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Surgical Procedures, Operative Commons

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Perioperative Family Updates Reduce Anxiety And Improve Satisfaction: A Randomized Controlled Trial, Lindsay S. Howe, Daniel Wigmore, Nathaniel Nelms, Patrick Schottel, Craig Bartlett, David Halsey, Martin Krag, David Lunardini, Robert Monsey, Bruce Beynnon, Michael Blankstein 2021 Larner College of Medicine at the University of Vermont

Perioperative Family Updates Reduce Anxiety And Improve Satisfaction: A Randomized Controlled Trial, Lindsay S. Howe, Daniel Wigmore, Nathaniel Nelms, Patrick Schottel, Craig Bartlett, David Halsey, Martin Krag, David Lunardini, Robert Monsey, Bruce Beynnon, Michael Blankstein

Journal of Patient-Centered Research and Reviews

Purpose: This study aimed to determine if standardized updates at specific perioperative events affect anxiety and satisfaction of the family members and if the length of surgical procedure affects the satisfaction with updates.

Methods: This study was a randomized control trial. In the control group, surgeons communicated with the family only once near the completion of the procedure. In the intervention group, families received electronic updates at 3 significant perioperative events during the procedure. A postoperative survey rating family member satisfaction and anxiety levels, using a Likert scale of 0–5, was administered.

Results: Mean level of overall satisfaction did ...


Pheochromocytoma Presenting As Testicular Pain: An Unusual Case Report, Jinal K. Patel, Varun Reddy, Gauthier L. Stepman, Debra Angelo, Johnathan Frunzi 2021 HCA Healthcare

Pheochromocytoma Presenting As Testicular Pain: An Unusual Case Report, Jinal K. Patel, Varun Reddy, Gauthier L. Stepman, Debra Angelo, Johnathan Frunzi

Endocrinology

Pheochromocytoma (PCC) is a rare catecholamine-secreting tumor that arises from chromaffin cells of the adrenal medulla which are derived from the neural crest. This report illustrates a 51-year-old Caucasian male with a history of hypertension diagnosed two years ago who presented to the hospital due to acute onset of right testicular pain of 3-day duration. Laboratory results and imaging revealed a presumptive diagnosis of PCC. The patient had undergone robot-assisted laparoscopic right adrenalectomy 14 days after being diagnosed with PCC due to perioperative management with phenoxybenzamine. The final pathology report revealed a PCC. At follow-up two weeks after discharge, the ...


Smartphone-Based Prediction Model For Postoperative Cardiac Surgery Outcomes Using Preoperative Gait And Posture Measures, Rahul Soangra, Thurmon Lockhart 2021 Chapman University

Smartphone-Based Prediction Model For Postoperative Cardiac Surgery Outcomes Using Preoperative Gait And Posture Measures, Rahul Soangra, Thurmon Lockhart

Physical Therapy Faculty Articles and Research

Gait speed assessment increases the predictive value of mortality and morbidity following older adults’ cardiac surgery. The purpose of this study was to improve clinical assessment and prediction of mortality and morbidity among older patients undergoing cardiac surgery through the identification of the relationships between preoperative gait and postural stability characteristics utilizing a noninvasive-wearable mobile phone device and postoperative cardiac surgical outcomes. This research was a prospective study of ambulatory patients aged over 70 years undergoing non-emergent cardiac surgery. Sixteen older adults with cardiovascular disease (Age 76.1 ± 3.6 years) scheduled for cardiac surgery within the next 24 h ...


Post-Operative Day 1 Versus Day 0 Follow-Up For Uncomplicated Cataract Surgeries: A Comparison Of Post-Operative Outcomes And Managements, Harsh Parekh BS, Shibandri Das MD, Vaama Patel MD, Ryan Freedman MD, Sabba Mansoor BS, Amanda Ismail MD, Faisal Ridha Al-Timimi MD 2021 Wayne State University School of Medicine

Post-Operative Day 1 Versus Day 0 Follow-Up For Uncomplicated Cataract Surgeries: A Comparison Of Post-Operative Outcomes And Managements, Harsh Parekh Bs, Shibandri Das Md, Vaama Patel Md, Ryan Freedman Md, Sabba Mansoor Bs, Amanda Ismail Md, Faisal Ridha Al-Timimi Md

Medical Student Research Symposium

Purpose: To compare the postoperative outcomes and management of uncomplicated cataract surgery (CEIOL) patients seen on post-operative day zero (POD 0) versus post-operative day one (POD 1).

Methods: A retrospective chart review of 533 patients who had CEIOL at the Kresge Eye Institute from December 2017 to September 2019 was performed. Visual acuity (VA) and intraocular pressure (IOP) were collected from the pre-operative visit, and the first and second post-operative day visits. In addition, changes in management were recorded from the first post-operative day visit. Patients were excluded if they had a complex cataract procedure, had combined glaucoma filtering surgery ...


Resident Heart Rate Variability During Cataract Surgery, Ahmad Baiyasi, Shibandri Das, Ferris Bayasi, Faisal Ridha Al-Timimi 2021 Wayne State University School of Medicine

Resident Heart Rate Variability During Cataract Surgery, Ahmad Baiyasi, Shibandri Das, Ferris Bayasi, Faisal Ridha Al-Timimi

Medical Student Research Symposium

Purpose: To evaluate ophthalmology resident anxiousness and cardiovascular response by tracking resident heart rate (HR) when performing cataract surgery during their last year of residency.

Methods: A prospective analysis of 31 cataract cases, completed by three residents (two females and one male), at the Kresge Eye Institute in August and September 2020 was performed. Inclusion criteria for cases included all cataract cases performed by PGY-4 residents at the Kresge Eye Institute who downloaded the Heart Graph app supported by iOS. Residents with android mobile devices were excluded from the study. Informed consent was obtained from all residents who utilized the ...


Potential Perioperative Complications Due To Difference In Timing Of Systemic Heparinization During Ruptured Aneurysm Coiling, Rouzbeh Kotaki, Ameer E. Hassan, Wondwossen G. Tekle 2021 The University of Texas Rio Grande Valley

Potential Perioperative Complications Due To Difference In Timing Of Systemic Heparinization During Ruptured Aneurysm Coiling, Rouzbeh Kotaki, Ameer E. Hassan, Wondwossen G. Tekle

MEDI 9331 Scholarly Activities Clinical Years

Potential Perioperative Complications Due To Differences in Timing Of Systemic Heparin Distribution During Ruptured Aneurysm Coiling

Introduction:

In general, systematic heparin anticoagulation is standard in regards to neurovascular intervention. When coiling ruptured aneurysms, many neurointerventionalists have their own protocol as to timing of systemic heparinization. There is ample research and literature reviewing the frequency of perioperative events, predictors and outcomes, as well as the efficacy in the use of anticoagulants and/or antiplatelets before, during, and after neurovascular procedures to prevent adverse outcomes. However, there currently exists a dearth of research in regards to timing of distribution of heparin intraoperatively ...


Opioid Use Disorder: The Timeline For Medication Assisted Therapy, Alexander Cristofori 2021 Arcadia University

Opioid Use Disorder: The Timeline For Medication Assisted Therapy, Alexander Cristofori

Capstone Showcase

Opioid Use Disorder is patterns of opioid use leading to withdrawal, giving up important life events in order to use opioids, and excessive time spent using opioids, to name a few diagnostic criteria. The clinical progression of the disorder involves periods of acute exacerbation and remission that are cyclic in nature. Treatment is most effective when it includes both pharmacological and psychosocial modalities, referred to as medication assisted therapy (MAT). Three drugs used commonly in MAT-based treatment for OUD from oldest to newest include Methadone, Buprenorphine-naloxone, and Naltrexone. Treatment program models that prioritize total abstinence from the addictive substance attached ...


Patency Of Arterial Repairs From Wartime Extremity Vascular Injuries, Lauren J. Haney, Esther Bae, Mary Jo V. Pugh, Laurel A. Copeland, Chen-Pin Wang, Daniel J. MacCarthy, Megan E. Amuan, Paula K. Shireman 2020 University of Texas at San Antonio

Patency Of Arterial Repairs From Wartime Extremity Vascular Injuries, Lauren J. Haney, Esther Bae, Mary Jo V. Pugh, Laurel A. Copeland, Chen-Pin Wang, Daniel J. Maccarthy, Megan E. Amuan, Paula K. Shireman

Open Access Publications by UMMS Authors

Background: Extremity vascular injury (EVI) causes significant disability in Veterans of the Afghanistan/Iraq conflicts. Advancements in acute trauma care improved survival and decreased amputations. The study of wartime EVI has relied on successful limb salvage as a surrogate for vascular repair. We used imaging studies as a specific measure of arterial repair durability.

Methods: Service members with EVI were identified using the Department of Defense Trauma Registry and validated by chart abstraction. Inclusion criteria for the arterial patency subgroup included an initial repair attempt with subsequent imaging reports (duplex ultrasound, CT angiography, and angiogram) documenting initial patency.

Results: The ...


Diagnostic Accuracy Of Mcmurry’S Test In The Diagnosis Of Meniscal Tears, Jessica Smyth, Hartwell Rainey 2020 James Madison University

Diagnostic Accuracy Of Mcmurry’S Test In The Diagnosis Of Meniscal Tears, Jessica Smyth, Hartwell Rainey

Physician Assistant Capstones, 2020-current

No abstract provided.


Prospective, Multicenter Study Of P4hb (Phasix) Mesh For Hernia Repair In Cohort At Risk For Complications: 3-Year Follow-Up, John Scott Roth, John R. Romanelli, Raymond M. Dunn 2020 University of Kentucky Medical Center

Prospective, Multicenter Study Of P4hb (Phasix) Mesh For Hernia Repair In Cohort At Risk For Complications: 3-Year Follow-Up, John Scott Roth, John R. Romanelli, Raymond M. Dunn

Open Access Publications by UMMS Authors

Background: This study represents a prospective, multicenter, open-label study to assess the safety, performance, and outcomes of poly-4-hydroxybutyrate (P4HB, Phasix) mesh for primary ventral, primary incisional, or multiply-recurrent hernia in subjects at risk for complications. This study reports 3-year clinical outcomes.

Materials and methods: P4HB mesh was implanted in 121 patients via retrorectus or onlay technique. Physical exam and/or quality of life surveys were completed at 1, 3, 6,12, 18, 24, and 36 months, with 5-year (60-month) follow-up ongoing.

Results: A total of n = 121 patients were implanted with P4HB mesh (n = 75 (62%) female) with a mean ...


Clinical Practice Guidelines On Ordering Echocardiography Before Hip Fracture Repair Perform Differently From One Another, Eric F. Swart, Chris Adair, Rachel B. Seymour, Madhav A. Karunakar 2020 University of Massachusetts Medical School

Clinical Practice Guidelines On Ordering Echocardiography Before Hip Fracture Repair Perform Differently From One Another, Eric F. Swart, Chris Adair, Rachel B. Seymour, Madhav A. Karunakar

University of Massachusetts Medical School Faculty Publications

Background: Osteoporotic hip fractures typically occur in frail elderly patients with multiple comorbidities, and repair of the fracture within 48 h is recommended. Pre-operative evaluation sometimes involves transthoracic echocardiography (TTE) to screen for heart disease that would alter peri-operative management, yet TTE can delay surgery and is resource intensive. Evidence suggests that the use of clinical practice guidelines (CPGs) can improve care. It is unclear which guidelines are most useful in hip fracture patients.

Questions/Purposes: We sought to evaluate the performance of the five commonly used CPGs in determining which patients with acute fragility hip fracture require TTE and ...


Gender-Specific Anatomical Distribution Of Internal Pudendal Artery Perforator: A Radiographic Study For Perineal Reconstruction, Regina Sonda, Andrea Monticelli, Erica Dalla Venezia, Chiara Giraudo, Giorgio Giatsidis, Franco Bassetto, Veronica Macchi, Cesare Tiengo 2020 Padova University Hospital

Gender-Specific Anatomical Distribution Of Internal Pudendal Artery Perforator: A Radiographic Study For Perineal Reconstruction, Regina Sonda, Andrea Monticelli, Erica Dalla Venezia, Chiara Giraudo, Giorgio Giatsidis, Franco Bassetto, Veronica Macchi, Cesare Tiengo

Open Access Publications by UMMS Authors

Background: Cancer, trauma, infection, or radiation can cause perineal defects. Fasciocutaneous flaps based on perforator vessels (PV) from the internal pudendal artery (IPA) provide an ideal reconstructive option for moderate defects. We hypothesized that, due to gender differences in the pelvic-perineal region, the anatomical distribution of PV differs between genders.

Methods: Computed tomography angiographies from male and female patients without pelvic-perineal pathologies were retrospectively analyzed to study the vascular anatomy of the IPA. The number, size, type, and distribution of PV were recorded and compared between genders. Four anatomical regions were defined to describe the distribution of PV on each ...


Validation Of An Endometrial Tumor Diameter Model For Risk Assessment In The Absence Of Lymph Node Mapping, McKayla J. Riggs, Callie M. Cox Bauer, Caela R. Miller, James K. Aden, Scott A. Kamelle 2020 Brooke Army Medical Center

Validation Of An Endometrial Tumor Diameter Model For Risk Assessment In The Absence Of Lymph Node Mapping, Mckayla J. Riggs, Callie M. Cox Bauer, Caela R. Miller, James K. Aden, Scott A. Kamelle

Journal of Patient-Centered Research and Reviews

Purpose: This study aimed to assess the optimal tumor diameter for predicting lymphatic metastasis and to determine intraoperatively the need for lymph node dissection in patients with endometrioid endometrial cancer.

Methods: Military beneficiaries diagnosed with stage I–III endometrioid endometrial cancer during 2003–2016 who had at least 7 pelvic and/or paraaortic lymph nodes removed during the time of hysterectomy were studied. Tumor diameter was compared against the presence of positive nodes, using the prior models of 20 mm (ie, Mayo model) and 50 mm (ie, Milwaukee model), to determine the false-negative rate of each threshold. A separate analysis ...


Improving Stamina And Mobility With Preop Walking In Surgical Patients With Frailty Traits -Oasis Iv: Randomized Clinical Trial Study Protocol, Laboni Hoque, Ryan Dewolf, David Meyers, Daniel K. White, Kathleen M. Mazor, Mihaela S. Stefan, Sybil L. Crawford, Karim Alavi, Jennifer K. Yates, Mark W. Maxfield, Feiran Lou, Karl Uy, J. Matthias Walz, Alok Kapoor 2020 University of Massachusetts Medical School

Improving Stamina And Mobility With Preop Walking In Surgical Patients With Frailty Traits -Oasis Iv: Randomized Clinical Trial Study Protocol, Laboni Hoque, Ryan Dewolf, David Meyers, Daniel K. White, Kathleen M. Mazor, Mihaela S. Stefan, Sybil L. Crawford, Karim Alavi, Jennifer K. Yates, Mark W. Maxfield, Feiran Lou, Karl Uy, J. Matthias Walz, Alok Kapoor

Open Access Publications by UMMS Authors

BACKGROUND: Frail older surgical patients face more than a two-fold increase in postoperative complications, including myocardial infarction, deep vein thrombosis, pulmonary embolism, pneumonia, ileus, and others. Many of these complications occur because of postoperative loss of stamina and poor mobility. Preoperative exercise may better prepare these vulnerable patients for surgery. We present the protocol for our ongoing randomized trial to assess the impact of a preoperative walking intervention with remote coaching and pedometer on outcomes of stamina (six-minute walk distance- 6MWD) and mobility (postoperative steps) in older adults with frailty traits.

METHODS: We will be conducting a randomized clinical trial ...


Transcutaneous Energy Transmission: Can We Do It Now?, Yuriy Pya 2020 National Research Cardiac Surgery Center

Transcutaneous Energy Transmission: Can We Do It Now?, Yuriy Pya

The VAD Journal

The percutaneous driveline used in contemporary LVADs presents a continuous risk of infection for the duration of support. Minimizing infection in durable mechanical circulatory support systems requires total implantation of all components and energy transfer by means other than percutaneous drivelines. A novel coplanar energy transfer (CET) system, similar to the original transcutaneous energy transfer (TET) design, is unique by incorporating two large rings with coil-within-the-coil topology to ensure strong resonance power. The CET system consists of an internal integrated controller, a battery coupled with an internal thoracic coil ring, and the LVAD pump. External equipment includes a power transmission ...


The Clinical Relevance Of Cement Volume In Percutaneous Vertebral Augmentation, Ravi G. Mirpuri, Madhuri Are, Virginia Hardie, Michael J. Warden, Robin High 2020 University of Nebraska Medical Center

The Clinical Relevance Of Cement Volume In Percutaneous Vertebral Augmentation, Ravi G. Mirpuri, Madhuri Are, Virginia Hardie, Michael J. Warden, Robin High

Graduate Medical Education Research Journal

Introduction: Vertebroplasty and Kyphoplasty are two forms of percutaneous vertebral augmentation (PVA), in which polymethylmethacrylate cement is used to stabilize vertebral compression fractures (VCF). This study sought to evaluate the relationship between cement volume and clinical outcomes, including pain reduction, opioid use, and complication rate.

Methods: Retrospective chart review produced 88 patients who received PVA at a tertiary care outpatient pain clinic. Cement volume, type of PVA, gender, level (thoracic vs lumbar) were collected, as well as clinical outcomes of numeric pain score (NPS) reduction, opioid percent change (OPC), and complications. Both pre-procedure and post-procedure (between 2-4 weeks) data were ...


Evaluation Of An Intervention To Maintain Therapeutic Pressure Of The Endotracheal Tube Cuff During Intraoperative Surgery, Jamare Reed 2020 The University of Southern Mississippi

Evaluation Of An Intervention To Maintain Therapeutic Pressure Of The Endotracheal Tube Cuff During Intraoperative Surgery, Jamare Reed

Doctoral Projects

The current practice of intraoperatively assessing the cuff pressure of the endotracheal tube (ETT) is arbitrary and potentially leads to negative impacts on patients. This best practice project aimed to review and synthesize the existing evidence-based literature on measuring ETT cuff pressure and to establish a policy guideline for anesthesia providers to measure ETT cuff pressure in the intraoperative environment. Based on the star model of the knowledge transformation framework model provided by the Academic Center for Evidence-Based Practice (ACE), the creation of evidence-based policy on ETT cuff measurement is expected to potentially prevent poor patient outcomes, patient expenses, and ...


Outcomes After Stereotactic Body Radiation Therapy As A Bridging Modality To Liver Transplantation For Hepatocellular Carcinoma, Rashi Garg, Kim Foley, Babak Movahedi, Mark Masciocchi, Jacob R. Bledsoe, Linda Ding, Paul Rava, Thomas J. Fitzgerald, Shirin Sioshansi 2020 Tufts University

Outcomes After Stereotactic Body Radiation Therapy As A Bridging Modality To Liver Transplantation For Hepatocellular Carcinoma, Rashi Garg, Kim Foley, Babak Movahedi, Mark Masciocchi, Jacob R. Bledsoe, Linda Ding, Paul Rava, Thomas J. Fitzgerald, Shirin Sioshansi

Radiology Publications

Purpose: For patients with hepatocellular carcinoma awaiting liver transplantation (LT), stereotactic body radiation therapy (SBRT) has emerged as a bridging treatment to ensure patients maintain priority status and eligibility per Milan criteria. In this study, we aimed to determine the efficacy and safety of SBRT in such situations.

Methods and Materials: A retrospective analysis was conducted of the outcomes of 27 patients treated with SBRT who were listed for LT at 1 institution. Among these, 20 patients with 26 tumors went on to LT and were the focus of this study. Operative reports and postoperative charts were evaluated for potential ...


Characterizing Recurrence Following Hybrid Ablation In Patients With Persistent Atrial Fibrillation, David C. Kress, Lynn Erickson, Tadele W. Mengesha, David Krum, Jasbir Sra 2020 Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke’s Medical Centers

Characterizing Recurrence Following Hybrid Ablation In Patients With Persistent Atrial Fibrillation, David C. Kress, Lynn Erickson, Tadele W. Mengesha, David Krum, Jasbir Sra

Journal of Patient-Centered Research and Reviews

Purpose: It is It is widely accepted that atrial fibrillation (AF) accounts for half of arrhythmia recurrences following endocardial catheter ablation of AF. An epicardial-endocardial approach (hybrid) has emerged as an alternative to endocardial ablation alone for the treatment of AF, yet recurrence after a hybrid procedure has not been well characterized. This retrospective study is aimed at characterizing recurrence following hybrid ablation for patients with persistent AF.

Methods: Patients with persistent AF (N = 108) received both endocardial and epicardial ablation of the posterior left atrial wall using catheter ablation and a small midline surgical approach (hybrid). Presence of atrial ...


The Migration And Wear Of Reverse Total Shoulder Arthroplasty, Madeleine L. Van de Kleut 2020 The University of Western Ontario

The Migration And Wear Of Reverse Total Shoulder Arthroplasty, Madeleine L. Van De Kleut

Electronic Thesis and Dissertation Repository

Reverse total shoulder arthroplasty (RTSA) inverts the ball and socket geometry of the shoulder. Though projected to become the most common shoulder replacement in the next decade, RTSA suffers from a high complication and revision rate, with implant loosening requiring revision. As the number of indications and demand from younger patients for RTSA continues to grow, there is the need to identify implant fixation techniques that promote longevity.

Radiostereometric analysis (RSA) is the current standard for measuring implant migration, which, if continuous in the first year postoperatively is highly predictive of later loosening and failure. RSA has also been used ...


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