What did we catch? Predictors of infection after tissue expander-based breast reconstruction in a safety-net system.

Background: Infection is a common complication following tissue expander (TE)-based breast reconstruction. Few studies have examined risk factors specifically in the unique populations encountered at safety-net hospitals. The purpose of this study was to identify predictors of TE infection at Harris Health safety-net hospitals, which serve the third most populous county in the United States.

Biologic Versus Synthetic Mesh in Ventral Hernia Repair: Participant-Level Analysis of Two Randomized Controlled Trials at Twenty-Four to Thirty-Six Months.

Biologic mesh has been used increasingly in complex ventral hernia repair despite limited evidence at low risk of bias supporting its use. We performed a participant-level analysis of published randomized controlled trials (RCTs) comparing biologic to synthetic mesh with complex ventral hernia repair at 24 to 36 months. Primary outcome was major complication (composite of mesh infection, recurrence, reoperation, or death) at 24 to 36 months post-operative.

Evaluation of ICARUS Guidelines and Recommendations Not Supported by Randomized Controlled Trials.

Background: The ICARUS guidelines are a systematic review and Delphi process that provide recommendations in the treatment and management of patients with gastroesophageal reflux disease (GERD). Many of the recommendations were supported by randomized trials; some were not. This study assesses guidelines with limited evidence and weak endorsement.

Reproducing Statistics Performed in Published Randomized Controlled Trials.

Introduction: Randomized controlled trials (RCT) represent evidence at the lowest potential risk for bias. Clinicians in all specialties depend upon RCTs to guide patient care. Issues such as statistical discordance, or reporting statistical results that cannot be reproduced, should be uncommon.

Prognosticators of Visual Acuity After Indirect Traumatic Optic Neuropathy.

Background: The purpose of this study is to determine whether there are radiographic and systemic clinical characteristics that can predict final visual outcomes in patients with indirect traumatic optic neuropathy (iTON).

Methods: This study is a retrospective, multicenter case series of adult patients with iTON treated initially at large, urban, and/or academic trauma centers with follow-up at an affiliated ophthalmology clinic. In addition to detailed cranial computed tomography characteristics, demographics, systemic comorbidities, coinjuries, blood products administered, and intracranial pressure, along with other factors, were gathered.

Review of SAGES GERD guidelines and recommendations.

Background: The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) developed evidence-based guidelines for the management of patients with gastroesophageal reflux disease (GERD). The aim of this study is to evaluate guidelines lacking agreement among experts (grades B-D) or lacking support from randomized controlled trials (levels II-III).

Methods: Six guidelines were chosen for evaluation.

Determining Risk Factors That Affect Progression in Patients with Nonproliferative Diabetic Retinopathy.

Purpose: To determine risk factors that affect nonproliferative diabetic retinopathy (NPDR) progression and establish a predictive model to estimate the probability of and time to progression in NPDR. . Charts of diabetic patients who received an initial eye exam between 2010 and 2017 at our county hospital were included.

Reducing chemotherapy administration time on an inpatient oncology unit.

Purpose: Due to the multifaceted chemotherapy workflow within the hospital, many patients often experience delays in receiving their treatment. This study aims to evaluate the causes for chemotherapy administration delays and implement new methods to reduce delays from order release to chemotherapy administration on an inpatient oncology unit at a community-focused academic medical center.

Methods: In this prospective quality improvement study, we developed a process map to track baseline time stamps and utilized performance improvement tools to identify causes for chemotherapy delays.

Is robotic surgery feasible at a safety net hospital?

Background: Robotic surgery offers potential advantages of improved ability to complete procedures using a minimally invasive approach, recovery, and clinical outcomes. It has been previously established that safety net hospitals are outliers for surgical complications. As such, the adoption of new technology may not achieve the same outcomes as other institutions.

Expectant Management of Patients with Ventral Hernias: 3 Years of Follow-up.

Background: The safety and effectiveness of expectant management (e.g., watchful waiting or initially managing non-operatively) for patients with a ventral hernia is unknown.

Toward development of a large field-of-view cancer screening patch (CASP) to detect cervical intraepithelial neoplasia.

Cervical cancers are primarily diagnosed via colposcopy, in which the tissue is visually assessed by a clinician for abnormalities, followed by directed biopsies and histologic analysis of excised tissue. Optical biopsy technologies offer a less invasive method of imaging such that subcellular features can be resolved without removing tissue. These techniques, however, are limited in field-of-view by the distal end of the probe.

Evolving Technologies for Tissue Cutting.

This article reviews evolving and lesser known technologies for tissue cutting and their application in oral and maxillofacial surgery.

Massive Self-Induced Subcutaneous Cervicofacial, Pneumomediastinum, and Pneumopericardium Emphysema Sequelae to a Nondisplaced Maxillary Wall Fracture: A Case Report and Literature Review.

Iatrogenic cervicofacial subcutaneous emphysema is a well-reported entity in the field of dentistry and oral and maxillofacial surgery, especially with the use of air-driven headpieces. Cervicofacial subcutaneous emphysema sequelae after maxillofacial trauma, however, has been reported less and the self-induced variant is even rarer. We report a case of massive cervicofacial subcutaneous emphysema, pneumomediastinum, and pneumopericardium in a healthy 16-year-old boy after blunt trauma to the face, which caused a nondisplaced anterior maxillary wall fracture.

Successful Implementation of a Multidisciplinary Chemotherapy Efficiency Initiative at a Community Hospital.

Purpose: Long wait times at chemotherapy infusion centers adversely affect patients' perception of quality of care and result in patient dissatisfaction. We conducted a quality improvement initiative at a busy community hospital to improve infusion center efficiency and reduce patient wait time, while maintaining patient safety and avoiding chemotherapy waste.

Methods: We used a coordinated and collaborative effort between providers, infusion center nurses, and pharmacists to ensure completion of orders, review of laboratory data, and prepreparation of chemotherapy 1 day ahead of each patient's scheduled infusion center appointment.

Accuracy of Intraoperative Frozen Section Diagnosis of Borderline Ovarian Tumors by Hospital Type.

Study Objective: To compare the accuracy of frozen section diagnosis of borderline ovarian tumors among 3 distinct types of hospital-academic hospital with gynecologic pathologists, academic hospital with nongynecologic pathologists, and community hospital with nongynecologic pathologists-and to determine if surgical staging alters patient care or outcomes for women with a frozen section diagnosis of borderline ovarian tumor.

Design: Retrospective study (Canadian Task Force classification II-1).

Setting: Tertiary care, academic, and community hospitals.

Characteristics and Outcomes of Advanced Cancer Patients Who Received Palliative Care at a Public Hospital Compared with Those at a Comprehensive Cancer Center.

Background: Patients with advanced cancer experience severe physical, psychosocial, and spiritual distress requiring palliative care (PC). There are limited literature regarding characteristics and outcomes of patients evaluated by PC services at public hospitals (PHs). Objective, Design, Setting/Subjects, and Measurements: To compare the outcomes of advanced cancer patients undergoing PC at a PH and those at a comprehensive cancer center (CCC).

Association of Fetal Abdominal-Head Circumference Size Difference With Shoulder Dystocia: A Multicenter Study.

Objective This study aims to determine if shoulder dystocia is associated with a difference in the fetal abdominal (AC) to head circumference (HC) of 50 mm or more noted on antenatal ultrasound. Study Design A multicenter matched case-control study was performed comparing women who had shoulder dystocia to controls who did not. Women with vaginal births of live born nonanomalous singletons ≥ 36 weeks of gestation with an antenatal ultrasound within 4 weeks of delivery were included.

Quantitative sensory testing in pain management.

Quantitative sensory testing (QST), a set of noninvasive methods used to assess sensory and pain perception, has been used for three decades. The precision of the instruments and the uninvasiveness encouraged many QST-based trials. The developments made have benefited multiple disciplines.

Diagnostic Yield and Complications of Bronchoscopy for Peripheral Lung Lesions. Results of the AQuIRE Registry.

Rationale: Advanced bronchoscopy techniques such as electromagnetic navigation (EMN) have been studied in clinical trials, but there are no randomized studies comparing EMN with standard bronchoscopy.

Objectives: To measure and identify the determinants of diagnostic yield for bronchoscopy in patients with peripheral lung lesions. Secondary outcomes included diagnostic yield of different sampling techniques, complications, and practice pattern variations.

Pain assessment and management in critically ill older adults.

Older adults comprise approximately 50% of patients admitted to critical care units in the United States. This population is particularly susceptible to multiple morbidities that can be exacerbated by confounding factors like age-related safety risks, polypharmacy, poor nutrition, and social isolation. The elderly are particularly vulnerable to health conditions (heart disease, stroke, and diabetes) that put them at greater risk of morbidity and mortality.

CE: Original Research: Staff nurses' use of research to facilitate evidence-based practice.

Objectives: To determine to what extent RNs in an acute care multihospital system used research findings in their practice; what types of knowledge they used in their practice; and what personal, professional, and organizational factors enhanced or hindered their research utilization.

Methods: A cross-sectional, descriptive, online survey design was used. The survey, which asked about use of research findings in practice and evidence-based practice (EBP) participation, was placed on the hospital system intranet.

Magnetic resonance imaging (MRI) in the diagnosis of head and neck disease.

Magnetic resonance imaging (MRI) is the modality of choice to identify intracranial or perineural spread from a head and neck primary tumor. Perineural spread is a form of metastatic disease in which primary tumors spread along neural pathways. Orbital cellulitis is a sight-threatening, and potentially life-threatening condition.