Faculty Bibliography
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school:SOM
Department/Unit:Plastic Surgery
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5797
The cost-effectiveness of sub-epidermal moisture scanning to assess pressure injury risk in U.S. health systems
Objective Hospital-acquired pressure injuries harm over 2.5 million patients at a U.S. cost of $26.8 billion. Sub-epidermal moisture scanning technology supports clinicians to anatomically identify locations at-risk of developing hospital-acquired pressure injuries. Our objective was to evaluate the cost-effectiveness of adopting sub-epidermal moisture scanners in comparison to existing hospital-acquired pressure injury prevention guidelines structured around subjective risk assessments. Methods A Markov cohort model was developed to analyze the cost-effectiveness of sub-epidermal moisture scanners in comparison to existing prevention guidelines, based on current clinical trial data from the U.S. health care sector perspective in the acute, acute rehabilitation and skilled nursing facility settings. A hypothetical cohort was simulated over a time horizon of one year. An incremental cost-effectiveness ratio was measured using U.S. dollars per quality-adjusted life year at a willingness-to-pay threshold of $100,000/quality-adjusted life year, and uncertainty was tested using probabilistic sensitivity analysis. Results Integration of sub-epidermal moisture scanners yielded cost-savings of $4054 and 0.35 quality-adjusted life years gained per acute care admission, suggesting that sub-epidermal moisture scanners are a dominant strategy compared to standard care and producing a net monetary benefit of $39,335. For every 1000 admissions in high-risk acute care, sub-epidermal moisture scanners could avert around seven hospital-acquired pressure injury-related deaths and decrease hospital-acquired pressure injury-related re-hospitalization by approximately 206 bed-days. Conclusions Acute care, acute rehabilitation and skilled nursing settings that adopt sub-epidermal moisture technology could achieve a return on investment in less than one year. Providers may want to consider these types of technology that aid clinical judgment with objective measures of risk in quality improvement bundles
ORIGINAL:0014614
ISSN: 2516-0435
CID: 4407662
Immigrant Status, Resilience, and Perceived Oral Health Among Chinese Americans in Hawaii
OBJECTIVES/UNASSIGNED:This study aims to examine the associations among immigrant status, resilience, and perceived oral health for Chinese American older adults in Hawaii. METHOD/UNASSIGNED:Data derived from 430 Chinese American adults aged 55 years and older residing in Honolulu, HI. We compared the self-rated oral health and oral health problems between U.S.-born Chinese Americans and foreign-born Chinese Americans by using ordered logistic regression and ordinary least squares regression models. RESULTS/UNASSIGNED:Findings suggest that immigrant status and lower levels of resilience are associated with poorer self-rated oral health and more oral health problems for Chinese American older adults in Hawaii. Resilience is more strongly associated with self-rated oral health for U.S.-born Chinese American than for foreign-born Chinese Americans, but this pattern was not evident for oral health problems. DISCUSSION/UNASSIGNED:Older Chinese American immigrants in Hawaii are disadvantaged in terms of their oral health. Understanding their susceptibilities may lead to targeted interventions.
PMID: 32195629
ISSN: 1552-7573
CID: 4371972
3D printing of Microgel-loaded Modular LEGO-like Cages as Instructive Scaffolds for Tissue Engineering
ORIGINAL:0016709
ISSN: 2692-8205
CID: 5457512
Acknowledgement to reviewers of journal of functional biomaterials in 2019
SCOPUS:85083294074
ISSN: 2079-4983
CID: 5457232
Three-Dimensional Topographic Surface Changes in Response to Volumization of the Lateral Suborbicularis Oculi Fat Compartment
BACKGROUND:Autologous fat grafting is an increasingly preferred method for aesthetic facial rejuvenation. The authors' group previously described the concept of "lipotopography" as topographic surface changes that occur with fat grafting to discrete facial fat compartments. The purpose of this study was to define the "augmentation zone" of the lateral suborbicularis oculi fat compartment to understand the topographical surface changes following augmentation. METHODS:Nine cadaver hemifaces were injected with fat analogue at intervals from 1 to 4 cc. Three-dimensional photographs were taken at baseline and following each 1-cc incremental injection. The interval surface changes were calculated using three-dimensional software including perimeter, diameter, and projection. RESULTS:The augmentation zone of the lateral suborbicularis oculi fat compartment was characterized by a consistent shape and boundary. The shape was an elongated oval bound superiorly by the lid-cheek junction and inferiorly at the level of the zygomaticocutaneous ligament. Vertical and horizontal diameter and perimeter showed initial increases between 1 and 2 cc and then a plateau between 2 and 3 cc. Projection changes demonstrated an initial slow increase from 1 to 2 cc injection followed by nearly linear growth from 2 to 4 cc. CONCLUSIONS:Three-dimensional photography and computer analysis provide tools to understand the surface anatomy change in response to fat grafting specific facial fat compartments. Targeted volumization of the lateral suborbicularis oculi fat compartment also results in a unique surface change with consistent shape and anatomical boundaries. The lid-cheek junction and zygomaticocutaneous ligament were observed to restrict the expansion of fat analogue for all injection volumes. CLINICAL QUESTION/LEVEL OF EVIDENCE/METHODS:Therapeutic, V.
PMID: 32097301
ISSN: 1529-4242
CID: 4323332
Is one nerve transfer enough? A systematic review and pooled analysis comparing ulnar fascicular nerve transfer and double ulnar and median fascicular nerve transfer for restoration of elbow flexion after traumatic brachial plexus injury
OBJECTIVES/OBJECTIVE:Double fascicular transfer is argued to result in improved elbow flexion compared to the traditional ulnar fascicular transfer because it reinnervates both the biceps and the brachialis. This study seeks to determine if double fascicular transfer should be preferred over ulnar fascicular transfer to restore elbow flexion in patients with upper trunk brachial plexus injuries (BPI) by analyzing the current database of literature on the topic. METHODS:A systematic review was conducted according to PRISMA guidelines. Inclusion criteria were studies reporting Medical Research Council (MRC) scores on individual patients undergoing ulnar fascicular transfer and double fascicular transfer (ulnar and median nerve fascicle donors). Patients were excluded if: age < 18 years old and follow-up <12 months. Demographics obtained include age, sex, extent of injury (C5-C6/C5-C7), preoperative interval, procedure type, and follow-up time. Outcomes included absolute MRC score and ability to achieve MRC score ≥3 and ≥4. Univariate and multivariate regression analyses were completed to evaluate predictors of postoperative outcomes. RESULTS:Eighteen studies (176 patients) were included for pooled analysis. Patients that underwent double fascicular transfer had a higher percentage of patients attain a MRC score ≥ 4 compared to ulnar fascicular transfer subjects (83.0% vs. 63.3%, p = .013). Double fascicular transfer was a predictor of achieving high MRC scores (OR = 2.829, p = .015). Multivariate analysis showed that procedure type was the only near significant predictor of ability to obtain MRC ≥4 (OR: 2.338, p = .054). CONCLUSIONS:This analysis demonstrates that double fascicular transfer is associated with superior postoperative outcomes and should be performed for restoring elbow flexion.
PMID: 31755577
ISSN: 1098-2752
CID: 4220862
Evolution of the Surgical Technique for "Breast in a Day" Direct-to-Implant Breast Reconstruction: Transitioning from Dual-Plane to Prepectoral Implant Placement
PMID: 32097340
ISSN: 1529-4242
CID: 4324282
Corrigendum to 'Society of Cardiovascular Anesthesiologists (SCA) Clinical Practice Improvement (CPI) Advisory for Management of Perioperative Bleeding and Hemostasis in Cardiac Surgery Patients' [Journal of Cardiothoracic and Vascular Anesthesia 33 (2019) 2887-2899](S1053077019303507)(10.1053/j.jvca.2019.04.0035)
The authors regret that the title of Christa Boer was incorrectly stated as MD in their published article. This has been corrected to PhD above. The authors apologise for any inconvenience caused.
Copyright
Copyright
EMBASE:2003862757
ISSN: 1053-0770
CID: 4296492
The Rich Get Richer: Osseous Chimeric Versatility to the Anterolateral Thigh Flap
BACKGROUND: The lateral femoral circumflex artery (LFCA) system, which supplies the anterolateral thigh (ALT) flap territory, offers a plethora of tissue types for composite, functional reconstruction. However, the ability to include a reliable and flexible osseous component is limited. Based on cadaveric dissections, we describe an isolated LFCA branch to the femur separate from the vastus intermedius that can be included in ALT flap harvest in cases requiring bony reconstruction. METHODS: Cadaveric dissection was undertaken to define the LFCA vascular system with specific dissection of the proximal branches of the descending branch of the LFCA (db-LFCA) to define any muscular, periosteal, and/or osseous branches to the femur. RESULTS: Six thighs in four cadavers were dissected. Consistent in all specimens, there was an isolated branch extending distally, medially, and posteriorly from the proximal LFCA and entering the periosteum of the femur. In five specimens, the identified branch to the femur was located approximately 1-cm distal to the rectus femoris branch of the LFCA and approximately 1-cm proximal to a separate branch entering and supplying the vastus intermedius. In one specimen, there was a common trunk. The length of this branch from the origin at the LFCA to insertion into the femoral periosteum was approximately 6 to 8 cm. CONCLUSION/CONCLUSIONS: There appears to be a consistent and reliable branch to the femur based on the proximal LFCA that may be included in ALT flap harvest, adding even more versatility, as another option in complex cases requiring composite reconstruction, including bone.
PMID: 31652481
ISSN: 1098-8947
CID: 4163112
The ethics of testing and research of manufactured organs on brain-dead/recently deceased subjects
Over 115 000 people are waiting for life-saving organ transplants, of whom a small fraction will receive transplants and many others will die while waiting. Existing efforts to expand the number of available organs, including increasing the number of registered donors and procuring organs in uncontrolled environments, are crucial but unlikely to address the shortage in the near future and will not improve donor/recipient compatibility or organ quality. If successful, organ bioengineering can solve the shortage and improve functional outcomes. Studying manufactured organs in animal models has produced valuable data, but is not sufficient to understand viability in humans. Before risking manufactured organ experimentation in living humans, study of bioengineered organs in recently deceased humans would facilitate evaluation of the function of engineered tissues and the complex interactions between the host and the transplanted tissue. Although such studies do not pose risk to human subjects, they pose unique ethical challenges concerning the previous wishes of the deceased, rights of surviving family members, effective operation and fair distribution of medical services, and public transparency. This article investigates the ethical, legal and social considerations in performing engineered organ research on the recently deceased.
PMID: 31563872
ISSN: 1473-4257
CID: 4115892
