Publications by authors named "Michael Grant"

347 Publications

Assigning shark fin origin using species distribution models needs a reality check.

Biol Lett 2021 07 14;17(7):20200907. Epub 2021 Jul 14.

Centre for Sustainable Tropical Fisheries and Aquaculture and College of Science and Engineering, James Cook University, 1 James Cook Drive, Townsville, Queensland 4811, Australia.

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http://dx.doi.org/10.1098/rsbl.2020.0907DOI Listing
July 2021

Forming the Hematology-Oncology Collaborative Videoconferencing (CO-VID) Learning Initiative: Experiential Lessons Learned From a Novel Trainee-Led Multidisciplinary Virtual Learning Platform.

JCO Oncol Pract 2021 Jul 9:OP2000960. Epub 2021 Jul 9.

Division of Hematology Oncology, Department of Medicine, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC.

Purpose: COVID-19 challenged medical practice and graduate medical education. Building on previous initiatives, we describe and reflect on the formative process and goals of the Hematology-Oncology Collaborative Videoconferencing Learning Initiative, a trainee-led multi-institutional virtual COVID-19 learning model.

Methods: Clinical fellows and faculty from 13 US training institutions developed consensus needs, goals, and objectives, recruited presenters, and generated a multidisciplinary COVID-19 curriculum. Weekly Zoom conferences consisted of two trainee-led instructional segments and a trainee-moderated faculty Q&A panel. Hematology-oncology training program faculty and trainees were the targeted audience. Leadership evaluations consisted of anonymized baseline and concluding mixed methods surveys. Presenter evaluations consisted of session debriefs and two structured focus groups. Conference evaluations consisted of attendance, demographics, and pre- or postmultiple-choice questions on topic learning objectives.

Results: In 6 weeks, the initiative produced five conferences: antivirals, anticoagulation, pulmonology, provider resilience, and resource scarcity ethics. The average attendance was 100 (range 57-185). Among attendees providing both pre- and postconference data, group-level knowledge appeared to increase: antiviral (n = 46) pre-/postcorrect 82.6%/97.8% and incorrect 10.9%/2.2%, anticoagulation (n = 60) pre-/postcorrect 75%/93.3% and incorrect 15%/6.7%, and pulmonary (n = 21) pre-/postcorrect 66.7%/95.2% and incorrect 33.3%/4.8%. Although pulmonary management comfort appeared to increase, comfort managing of antivirals and anticoagulation was unchanged. At the conclusion of the pilot, leadership trainees reported improved self-confidence organizing multi-institutional collaborations, median (interquartile range) 58.5 (50-64) compared with baseline 34 (26-39), but did not report improved confidence in other educational or leadership skills.

Conclusion: During crisis, trainees built a multi-institutional virtual education platform for the purposes of sharing pandemic experiences and knowledge. Accomplishment of initiative goals was mixed. Lessons learned from the process and goals may improve future disaster educational initiatives.
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http://dx.doi.org/10.1200/OP.20.00960DOI Listing
July 2021

Learning from Crisis: a Multicentre Study of Oncology Telemedicine Clinics Introduced During COVID-19.

J Cancer Educ 2021 Jul 2. Epub 2021 Jul 2.

Barts Cancer Institute, Bart's and The London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, Barbican, London, EC1M 6BE, UK.

The COVID-19 pandemic has necessitated adaptation of cancer patient care. Oncology patients who contract COVID-19 have poor outcomes. Telemedicine clinics (teleclinics) have been introduced for cancer patients to reduce the risk of horizontal transmission at St. Bartholomew's Hospital and The Royal Free Hospital in London. Teleclinics have become routine in many specialities; however, inclusion in oncology care was not standard prior to the pandemic. A mixed-methods survey was designed and delivered to cancer patients (n = 106) at St. Bartholomew's Hospital and The Royal Free Hospital who had transitioned to teleclinics in March 2020. The survey explored patients' perceptions of this format. In total, 96 (90.5%) patients consented to take part, across a range of tumour types. Overall, respondents reacted favourably to the format of the teleclinics, with 90.6% of respondents (87/96) stating they would utilise teleclinics beyond the pandemic. Additionally, a survey was distributed to clinicians delivering these teleclinics (n = 16) to explore previous training in, perceptions of, and lessons learned from the introduction of telemedicine. Results suggest patients are accepting of teleclinic use for most clinical purposes. Teleclinic implementation affords benefits to cancer patient care both during and after COVID-19, but there is an urgent need for telemedicine education in oncology specialty training.
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http://dx.doi.org/10.1007/s13187-021-02053-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8249430PMC
July 2021

Selecting the optimal immunotherapy regimen in driver-negative metastatic NSCLC.

Nat Rev Clin Oncol 2021 Jun 24. Epub 2021 Jun 24.

Department of Medicine (Medical Oncology), Yale School of Medicine, Yale Cancer Center, New Haven, CT, USA.

The treatment landscape of driver-negative non-small-cell lung cancer (NSCLC) is rapidly evolving. Immune-checkpoint inhibitors, specifically those targeting PD-1 or PD-L1, have demonstrated durable efficacy in a subset of patients with NSCLC, and these agents have become the cornerstone of first-line therapy. Approved immunotherapeutic strategies for treatment-naive patients now include monotherapy, immunotherapy-exclusive regimens or chemotherapy-immunotherapy combinations. Decision making in this space is complex given the absence of head-to-head prospective comparisons, although a thorough analysis of long-term efficacy and safety data from pivotal clinical trials can provide insight into the optimal management of each subset of patients. Indeed, histological subtype and the extent of tumour cell PD-L1 expression are paramount to regimen selection, although other clinicopathological factors and patient preferences might also be relevant in certain scenarios. Finally, several emerging biomarkers and novel therapeutic strategies are currently under investigation, and these might further refine the current treatment paradigm. In this Review, we discuss the current treatment landscape and detail our approach to first-line immunotherapy regimen selection for patients with advanced-stage, driver-negative NSCLC.
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http://dx.doi.org/10.1038/s41571-021-00520-1DOI Listing
June 2021

Institutional factors associated with adherence to enhanced recovery protocols for colorectal surgery: Secondary analysis of a multicenter study.

J Clin Anesth 2021 Jun 16;74:110378. Epub 2021 Jun 16.

Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins Hospital School of Medicine, Baltimore, MD, USA.

Introduction: Adherence to Enhanced Recovery Protocols (ERPs) is associated with faster functional recovery, better patient satisfaction, lower complication rates and reduced length of hospital stay. Understanding institutional barriers and facilitators is essential for improving adherence to ERPs. The purpose of this study was to identify institutional factors associated with adherence to an ERP for colorectal surgery.

Methods: A secondary analysis of a nationwide study was conducted including 686 patients who underwent colorectal surgery across twenty-one institutions in Spain. Adherence to ERPs was calculated based upon the components recommended by the Enhanced Recovery After Surgery (ERAS®) Society. Institutional characteristics (i.e., case volume, ERP duration, anesthesia staff size, multidisciplinary meetings, leadership discipline) were captured from each participating program. Multivariable regression was performed to determine characteristics associated with adherence.

Results: The median adherence to ERAS was 68.2% (IQR 59.1%-81.8%). Multivariable linear regression revealed that anesthesiologist leadership (+5.49%, 95%CI +2.81% to +8.18%, P < 0.01), duration of ERAS implementation (+0.46% per year, 95%CI +0.06% to +0.86%, P < 0.01) and the use of regular multidisciplinary meetings (+4.66%, 95%CI +0.06 to +7.74%, P < 0.01) were independently associated with greater adherence. Case volume (-2.38% per 4 cases weekly, 95%CI -3.03 to -1.74, P < 0.01) and number of anesthesia providers (-1.19% per 10 providers, 95%CI +2.23 to -8.18%, P < 0.01) were negatively associated with adherence.

Conclusion: Adherence to ERPs is strongly associated with anesthesiology leadership, regular multidisciplinary meetings, and program duration, whereas case volume and the size of the anesthesia staff were potential barriers. These findings highlight the importance of strong leadership, experience and establishing a multidisciplinary team when developing an ERP for colorectal surgery.
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http://dx.doi.org/10.1016/j.jclinane.2021.110378DOI Listing
June 2021

Selecting Elements for a Cardiac Enhanced Recovery Protocol.

J Cardiothorac Vasc Anesth 2021 May 11. Epub 2021 May 11.

University of Massachusetts-Baystate, Heart, Vascular and Critical Care Units, Baystate Medical Center, Springfield, MA.

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http://dx.doi.org/10.1053/j.jvca.2021.05.006DOI Listing
May 2021

Neuroma of The Supraorbital Nerve Following Forehead Flap Reconstruction - Presentation and Surgical Management.

J Craniofac Surg 2021 Jun;32(4):1515-1516

Department of Plastic and Reconstructive Surgery.

Abstract: Localized pain or headache from neuroma formation is a rare and challenging complication of forehead flap surgery. Here the authors present a patient who developed local pain and dysesthesia following iatrogenic injury to the left supraorbital nerve during forehead flap elevation. Following a diagnostic nerve block in clinic, surgical excision of the neuroma was performed through an upper blepharoplasty approach. The patient had immediate postoperative pain relief and remains pain free at fifteen-month follow-up. The authors describe etiology, workup, and surgical management of sensory nerve injury during forehead flap reconstruction.
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http://dx.doi.org/10.1097/SCS.0000000000007566DOI Listing
June 2021

How Do We Use Dashboards to Enhance Quality in Cardiac Anesthesia?

J Cardiothorac Vasc Anesth 2021 Apr 28. Epub 2021 Apr 28.

Department of Anesthesiology and Critical Care Medicine, Division of Cardiac Anesthesiology, Johns Hopkins University School of Medicine, Baltimore, MD.

The use of clinical dashboards has expanded significantly in healthcare in recent years in a variety of settings. The ability to analyze data related to quality metrics in one screen is highly desirable for cardiac anesthesiologists, as they have considerable influence on important clinical outcomes. Building a robust quality program within cardiac anesthesia relies on consistent access and review of quality outcome measures, process measures, and operational measures through a clinical dashboard. Signals and trends in these measures may be compared to other cardiac surgical programs to analyze gaps and areas for quality improvement efforts. In this article, the authors describe how they designed a clinical cardiac anesthesia dashboard for quality efforts at their institution.
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http://dx.doi.org/10.1053/j.jvca.2021.04.034DOI Listing
April 2021

Disseminating Hand Surgery Research Using Social Media: The Relationship Between Altmetrics and Citations.

J Hand Surg Am 2021 May 26. Epub 2021 May 26.

Department of Plastic and Reconstructive Surgery, Leeds General Infirmary, Leeds; Faculty of Medicine and Health, Worsley Building, University of Leeds, Leeds, United Kingdom. Electronic address:

Purpose: Social media adds to the traditional methods of research dissemination. It allows researchers and publishers to immediately share content directly with interested end users on a global scale. Alternative metrics (altmetrics) are new bibliometrics that describe article-level activity on platforms such as Twitter, Wikipedia, and online news media. Altmetrics are strongly associated with citation counts in numerous medical disciplines. The aim of this study was to investigate the relationship of altmetrics to citation counts in the field of hand surgery.

Methods: Altmetric Explorer was used to extract data on altmetrics and citation rates for articles published in 2017 in 6 prominent hand surgery journals. Multivariable negative binomial regression was used to estimate the relationship between citation counts and predictors (presented as the incidence rate ratio with a 95% confidence interval [CI]).

Results: Overall, 624 articles were included. Mentions on social media platforms were independently associated with more citations (adjusted incidence rate ratio 1.04 [95% CI 1.02-1.05]). The factor that most influenced the rate of citations was the journal in which the article was published; articles in the Journal of Hand Surgery had at least 1 more citation than articles published elsewhere (median difference 3 [interquartile range {IQR} 2-3]) and had a median Altmetric Attention Score which was 3 points higher (IQR 2-3) than articles published elsewhere.

Conclusions: The dissemination of hand surgery research through social media channels is associated with substantial and measurable improvements in short-term citation rates CLINICAL RELEVANCE: Social media appears to be a valuable tool for communicating important research directly to hand surgeons in a timely and succinct manner.
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http://dx.doi.org/10.1016/j.jhsa.2021.03.028DOI Listing
May 2021

Radiomics for Renal Cell Carcinoma: Predicting Outcomes from Immunotherapy and Targeted Therapies-A Narrative Review.

Eur Urol Focus 2021 May 11. Epub 2021 May 11.

Centre for Experimental Cancer Medicine, Barts Cancer Institute, Queen Mary University of London, London, UK.

T-cell immunotherapy and molecular targeted therapies have become standard-of-care treatments for renal cell carcinoma (RCC). There is a need to develop robust biomarkers that predict patient outcomes to targeted therapies to personalise treatment. In recent years, quantitative analysis of imaging features, termed radiomics, has been used to extract tumour features. This narrative mini review summarises the evidence for radiomics prediction of immunotherapy and molecular targeted therapy outcomes in RCC. Radiomics may predict survival, treatment response, and disease progression in RCC treated with tyrosine kinase inhibitors (eg, sunitinib) and immune checkpoint inhibitors (eg, nivolumab). Further validation is necessary in large-scale studies. PATIENT SUMMARY: We summarise evidence on the ability of features extracted from CT (computed tomography) scans to predict patient outcomes from new treatments for kidney cancer. Although these features can predict treatment outcomes for patients, including survival, treatment response, and cancer progression, further research is necessary before this technology can be applied clinically.
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http://dx.doi.org/10.1016/j.euf.2021.04.024DOI Listing
May 2021

Transesophageal Echocardiography in Patients Undergoing Coronary Artery Bypass Graft Surgery.

J Am Coll Cardiol 2021 Jul 3;78(2):112-122. Epub 2021 May 3.

Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, Florida, USA.

Background: The impact of utilization of intraoperative transesophageal echocardiography (TEE) at the time of isolated coronary artery bypass grafting (CABG) on clinical decision making and associated outcomes is not well understood.

Objectives: The purpose of this study was to determine the association of TEE with post-CABG mortality and changes to the operative plan.

Methods: A retrospective cohort study of planned isolated CABG patients from the Society of Thoracic Surgeons Adult Cardiac Surgery Database between January 1, 2011, and June 30, 2019, was performed. The exposure variable of interest was use of intraoperative TEE during CABG compared with no TEE. The primary outcome was operative mortality. The association of TEE with unplanned valve surgery was also assessed.

Results: Of 1,255,860 planned isolated CABG procedures across 1218 centers, 676,803 (53.9%) had intraoperative TEE. The percentage of patients receiving intraoperative TEE increased over time from 39.9% in 2011 to 62.1% in 2019 (p trend <0.0001). CABG patients undergoing intraoperative TEE had lower odds of mortality (adjusted odds ratio: 0.95; 95% confidence interval: 0.91 to 0.99; p = 0.025), with heterogeneity across STS risk groups (p interaction = 0.015). TEE was associated with increased odds of unplanned valve procedure in lieu of planned isolated CABG (adjusted odds ratio: 4.98; 95% confidence interval: 3.98 to 6.22; p < 0.0001).

Conclusions: Intraoperative TEE usage during planned isolated CABG is associated with lower operative mortality, particularly in higher-risk patients, as well as greater odds of unplanned valve procedure. These findings support usage of TEE to improve outcomes for isolated CABG for high-risk patients.
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http://dx.doi.org/10.1016/j.jacc.2021.04.064DOI Listing
July 2021

The monthly operating cost of an institutional COVID-19 airway response team: A financial model and sensitivity analysis based on experience at an academic medical center.

Perioper Care Oper Room Manag 2021 Jun 20;23:100168. Epub 2021 Apr 20.

Brigham and Women's Hospital, Boston, MA, USA.

Background: Coronavirus disease 2019 (COVID-19) airway response teams concentrate equipment and expertise while minimizing the number of providers exposed to aerosol generating procedures. These airway teams were implemented in various hospitals around the world to respond to the acute increase of critical ill patients requiring ventilatory support. We created a financial model to estimate the costs for staffing and maintaining a dedicated COVID-19 airway response team based on the experience at an urban academic hospital in the Northeastern United States between March and June of 2020.

Methods: The institutional review board at Brigham and Women's Hospital approved this protocol and the requirement for informed consent was waived. The average reimbursement for 125 COVID-19 airway consultations was measured. Our team estimated the costs of consumable items for each airway based on previously published recommendations for equipment and personal protective equipment. A sensitivity analyses was performed for variable numbers of monthly airway consults and different staffing patterns based on a literature review of available COVID-19 airway team structures.

Results: Based on the average reimbursements and estimates of the consumable costs, each airway procedure represented a net loss of $34 to the institution. The overall estimated cost of staffing a dedicated airway team was between $109,472 and $204,575 per month.

Conclusions: Development and implementation of a dedicated COVID-19 airway response teams represents a significant institutional expense. Institutions should establish necessary cost sharing, consider volume and team structure, and identify reimbursement opportunities that mitigate the necessary expense associated with airway response programs.
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http://dx.doi.org/10.1016/j.pcorm.2021.100168DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8056877PMC
June 2021

In Response.

Authors:
Michael C Grant

Anesth Analg 2021 05;132(5):e79-e80

Department of Anesthesiology and Critical Care Medicine, Department of Surgery, Armstrong Institute for Patient Safety and Quality, The Johns Hopkins Medical Institutions, Baltimore, Maryland,

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http://dx.doi.org/10.1213/ANE.0000000000005452DOI Listing
May 2021

Hip fractures in the young polytrauma patient: a review and the latest data from the UK.

Eur J Orthop Surg Traumatol 2021 Jul 22;31(5):817-823. Epub 2021 Mar 22.

Liverpool University Foundation Teaching Hospital, Aintree, Lower Lane, Liverpool, L9 7AL, Merseyside, UK.

Managing a hip fracture in a young adult patient in the setting of polytrauma is a particularly challenging prospect. In the UK between 2018 and 2020, 11,969 patients were recorded in the Trauma Audit and Research Network as a patient with polytrauma. Of these patients, 611 (5.1%) had a hip fracture. In this article, we discuss the initial assessment and management of these patients and common problems that are encountered and how the evidence available can help guide management.
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http://dx.doi.org/10.1007/s00590-021-02923-3DOI Listing
July 2021

Guidelines for Perioperative Care for Emergency Laparotomy Enhanced Recovery After Surgery (ERAS) Society Recommendations: Part 1-Preoperative: Diagnosis, Rapid Assessment and Optimization.

World J Surg 2021 05 6;45(5):1272-1290. Epub 2021 Mar 6.

Department of Anesthesiology and Critical Care Medicine, University of Pennsylvania, 3400 Spruce St, Philadelphia, PA, 19104, USA.

Background: Enhanced Recovery After Surgery (ERAS) protocols reduce length of stay, complications and costs for a large number of elective surgical procedures. A similar, structured approach appears to improve outcomes, including mortality, for patients undergoing high-risk emergency general surgery, and specifically emergency laparotomy. These are the first consensus guidelines for optimal care of these patients using an ERAS approach.

Methods: Experts in aspects of management of the high-risk and emergency general surgical patient were invited to contribute by the International ERAS® Society. Pubmed, Cochrane, Embase, and MEDLINE database searches on English language publications were performed for ERAS elements and relevant specific topics. Studies on each item were selected with particular attention to randomized controlled trials, systematic reviews, meta-analyses and large cohort studies, and reviewed and graded using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. Recommendations were made on the best level of evidence, or extrapolation from studies on non-emergency patients when appropriate. The Delphi method was used to validate final recommendations. The guideline has been divided into two parts: Part 1-Preoperative Care and Part 2-Intraoperative and Postoperative management. This paper provides guidelines for Part 1.

Results: Twelve components of preoperative care were considered. Consensus was reached after three rounds.

Conclusions: These guidelines are based on the best available evidence for an ERAS approach to patients undergoing emergency laparotomy. Initial management is particularly important for patients with sepsis and physiological derangement. These guidelines should be used to improve outcomes for these high-risk patients.
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http://dx.doi.org/10.1007/s00268-021-05994-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8026421PMC
May 2021

Computer-Assisted Secondary Orbital Reconstruction.

Craniomaxillofac Trauma Reconstr 2021 Mar 9;14(1):29-35. Epub 2020 Jul 9.

Department of Oral-, Maxillo- and Plastic Facial Surgery, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany.

Study Design: This study presents a case-control study of 33 patients who underwent secondary orbital reconstruction, evaluating techniques and outcome.

Objective: Adequate functional and aesthetical appearance are main goals for secondary orbital reconstruction. Insufficient premorbid orbital reconstruction can result in hypoglobus, enophthalmos, and diplopia. Computer-assisted surgery and the use of patient-specific implants (PSIs) is widely described in the literature. The authors evaluate the use of selective laser-melted PSIs and hypothesize that PSIs are an excellent option for secondary orbital reconstruction.

Methods: The sample was composed of 33 patients, previously treated with primary orbital reconstruction, presenting themselves with indications for secondary reconstruction (i.e. enophthalmos, diplopia, or limited eye motility). Computed tomography and/or cone beam data sets were assessed before and after secondary reconstruction comparing intraorbital volumes, infraorbital angles, and clinical symptoms. Clinical outcomes were assessed using a standardized protocol.

Results: Results show a significant change in intraorbital volumes and a reduction of clinical symptoms after secondary reconstruction.

Conclusions: Outcomes of this study suggest that secondary orbital reconstruction can be performed routinely using selective laser-melted PSIs and titanium spacers.
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http://dx.doi.org/10.1177/1943387520935004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7868513PMC
March 2021

Development and application of an innovative instrument to assess work environment factors for injury prevention in the food service industry.

Work 2021 ;68(3):641-651

Dana Farber Cancer Institute, Boston, MA, USA.

Background: With the growth the food service industry and associated high injury and illness rates, there is a need to assess workplace factors that contribute to injury prevention.

Objective: The objective of this report is to describe the development, application, and utility of a new instrument to evaluate ergonomics and safety for food service workers.

Methods: Starting with a similar tool developed for use in healthcare, a new tool was designed through a collaborative, participatory process with the stakeholders from a collaborating food service company. The new instrument enables the identification and assessment of key safety and health factors through a focused walkthrough of the physical work environment, and structured interviews exploring the organizational work environment. The researchers applied the instrument at 10 of the partnering company's worksites.

Results: The instrument identified factors related to both the physical work environment and organizational and contextual environment (e.g., vendor-client relationships) impacting worker safety and health.

Conclusions: Modern assessment approaches should address both the physical and organizational aspects of the work environment, and consider the context complexities in which the worksites and the industry operate.
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http://dx.doi.org/10.3233/WOR-203399DOI Listing
June 2021

Response.

J Foot Ankle Surg 2021 May-Jun;60(3):648. Epub 2021 Feb 5.

Consultant Foot and Ankle Surgeon, Liverpool University Hospital Foundation, Liverpool, United Kingdom.

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http://dx.doi.org/10.1053/j.jfas.2020.04.009DOI Listing
May 2021

Expert Consensus of Data Elements for Collection for Enhanced Recovery After Cardiac Surgery.

World J Surg 2021 Apr 31;45(4):917-925. Epub 2021 Jan 31.

Heart and Vascular Program, Baystate Health, Springfield, MA, USA.

Background: Despite the emergence of Enhanced Recovery Protocols (ERPs) in cardiac surgery, there is no consensus on the essential elements for data reporting for quality improvement efforts, as well as accountability and standardization of outcome reporting across institutions. The aim of this study was to establish a consensus on essential data elements for cardiac ERAS®.

Methods: A 2-round modified Delphi technique was utilized based on existing recommendations from the recently published ERAS® cardiac surgery consensus guidelines. Round 1 included a steering committee of 10 experts who oversaw formulation of a focused list of data elements into 3 main areas: Preoperative, intraoperative and postoperative. Round 2 consisted of a multidisciplinary, multinational, heterogenous group of 50 voting experts from across the United States and Europe. All participants evaluated their level of agreement with each data element using a 5-point Likert scale with consensus threshold of 70%.

Results: In round 1, 17 data elements were considered essential (consensus >  = 70%, either positive or negative) and 6 were considered marginal (consensus <  = 70%, either positive or negative). In round 2, positive consensus was achieved for 15/17 (88.2%) data elements in the essential category, and all six data elements (100%) in the marginal category, indicating a high level of overall agreement.

Conclusion: This initial study, which identified 21 key data elements for collection in an ERAS® cardiac program, will aid clinicians in establishing a framework for evaluating the quality of their contemporary ERP processes and will allow acquisition of data to help benchmark performance metrics between hospitals.
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http://dx.doi.org/10.1007/s00268-021-05964-1DOI Listing
April 2021

Resolution of Vertical Gaze Following a Delayed Presentation of Orbital Floor Fracture With Inferior Rectus Entrapment: The Contributions of Charles E. Iliff and Joseph S. Gruss in Orbital Surgery.

Craniomaxillofac Trauma Reconstr 2020 Dec 18;13(4):253-259. Epub 2020 Nov 18.

Division of Plastic and Reconstructive Surgery, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, USA.

Introduction: Orbital floor fractures occur commonly as a result of blunt trauma to the face and periorbital region. Orbital floor fractures with a "trapdoor" component allow both herniation and incarceration of contents through a bone defect into the maxillary sinus as the bone rebounds faster than the soft tissue, trapping muscle, fat, and fascia in the fracture site. In children, the fractured floor, which is often hinged on one side, tends to return toward its original anatomical position due to the incomplete nature of the fracture and elasticity of the bone. The entrapment of the inferior rectus muscle itself is considered a true surgical emergency-prolonged entrapment frequently leads to muscle ischemia and necrosis leading to permanent limitation of extraocular motility and difficult to correct diplopia. For this reason, prompt surgical intervention is recommended by most surgeons. In adults, true entrapment of the muscle itself is not as common because the orbital floor is not as elastic and fractures are more complete.

Methods: We present an adult patient with an isolated orbital floor fracture with clinical and radiologic evidence of true entrapment of the inferior rectus muscle itself.

Results: Despite the delayed surgical repair (4 days after the injury), the patient's inferior rectus muscle function returned to near normal with mild upward gaze diplopia.

Conclusions: Inferior rectus entrapment in adults may more likely be associated with immobilization of the muscle without total vascular compression/incarceration significant enough to lead to complete ischemic necrosis.
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http://dx.doi.org/10.1177/1943387520965804DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7797985PMC
December 2020

The Global Impact of COVID-19 on Craniomaxillofacial Surgeons.

Craniomaxillofac Trauma Reconstr 2020 Sep 31;13(3):157-167. Epub 2020 May 31.

Department of Oral and Maxillofacial Surgery, Erasmus MC, Rotterdam, the Netherlands.

Study Design: The COrona VIrus Disease-19 (COVID-19) pandemic has disrupted craniomaxillofacial (CMF) surgeons practice worldwide. We implemented a cross-sectional study and enrolled a sample of CMF surgeons who completed a survey.

Objective: To measure the impact that COVID-19 has had on CMF surgeons by (1) identifying variations that may exist by geographic region and specialty and (2) measuring access to adequate personal protective equipment (PPE) and identify factors associated with limited access to adequate PPE.

Methods: Primary outcome variable was availability of adequate PPE for health-care workers (HCWs) in the front line and surgeons. Descriptive and analytic statistics were computed. Level of statistical significance was set at < .05. Binary logistic regression models were created to identify variables associated with PPE status (adequate or inadequate).

Results: Most of the respondents felt that hospitals did not provide adequate PPE to the HCWs (57.3%) with significant regional differences ( = .04). Most adequate PPE was available to surgeons in North America with the least offered in Africa. Differences in PPE adequacy per region ( < .001) and per country ( < .001) were significant. In Africa and South America, regions reporting previous virus outbreaks, the differences in access to adequate PPE evaporated compared to Europe ( = .18 and = .15, respectively).

Conclusion: The impact of COVID-19 among CMF surgeons is global and adversely affects both clinical practice and personal lives of CMF surgeons. Future surveys should capture what the mid- and long-term impact of the COVID-19 crisis will look like.
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http://dx.doi.org/10.1177/1943387520929809DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7797976PMC
September 2020

AO CMF International Task Force Recommendations on Best Practices for Maxillofacial Procedures During COVID-19 Pandemic.

Craniomaxillofac Trauma Reconstr 2020 Sep 27;13(3):151-156. Epub 2020 Sep 27.

Department of Oral and Maxillofacial Surgery, Erasmus MC, Rotterdam, Netherlands.

The COVID-19 pandemic is a global problem that has adversely and significantly impacted the safe practice of maxillofacial surgery. The risk lies in the heavy viral load in the oral/nasal/upper respiratory mucosal surfaces. Surgical procedures performed in this anatomic regional produce aerosalized viral particles which are highly infectious. Best practices and recommendations are outlined to mitigate the risk to the provider.
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http://dx.doi.org/10.1177/1943387520948826DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7797968PMC
September 2020

Perioperative Precedex: Whole New Ball Game or Whole New Ball of Wax?

Anesth Analg 2021 02;132(2):317-319

Departments of Anesthesiology.

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http://dx.doi.org/10.1213/ANE.0000000000005158DOI Listing
February 2021

Perioperative methadone prescribing and association with respiratory depression.

J Opioid Manag 2020 Nov-Dec;16(6):443-449

Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, Maryland.

Objective: Over 80 percent of surgery patients experience acute post-operative pain and less than half feel their pain is adequately controlled. Patients receiving chronic opioids, including methadone, are at the highest risk of inadequate pain control. Guidelines do not provide specific recommendations for analgesia management in this population. The purpose of this study was to evaluate the association between post-operative methadone use and respiratory depression.

Design: This study was a single center, retrospective, cohort study of adult patients.

Setting: Patients included were admitted to a single academic medical center from July 2016 to September 2018.

Participants: Medical records of adult inpatients with an operative procedure who received perioperative methadone were reviewed.

Main Outcome Measures: Preoperative methadone use was evaluated for all patients. Post-operative methadone dosing was compared to preoperative methadone dosing. Post-operative respiratory depression was evaluated. Logistic regression was performed to identify risk factors for respiratory depression.

Results: Two hundred ninety-eight patients were included in the study. Patients were divided into groups based on pre-operative methadone use. Over 90 percent of patients were on preoperative methadone. There were no significant differences in baseline characteristics between groups. In the initial seven post-operative days, 14.8 percent of patients had documented respiratory depression. Respiratory depression was more common among patients who were newly initiated on methadone post-operatively. Factors associated with respiratory depression included male sex, increased age, and new post-operative methadone initiation.

Conclusions: Most patients who were administered post-operative methadone were on preoperative methadone. New post-operative methadone initiation was a risk factor for respiratory depression.
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http://dx.doi.org/10.5055/jom.2020.0602DOI Listing
January 2021

Improving Payment for Collaborative Mental Health Care in Primary Care.

Med Care 2021 04;59(4):324-326

Departments of Psychiatry and Behavioral Sciences.

Background: There is strong evidence supporting implementation of the Collaborative Care Model within primary care. Fee-for-service payment codes, published by Current Procedural Terminology in 2018, have made collaborative care separately reimbursable for the first time. These codes (ie, 99492-99494) reimburse for time spent per month by any member of the care team engaged in Collaborative Care, including behavioral care managers, primary care providers, and consulting psychiatrists. Time-based billing for these codes presents challenges for providers delivering Collaborative Care services.

Objectives: Based on experience from multiple health care organizations, we reflect on these challenges and provide suggestions for implementation and future refinement of the codes.

Conclusions: Further refinements to the codes are encouraged, including moving from a calendar month to a 30-day reimbursement cycle. In addition, we recommend payers adopt the new code proposed by the Centers for Medicare and Medicaid Services to account for smaller increments of time.
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http://dx.doi.org/10.1097/MLR.0000000000001485DOI Listing
April 2021

Enhanced Recovery Programs for Colorectal Surgery and Postoperative Acute Kidney Injury: Results From a Systematic Review and Meta-Analysis of Observational Studies.

Am Surg 2020 Dec 29:3134820954846. Epub 2020 Dec 29.

Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

Background: Enhanced recovery programs (ERPs) for colorectal surgery bundle evidence-based measures to reduce complications, accelerate postoperative recovery, and improve the value of perioperative health care. Despite these successes, several recent studies have identified an association between ERPs and postoperative acute kidney injury (AKI). We conducted a systematic review and meta-analysis to determine the association between ERPs for colorectal surgery and postoperative AKI.

Methodology: After conducting a search of major databases (PubMed, Embase, Scopus, Google Scholar, and ScienceDirect), we conducted a meta-analysis of observational studies that reported on the association between ERPs and postoperative AKI.

Results: Six observational studies (n = 4765 patients) comparing ERP (n = 2140) to conventional care (n = 2625) were included. Overall, ERP patients had a significantly greater odds of developing postoperative AKI (odds ratio [OR] = 1.98, 95% confidence interval [CI] 1.31-3.00, = .001) than those who received conventional care. There was no evidence of publication bias (Begg's test = 1.0, Egger's value = .95).

Conclusions: Based upon pooled results from observational studies, ERPs are associated with increased odds of developing postoperative AKI compared to conventional perioperative care. The mechanism for this effect is likely multifactorial. Additional research targeting high risk patient populations should evaluate the role of restrictive fluid administration, hemodynamic goals, and scheduled nephrotoxic agents in ERP protocols.
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December 2020

Surgical Treatment and Visual Outcomes of Adult Orbital Roof Fractures.

Plast Reconstr Surg 2021 01;147(1):82e-93e

From the Division of Plastic, Reconstructive, and Maxillofacial Surgery, R Adams Cowley Shock Trauma Center; the Department of Plastic and Reconstructive Surgery, Johns Hopkins University; and the Division of Plastic and Reconstructive Surgery, University of Maryland School of Medicine.

Background: Fractures of the orbital roof require high-energy trauma and have been linked to high rates of neurologic and ocular complications. However, there is a paucity of literature exploring the association between injury, management, and visual prognosis.

Methods: The authors performed a 3-year retrospective review of orbital roof fracture admissions to a Level I trauma center. Fracture displacement, comminution, and frontobasal type were ascertained from computed tomographic images. Pretreatment characteristics of operative orbital roof fractures were compared to those of nonoperative fractures. Risk factors for ophthalmologic complications were assessed using univariable/multivariable regression analyses.

Results: In total, 225 patients fulfilled the inclusion criteria. Fractures were most commonly nondisplaced [n = 118 (52.4 percent)] and/or of type II frontobasal pattern (linear vault involving) [n = 100 (48.5 percent)]. Eight patients underwent open reduction and internal fixation of their orbital roof fractures (14.0 percent of displaced fractures). All repairs took place within 10 days from injury. Traumatic optic neuropathy [n = 19 (12.3 percent)] and retrobulbar hematoma [n = 11 (7.1 percent)] were the most common ophthalmologic complications, and led to long-term visual impairment in 51.6 percent of cases.

Conclusions: Most orbital roof fractures can be managed conservatively, with no patients in this cohort incurring long-term fracture-related complications or returning for secondary treatment. Early fracture treatment is safe and may be beneficial in patients with vertical dysmotility, globe malposition, and/or a defect surface area larger than 4 cm2. Ophthalmologic prognosis is generally favorable; however, traumatic optic neuropathy is major cause of worse visual outcome in this population.

Clinical Question/level Of Evidence: Risk, III.
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January 2021

Goal-Directed Fluid Therapy and Postoperative Outcomes in an Enhanced Recovery Program for Colorectal Surgery: A Propensity Score-Matched Multicenter Study.

Am Surg 2020 Dec 19:3134820973365. Epub 2020 Dec 19.

Department of Anesthesiology and Critical Care Medicine, 1501Johns Hopkins Hospital, MD, USA.

Introduction: Goal-directed fluid therapy (GDFT) has increasingly been utilized in major surgery as a key component to ensure fluid optimization and adequate tissue perfusion, showing improvements in the rate of morbidity and mortality under conventional care. It is unclear if patients derive similar benefit as part of an enhanced recovery program (ERP). Our group sought to assess the association between GDFT and postoperative outcomes within an ERP for colorectal surgery.

Methods: A propensity score-matched analysis, based upon demographic characteristics, comorbidities, and ERP components, was utilized to assess the association between GDFT and outcomes in a multicenter prospective ERP for colorectal surgery cohort study. Outcomes included pulmonary edema, acute kidney injury (AKI), ileus, surgical site infection (SSI), and anastomotic dehiscence. The calipmatch module was used to match patients who received GDFT to non-GDFT in a 1-to-1 propensity score fashion.

Results: A total of 151 matched pairs were included in the analysis (n = 302, 23%). Both groups had comparable baseline demographics, as well as similar rates of compliance with enhanced recovery after surgery (ERAS) components. Goal-directed fluid therapy patients received significantly more colloid (237 ± 320 mL vs. 140 ± 245 mL, < .01) than non-GDFT counterparts. Goal-directed fluid therapy was not associated with improved rates of postoperative AKI (odds ratios (OR) 1.00, 95% confidence intervals (CI) .39-2.59, = 1.00), ileus (OR 1.40, 95% CI .82-2.41, = .22), SSI (OR 1.06, 95% CI .54-2.08, = .86), or length of hospital stay (LOS) (10.8 ± 8.9 vs. 11.1±13.2 days, = .84).

Conclusions: There was no associated between GDFT and major postoperative outcomes within an ERAS program for colorectal surgery. Additional large-scale or pragmatic randomized trials are necessary to determine whether GDFT has a role in ERP for colorectal surgery.
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December 2020

Multiple Cranial Neuropathies as the Presenting Sign in a Patient with Metastatic BRAF-Mutated Lung Adenocarcinoma with Leptomeningeal Involvement.

Case Rep Oncol 2020 Sep-Dec;13(3):1258-1262. Epub 2020 Oct 15.

Yale University School of Medicine and Smilowa Cncer Center, Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut, USA.

Leptomeningeal carcinomatosis accounts for only 4% of cases of multiple cranial neuropathies. Here, we report the case of a patient who presented with multiple synchronous cranial neuropathies. After treatment for neuroborreliosis and broad infectious workup, endobronchial ultrasound-guided mediastinal lymph node biopsy confirmed a diagnosis of metastatic BRAF-mutated lung adenocarcinoma with leptomeningeal involvement. To our knowledge, this is the first reported case of metastatic BRAF-driven lung adenocarcinoma with leptomeningeal disease at diagnosis. In this case, the presence of leptomeningeal carcinomatosis at diagnosis, not as a late manifestation of heavily pretreated disease, alludes to a possible association between leptomeningeal involvement and BRAF-mutated non-small cell lung cancer.
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http://dx.doi.org/10.1159/000510743DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7670331PMC
October 2020

The role of social media in disseminating plastic surgery research: The relationship between citations, altmetrics and article characteristics.

J Plast Reconstr Aesthet Surg 2021 05 10;74(5):1101-1160. Epub 2020 Nov 10.

Department of Plastic and Reconstructive Surgery, Leeds General Infirmary, Leeds, United Kingdom; Faculty of Medicine and Health, Worsley Building, University of Leeds, Leeds, United Kingdom. Electronic address:

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May 2021
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