Closed Incision Negative-Pressure Therapy on Free Flap Donor Sites: A Meta-analysis of Postoperative Outcomes.

Background: Closed incision negative-pressure therapy (ciNPT) has become increasingly used on surgical sites to attempt to minimize postoperative complications. The literature describing the benefits of ciNPT in reducing donor site morbidity after free tissue transfer is limited. This review compares the effectiveness of ciNPT and conventional dressings in reducing donor site complications after free tissue transfer.

Novel Case of Streptococcus Mitis-infected Chronic Subdural Hematoma.

Purpose: Subdural hematoma (SDH) is a common pathology found in neurosurgery. Infected SDH, however, is less common, and reports have typically identified Escherichia coli as the causative organism.

Case Report: We present here a case of an infected chronic SDH caused by Streptococcus mitis, likely for the first time, following a burn injury in a 40-year-old male patient.

Patient Safety and Quality Improvement in Minimally Invasive Surgery.

The journey of minimally invasive (MI) urology is one of quality improvement (QI) and patient safety. New techniques have been progressively studied for adoption and growth. As more advanced methods of data collection and analysis are developed, a review of the patterns and history of these principles in the development of MI urology can inform future urologic QI and patient safety initiatives.

Evaluating ChatGPT Performance on the Orthopaedic In-Training Examination.

Background: Artificial intelligence (AI) holds potential in improving medical education and healthcare delivery. ChatGPT is a state-of-the-art natural language processing AI model which has shown impressive capabilities, scoring in the top percentiles on numerous standardized examinations, including the Uniform Bar Exam and Scholastic Aptitude Test. The goal of this study was to evaluate ChatGPT performance on the Orthopaedic In-Training Examination (OITE), an assessment of medical knowledge for orthopedic residents.

Autologous Fat Versus Hydroxyapatite Cement for Use in Frontal Sinus Obliteration: Systematic Review and Meta-Analysis.

Background: Frontal sinus obliteration is a possible terminus for the management of chronic sinusitis, frontal bone trauma, cancer extirpation, or mucocele. The mucosa of the sinus is stripped and space obliterated with either autogenic, allopathic, or synthetic materials. This study aimed to compare the outcomes of autologous fat and hydroxyapatite cement (HAC) for frontal sinus obliteration.

PROMIS cluster analysis predicts two-year outcomes in knee surgery patients.

Aims & Objectives: Meaningful clinical interpretation of orthopaedic patient-reported outcome scores remains challenging. Grouping scores may be more meaningful than individual score analysis. The purpose of this study was to determine if grouping knee surgery patients into four preoperative Patient-Reported Outcomes Measurement Information System (PROMIS) clusters would have prognostic value for two-year postoperative outcomes.

Opioid Usage After Hallux Valgus Correction Surgery.

Background: Given the lack of objective data on opioid use and the difficulty of addressing a patient's postoperative pain, we sought to quantify patient's narcotic use after hallux valgus surgery. The purpose of our study was to determine the average quantity and type of postoperative opioids consumed after hallux valgus surgery and to assess potential predictive factors for increased opioid consumption.

Methods: At the preoperative visit, patients were consented and completed a demographical questionnaire.

Piloting a Layperson Prehospital Care System in Rural Uganda.

Introduction: In many low-income countries, basic prehospital Emergency Medical Services (EMS) remain under-developed, resulting in significant delays or the complete inability to access care.

Study Objective: The purpose of this study was to analyze the effectiveness of a layperson EMS training targeting motorcycle taxi (boda) drivers in a rural region of Uganda.

Methods: Fifty (50) adult boda drivers from Masindi, Uganda were selected for a one-day training course including lectures and simulation.

Looking back, moving forward: A practical guide to implementing the updated ACGME geriatric medicine Milestones 2.0.

The Accreditation Council for Graduate Medical Education (ACGME) developed the Milestones as a tool to aid trainee assessment based on the framework of the six core competencies of practice. Variability in the interpretation and application of the original Milestones prompted the ACGME to convene work groups within the different specialties and subspecialties to update the Milestones. The Geriatric Medicine work group was convened in 2019 with the goal of clarifying and simplifying the language of the Milestones, revising content to be specific to geriatrics, and developing supplemental resources to aid in implementation and use.

Lateral Lumbar Interbody Fusion at the L5-S1 Vertebral Level: A Unique Anatomical Case Report.

A 57-year-old female presented with L4-L5 and L5-S1 mobile spondylolisthesis and associated stenosis with radiculopathy who failed conservative treatment. This patient underwent lateral lumbar interbody fusion (LLIF) of L4-L5 and L5-S1, and posterior spinal fusion (PSF) with instrumentation. LLIF is a minimally invasive procedure to treat degenerative diseases of the lumbar spine.

Motivations, barriers, and professional engagement: a multisite qualitative study of internal medicine faculty's experiences learning and teaching point-of-care ultrasound.

Background: Point-of-care ultrasound (POCUS) graduate medical education is expanding across many specialties, but a lack of trained faculty is a common barrier. Even well-designed faculty development programs struggle with retention, yet little is known about the experiences of practicing physicians learning POCUS. Our objective is to explore the experiences of clinician-educators as they integrate POCUS into their clinical and teaching practices to help inform curriculum design.

Traumatic Abdominal Wall Hernia Repair with Dermal Autograft within a Morel-Lavallée Lesion.

Morel-Lavallée lesions and traumatic abdominal wall hernias seldom present together and have no standardized guidelines for treatment. We present a unique case of a traumatic abdominal wall hernia present within a patient's abdominal Morel-Lavallée lesion, which was reduced and repaired with a dermal autograft. This is a novel approach to repairing a rare and unusual injury.

Frailty Status Is a More Robust Predictor Than Age of Spinal Tumor Surgery Outcomes: A NSQIP Analysis of 4,662 Patients.

Objective: The present study aimed to evaluate the effect of baseline frailty status (as measured by modified frailty index-5 [mFI-5]) versus age on postoperative outcomes of patients undergoing surgery for spinal tumors using data from a large national registry.

Methods: The National Surgical Quality Improvement Program database was used to collect spinal tumor resection patients' data from 2015 to 2019 (n = 4,662). Univariate and multivariate analyses for age and mFI-5 were performed for the following outcomes: 30-day mortality, major complications, unplanned reoperation, unplanned readmission, hospital length of stay (LOS), and discharge to a nonhome destination.

Endovascular thrombectomy with and without preceding intravenous thrombolysis for treatment of large vessel anterior circulation stroke: A cross-sectional analysis of 50,000 patients.

Introduction: The safety and efficacy of intravenous thrombolysis (IVT) before endovascular thrombectomy (EVT) for large vessel occlusion stroke remains a highly contested and unanswered clinical question. We aim to characterize the clinical profile, complications, and discharge disposition of EVT patients treated with and without preceding IVT using a large, nationally-representative sample.

Methods: The National Inpatient Sample was queried from 2015 to 2018 to identify adult patients with anterior circulation stroke treated with EVT with and without preceding IVT.

Trauma training in low- and middle-income countries: A scoping review of ATLS alternatives.

Introduction: Trauma training for front-line providers is a critical component of injury mitigation and trauma systems strengthening. Although the Advanced Trauma Life Support (ATLS) course is standard in much of the world, cost and administrative barriers are prohibitive to deploying the course in many low and middle income countries (LMICs). The purpose of this study was to identify alternative trauma training courses used in LMICs by scoping review and compare their effectiveness.

Development and initial validation of a patient-centered stroke outcome measure in young stroke survivors.

Background And Purpose: This study was undertaken to develop a patient-centered stroke outcome measure and initial validation of the proposed Young Stroke Questionnaire (YSQ).

Methods: This study assessed the reliability and discriminant validity of the YSQ. The initial questionnaire evolved from a focus group comprised of six young stroke survivors and six stroke neurologists centralized around four patient-centered domains.

Wise Pattern Direct Implant Breast Reconstruction: A Review and Improved Outcomes Using Dermal Matrix.

Background: The inverted T (Wise pattern) mastectomy for patients with macromastia or significant breast ptosis has evolved along with generalized techniques for breast reconstruction. We present a review of Wise pattern breast reconstruction along with our technique for direct to implant reconstruction using dermal matrix.

Methods: The literature was reviewed and an analysis of techniques and complications was performed.