prophylaxis strategies, including variation in anesthetic management, use of elastic compression stockings or intermittent pneumatic compression, and use of chemoprophylaxis. The authors also sought to examine effectiveness and safety of prophylaxis in patients risk-stratified by procedure type or 2005 Caprini score.

Evidence-based medicine: reduction mammaplasty.

Learning Objectives: After reading this article, the participant should be able to: 1. Accurately state the indications for breast imaging prior to breast reduction; 2. List the modifiable risk factors in a woman considering breast reduction.

Harmonic scalpel versus electrocautery in breast reduction surgery: a randomized controlled trial.

Background: The authors hypothesized that the Harmonic Scalpel (Ethicon Endo-Surgery, Cincinnati, Ohio) might outperform electrocautery in bilateral breast reduction surgery, possibly resulting in (1) shorter operative times, (2) lower postoperative fluid drainage rates, and (3) reduced postoperative pain scores.

Methods: Thirty-one patients were evaluated in a matched-pair design, with random (blinded) assignment of one side to the Harmonic Scalpel, with the other side defaulting to electrocautery. Main outcome measures were: (1) resection/hemostasis time, (2) drainage volume, and (3) postoperative pain.

A cost, profit, and efficiency analysis of performing carpal tunnel surgery in the operating room versus the clinic setting in the United States.

Background: Carpal tunnel surgery (CTS) can be performed in the clinic or operating room with similar outcomes. Our goals were to perform a total cost comparison, profit analysis, and assess efficiency of CTS in each setting.

Methods: A detailed cost analysis for all CTSs at a tertiary care academic center was done for the year 2007.

A detailed analysis of level I evidence (randomized controlled trials and meta-analyses) in five plastic surgery journals to date: 1978 to 2009.

Background: Evidence-based medicine is the synthesis of clinical expertise, best available clinical evidence, and patient values to provide optimal health outcomes. A scant number of randomized controlled trials exist in the plastic surgery literature. The authors sought to analyze the level I studies (randomized controlled trials and meta-analyses) in five leading plastic surgery journals to date to understand the distribution of primary categories of study, primary outcomes, age breakdown, degree of quality, and the trend in publication rates.

Evaluation of a new wound closure device for linear surgical incisions: 3M Steri-Strip S Surgical Skin Closure versus subcuticular closure.

Background: Technological innovations are often adopted before scientific comparison to an accepted standard. The authors' study compared suture with a new coaptive film device, 3M Steri-Strip S Surgical Skin Closure, on linear incisions.

Methods: Patients undergoing Wise-pattern breast reduction or abdominal procedures had paired incisions randomly assigned to Steri-Strip S or suture closure.

Visual assessment of linear scars: a new tool.

Background: Existing scar evaluation tools are based on verbal descriptions and used primarily for burn scar assessment. To evaluate linear scars, the authors developed a new tool called the visual assessment of linear scars. This study was designed to determine whether patients and surgeons rated scars similarly and to test the intrarater and interrater reliability of the surgeons' ratings.

Surgery versus non-surgical therapy for carpal tunnel syndrome: a randomised parallel-group trial.

Background: A previous randomised controlled trial reported greater efficacy of surgery than of splinting for patients with carpal tunnel syndrome. Our aim was to compare surgical versus multi-modality, non-surgical treatment for patients with carpal tunnel syndrome without denervation. We hypothesised that surgery would result in improved functional and symptom outcomes.

Using evidence to minimize the cost of trigger finger care.

Purpose: Critics of U.S. health care cite both underuse and overuse of resources.

Silicone breast implants and magnetic resonance imaging screening for rupture: do U.S. Food and Drug Administration recommendations reflect an evidence-based practice approach to patient care?

Regular magnetic resonance imaging has been recommended for the purpose of screening for silicone implant rupture. However, when its use as a screening test is critically examined, it appears that evidence to support its use is lacking. For example, there is no conclusive evidence at this time to show that using magnetic resonance imaging screening of asymptomatic women leads to a reduction in patient morbidity.

Clinical research in breast surgery: reduction and postmastectomy reconstruction.

In the last decade, entirely new techniques in breast reduction and reconstruction have evolved. What remains unclear is whether or not these new procedures, some of which carry additional surgical risk and cost, are superior from a patient perspective. Thus, plastic surgeons are ever more reliant on clinical research to provide high-level evidence to facilitate clinical decision-making, as well as policy negotiations and advocacy.

Analysis of breast reduction complications derived from the BRAVO study.

Background: Analysis of complication data derived from the Breast Reduction Assessment: Value and Outcomes (BRAVO) study, a 9-month prospective, multicenter trial, is presented.

Methods: Data derived from 179 patients were analyzed, including bivariate associations between complications and single predictor variables (Fisher's exact test or chi-square testing) or continuous variables (two-sample t test) and, finally, logistic regression.

Results: The overall complication rate was 43 percent (77 patients).

The effects of the nitric oxide donor SIN-1 on ischemia-reperfused cutaneous and myocutaneous flaps.

Ischemia-reperfusion injury causes tissue damage that leads to a decrease in bioavailability of nitric oxide. The authors hypothesized that an exogenous supply of nitric oxide will have beneficial effects on survival of skin and skeletal muscle subjected to ischemia-reperfusion injury. By using the nitric oxide donor SIN-1 (3-morpholino-sydnonimine) the effects of direct intraarterial infusion of an exogenous source of nitric oxide in reperfused flaps was studied.

Reduction mammaplasty: defining medical necessity.

The authors evaluated existing and new criteria for defining the medical necessity for breast reduction surgery. Two cohorts of women (those requesting breast reduction surgery [N = 266] and a group of controls [N = 184]) completed a questionnaire including breast-specific symptom severity, the Short Form 36, the EuroQol, the McGill Pain Questionnaire, and the Multidimensional Body Self Relations Questionnaire. To evaluate prediction validity, the most widely accepted decision criteria and a new definition of medical necessity were applied to the data set to determine whether women meeting the definition had more favorable outcomes than those who did not as measured by validated self-report instruments.

Rapid and dynamic regulation of TGF-beta receptors on blood vessels and fibroblasts during ischemia-reperfusion injury.

The pathophysiological mechanisms involved in ischemia-reperfusion injury are poorly understood. Although transforming growth factor (TGF)-beta has been shown to provide protection against ischemia-reperfusion injury in different organ systems, little is known about the regulation of TGF-beta action during this process. Here we analyzed the effect of ischemia and reperfusion on the expression of TGF-beta and its receptors in vivo with a pig skin flap model.