Replacing the Scalpel With a Computer Mouse: An Evaluation of Time Spent on Electronic Health Record for Plastic Surgery Residents and Its Impact on Resident Training.

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.

Introduction to Disability and Antiableist Health Care: A Pilot, Student-Led Module for Preclinical Medical Students.

Physical medicine and rehabilitation physicians often care for disabled patients, who comprise America's largest marginalized population. Despite medical students' and physicians' discomfort with caring for disabled patients and the pervasiveness of ableism in health care, medical education lacks disability-focused education. Kern's approach to curriculum development and disability community input were used to design a three-part, elective curriculum for first-year medical students.

Current Trends in Total Ankle Replacement.

Ankle arthritis can result in significant pain and restriction in range of motion. Total ankle replacement (TAR) is a motion-preserving surgical option used as an alternative to total ankle arthrodesis to treat end-stage ankle arthritis. There are several generations of TAR techniques based on component design, implant material, and surgical technique.

Referrals for Pediatric Appendicitis to a Tertiary Care Children's Hospital.

Objectives: This study aimed to analyze pediatric referrals for definite or possible appendicitis, to compare clinical predictors and laboratory values between patients with and without a final diagnosis of appendicitis, and to determine the accuracy of prereferral diagnostic interpretations of computed tomography scans, ultrasound, and magnetic resonance imaging modalities.

Methods: We conducted a retrospective analysis of pediatric patients referred from 2015 to 2019 to a tertiary care children's emergency department with definitive or possible appendicitis. Data abstracted included patient demographics, clinical symptoms, physical examination findings, laboratory results, and diagnostic imaging findings (by the referring center and the pediatric radiologist at the accepting center).

Plastic Surgery Roles in Wound Centers in the Northeastern United States.

Introduction: Wound care is a substantial industry costing nearly $19 billion USD, and dedicated wound care centers play a critical role via a multidisciplinary team-based approach. At the same time, plastic surgeons are often considered experts in evaluation and management of wounds, particularly chronic and complex wounds. However, the extent of direct involvement of plastic surgeons in wound care centers is unclear.

Opportunities for Antibiotic Reduction in Pediatric Patients With Urinary Tract Infection After Discharge From the Emergency Department.

Objectives: The aim of this study was to evaluate how often antibiotics are adjusted by providers, specifically discontinued or de-escalated to a more narrow-spectrum agent, based on final culture and susceptibility results, when treating patients diagnosed with a urinary tract infection (UTI) in the pediatric emergency department (ED).

Methods: This was a retrospective study of pediatric patients younger than 18 years who were discharged home from the ED with a diagnosis of UTI between January 1, 2018, and December 31, 2019. Patients were included if a urine culture was sent as part of their UTI workup and were excluded if they had been pretreated with antibiotics before the diagnosis.

A Descriptive Analysis of Integrated Plastic Surgery Residency Program Directors in the United States.

Background: The role sex plays in surgical leadership positions is heavily discussed in the literature; however, there is an absence of research looking at plastic surgery program director (PD) demographics and the differences between male and female PDs.

Methods: A cross sectional study of publicly available online resources of all integrated plastic surgery residency programs was performed. Demographic and academic data of integrated plastic surgery PDs was analyzed focusing on the differences in PDs based on sex.

Outcomes of the Supine Anterior-based Muscle-sparing Approach for Primary and Revision Hip Arthroplasty.

Introduction: Risks and outcomes of total hip arthroplasty (THA) are believed to vary relative to the surgical approach. This study compares the supine anterior-based muscle-sparing (ABMS) approach with its modern-day counterparts.

Methods: A retrospective review was done on 550 patients undergoing primary or revision THA from 2016 to 2018.

The need for continuous quality assessment for providing optimal comprehensive care for patients with alpha-1 antitrypsin deficiency.

Alpha-1-antitrypsin deficiency (AATD) is an orphan disease that mainly affecting the liver and the lung. This creates difficulties to ensure that comprehensive care is administered to both organ systems. Past assessments of care delivered to patients with AATD demonstrated that improvements are needed.

Allergic Contact Dermatitis and Concomitant Dermatologic Diseases: A Retrospective Study.

Background: Allergic contact dermatitis (ACD) can exist in the setting of other dermatologic conditions. It is known that the treatment of these conditions can cause ACD, increasing both diagnostic and treatment difficulty.

Objective: The aim of this study was to determine the frequency of common dermatologic conditions in the setting of ACD and in specific patient populations.

Reduced Vancomycin Susceptibility, MRSA and Treatment Failure in Pediatric Staphylococcus aureus Bloodstream Infections.

Background: Clinical implications of reduced vancomycin susceptibility (RVS) among pediatric Staphylococcus aureus bloodstream infections are unknown.

Methods: We identified all children at 2 children's hospitals with ≥1 blood culture positive for S. aureus.

Assessing the Necessity for the "Joint Above and Below" Radiography Approach for Lower-extremity Long Bone Fractures in Children.

Objectives: A common strategy for evaluation of extremity fractures is the "joint above and below" (JAB) radiograph approach, which includes dedicated imaging of the joint proximal and distal to a fracture independent of clinical suspicion for an injury involving the joint. The incidence of concomitant ipsilateral lower-extremity fractures or dislocations associated with lower-extremity long bone fractures in children has not been commonly reported and represents an evidential gap for determining a radiograph approach. Our purpose was to determine the frequency of and risk factors for concomitant ipsilateral lower-extremity fractures or dislocations.

Factors in Orthopaedic Residency Decision-making for Female Applicants: A Cross-sectional Study.

Background: Orthopaedics continues to remain the medical specialty with the lowest sex diversity in the United States. Orthopaedic residency programs are highly motivated to attract the best female candidates in an effort to improve their program diversity, but no studies currently exist that examine the factors of highest importance to female applicants for orthopaedic residency selection.

Methods: A two-part survey was sent to female orthopaedic residents by e-mails available in the American Academy of Orthopaedic Surgery directory, residency program coordinators, Doximity, and institutional websites.

Hospital-acquired Pneumonia and Ventilator-associated Pneumonia in Children: A Prospective Natural History and Case-Control Study.

Background: Clinical trials for antibiotics designed to treat hospital-acquired and ventilator-associated bacterial pneumonias (HABP/VABP) are hampered by making these diagnoses in a way that is acceptable to the United States Food and Drug Administration and consistent with standards of care. We examined laboratory and clinical features that might improve pediatric HABP/VABP trial efficiency by identifying risk factors predisposing children to HABP/VABP and describing the epidemiology of pediatric HABP/VABP.

Methods: We prospectively reviewed the electronic medical records of patients <18 years of age admitted to intensive and intermediate care units (ICUs) if they received qualifying respiratory support or were started on antibiotics for a lower respiratory tract infection or undifferentiated sepsis.

Long-term assessment of aspirin desensitization shows successful bridging with non-aspirin nonsteroidal anti-inflammatory drugs for procedures.

Aspirin (ASA) desensitization and continuous daily ASA therapy is the criterion standard treatment for ASA-exacerbated respiratory disease (AERD). However, the optimal maintenance dosage of ASA and safety of "bridging" patients with AERD and with alternative cyclooxygenase-1 inhibitors for surgery have not been determined and require further investigation. This study was designed to compare the long-term effects of different maintenance doses of ASA and to assess the success of bridging subjects with AERD for surgery without losing desensitization.

EMS Activations for School-Aged Children From Public Buildings, Places of Recreation or Sport, and Health Care Facilities in Pennsylvania.

Objectives: To determine the etiology of emergency medical services (EMS) activations in 2011 to public buildings, places of recreation or sport, and health care facilities involving children aged 5 to 18 years in Pennsylvania.

Methods: Electronic records documenting 2011 EMS activations as provided by the Pennsylvania Department of Health's Bureau of EMS were reviewed. Data elements (demographics, dispatch complaint, mechanism of injury, primary assessment) from patients aged 5 to 18 years involved in an EMS response call originating from either a public building, a place of recreation and sport, or health care facility were analyzed.

Severity of end-organ damage as a predictor of outcomes after implantation of left ventricular assist device.

The optimal timing of left ventricular assist device (LVAD) implantation in the management of advanced heart failure remains controversial. We hypothesize that in patients with cardiogenic shock, the severity of end-organ dysfunction as determined by the sequential organ failure assessment (SOFA) score is a determinant of outcomes after LVAD implantation. We determined the preoperative SOFA score and short- and long-term outcomes of 97 consecutive patients who received HeartMate II or HeartWare LVAD at our institution since January 2007.