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Breast sensorisexual function: a novel patient-reported outcome measure of sexual sensory functions of the breast

Abramsohn, Emily M; Pinkerton, El A; Wroblewski, Kristen; Anitescu, Magdalena; Flynn, Kathryn E; Hazen, Alexes; Schumm, Phil; Lindau, Stacy Tessler
BACKGROUND:A validated measure assessing sexual sensory functions of the breast is needed to optimize sexual and other health outcomes after breast procedures. AIM/OBJECTIVE:To describe the development of a patient-reported outcome measure (PROM) to assess breast sensorisexual function (BSF). METHODS:We applied the PROMIS standards (Patient Reported Outcomes Measurement Information System) for measure development and evaluation of validity. An initial conceptual model of BSF was developed with patients and experts. A literature review yielded a pool of 117 candidate items that underwent cognitive testing and iteration. Forty-eight items were administered to an ethnically diverse, national panel-based sample of sexually active women with breast cancer (n = 350) or without (n = 300). Psychometric analyses were performed. OUTCOMES/RESULTS:The main outcome was BSF, a measure that assesses affective (satisfaction, pleasure, importance, pain, discomfort) and functional (touch, pressure, thermoreception, nipple erection) sensorisexual domains. RESULTS:A bifactor model fit to 6 domains-excluding 2 domains with only 2 items each and 2 pain-related domains-revealed a single general factor representing BSF that may be adequately measured by the average of the items. This factor, with higher values denoting better function and with the standard deviation set to 1, was highest among women without breast cancer (mean, 0.24), intermediate among women with breast cancer but not bilateral mastectomy and reconstruction (-0.01), and lowest among those with bilateral mastectomy and reconstruction (-0.56). Between women with and without breast cancer, the BSF general factor accounted for 40%, 49%, and 100% of the difference in arousal, ability to orgasm, and sexual satisfaction, respectively. Items in each of 8 domains demonstrated unidimensionality (ie, they measured 1 underlying BSF trait) and high Cronbach's alphas for the entire sample (0.77-0.93) and the cancer group (0.71-0.95). Correlations with sexual function, health, and quality of life were positive for the BSF general factor and mostly negative for the pain domains. CLINICAL IMPLICATIONS/CONCLUSIONS:The BSF PROM can be used to assess the impact of breast surgery or other procedures on the sexual sensory functions of the breast in women with and without breast cancer. STRENGTHS AND LIMITATIONS/UNASSIGNED:The BSF PROM was developed by using evidence-based standards, and it applies to sexually active women with and without breast cancer. Generalizability to sexually inactive women and other women warrants further study. CONCLUSION/CONCLUSIONS:The BSF PROM is a measure of women's breast sensorisexual function with evidence of validity among women affected and unaffected by breast cancer.
PMCID:10149380
PMID: 36897194
ISSN: 1743-6109
CID: 5502362

Oral health-related quality of life after radiation therapy for head and neck cancer: the OraRad study

Patton, Lauren L; Helgeson, Erika S; Brennan, Michael T; Treister, Nathaniel S; Sollecito, Thomas P; Schmidt, Brian L; Lin, Alexander; Chera, Bhishamjit S; Lalla, Rajesh V
PURPOSE/OBJECTIVE:Head and neck cancer (HNC) treatment results in morbidity impacting quality of life (QOL) in survivorship. This analysis evaluated changes in oral health-related QOL (OH-QOL) up to 2 years after curative intent radiation therapy (RT) for HNC patients and factors associated with these changes. METHODS:572 HNC patients participated in a multicenter, prospective observational study (OraRad). Data collected included sociodemographic, tumor, and treatment variables. Ten single-item questions and 2 composite scales of swallowing problems and senses problems (taste and smell) from a standard QOL instrument were assessed before RT and at 6-month intervals after RT. RESULTS:The most persistently impacted OH-QOL variables at 24 months included: dry mouth; sticky saliva, and senses problems. These measures were most elevated at the 6-month visit. Aspects of swallowing were most impacted by oropharyngeal tumor site, chemotherapy, and non-Hispanic ethnicity. Problems with senses and dry mouth were worse with older age. Dry mouth and sticky saliva increased more among men and those with oropharyngeal cancer, nodal involvement, and use of chemotherapy. Problems with mouth opening were increased by chemotherapy and were more common among non-White and Hispanic individuals. A 1000 cGy increase in RT dose was associated with a clinically meaningful change in difficulty swallowing solid food, dry mouth, sticky saliva, sense of taste, and senses problems. CONCLUSIONS:Demographic, tumor, and treatment variables impacted OH-QOL for HNC patients up to 2 years after RT. Dry mouth is the most intense and sustained toxicity of RT that negatively impacts OH-QOL of HNC survivors. GOV IDENTIFIER/UNASSIGNED:NCT02057510; first posted February 7, 2014.
PMID: 37079106
ISSN: 1433-7339
CID: 5464562

Characterizing Cleft Rhinoplasty Across Skeletal Maturity: A Systematic Review of Terminology and Surgical Techniques

Park, Jenn J; Laspro, Matteo; Arias, Fernando D; Rodriguez Colon, Ricardo; Chaya, Bachar F; Rochlin, Danielle H; Staffenberg, David A; Flores, Roberto L
OBJECTIVE:The purpose of this study is to assess cleft rhinoplasty terminology across phases of growth.Design/Setting: A systematic review was performed on cleft rhinoplasty publications over 20 years.Interventions: Studies were categorized by age at surgical intervention: infant (<1 year); immature (1 to 14 years); mature (>15 years).Main Outcome Measures: Collected data included terminology used and surgical techniques. RESULTS:The 288 studies included demonstrated a wide range of terminology. In the infant group, 51/54 studies used the term "primary." In the immature group, 7/18 studies used the term "primary," 3/18 used "secondary." In the mature group, 2/33 studies used the term "primary," 16/33 used "secondary," 2/33 used "definitive," 5/33 used terms such as "mature," "adult," and "late," and 8/33 did not use terminology.Surgical technique assessment demonstrated: cleft rhinoplasty at infancy used nostril rim or no nasal incision, immature rhinoplasty used closed and open rhinoplasty incisions; and mature rhinoplasty used a majority of open rhinoplasty. Infant and immature cleft rhinoplasty incorporated septal harvest or spur removal in <10% of cases, whereas these procedures were common in mature rhinoplasty. No studies in infants or immature patients used osteotomies or septal grafts, common techniques in mature rhinoplasty. CONCLUSIONS:Current terminology for cleft rhinoplasty is varied and inconsistently applied across stages of facial development. However, cleft rhinoplasty performed at infancy, childhood, and facial maturity are surgically distinct procedures. The authors recommend the terminology "infant," "immature," and "mature" cleft rhinoplasty to accurately describe this procedure within the context of skeletal growth.
PMID: 37050895
ISSN: 1545-1569
CID: 5464222

Platysma Hammock or Sling: Are They Different? [Comment]

Aston, Sherrell J; Hanna, Steven A
PMID: 36624072
ISSN: 1527-330x
CID: 5507732

Re-cognizing the new self: The neurocognitive plasticity of self-processing following facial transplantation

Azevedo, Ruben T; Diaz-Siso, J Rodrigo; Alfonso, Allyson R; Ramly, Elie P; Kantar, Rami S; Berman, Zoe P; Diep, Gustave K; Rifkin, William J; Rodriguez, Eduardo D; Tsakiris, Manos
The face is a defining feature of our individuality, crucial for our social interactions. But what happens when the face connected to the self is radically altered or replaced? We address the plasticity of self-face recognition in the context of facial transplantation. While the acquisition of a new face following facial transplantation is a medical fact, the experience of a new identity is an unexplored psychological outcome. We traced the changes in self-face recognition before and after facial transplantation to understand if and how the transplanted face gradually comes to be perceived and recognized as the recipient's own new face. Neurobehavioral evidence documents a strong representation of the pre-injury appearance pre-operatively, while following the transplantation, the recipient incorporates the new face into his self-identity. The acquisition of this new facial identity is supported by neural activity in medial frontal regions that are considered to integrate psychological and perceptual aspects of the self.
PMCID:10083597
PMID: 36972456
ISSN: 1091-6490
CID: 5463102

Debridement: Technical Considerations and Treatment Options for the Interprofessional Team

Tran, David L; Huang, Ren-Weng; Chiu, Ernest S; Rajhathy, Erin M; Gregory, John H; Ayello, Elizabeth A; Sibbald, R Gary
GENERAL PURPOSE/OBJECTIVE:To enhance the learner's chronic wound debridement competence as an interprofessional team member. TARGET AUDIENCE/BACKGROUND:This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES/OBJECTIVE:After participating in this educational activity, the participant will:1. Differentiate healable, maintenance, and nonhealable wounds to create a holistic debridement treatment plan using the Wound Bed Preparation paradigm.2. Evaluate active debridement options including the potential need for an interprofessional referral or specialized investigations.3. Assess chronic wound debridement options.4. Analyze case studies for appropriate clinical application of debridement modalities.
PMID: 36940374
ISSN: 1538-8654
CID: 5449122

"One Incision Does Not Fit All"

Salibian, Ara A; Bekisz, Jonathan M; Karp, Nolan S; Choi, Mihye
PMID: 36729722
ISSN: 1529-4242
CID: 5420332

Genital Hypoplasia before Gender-Affirming Vaginoplasty: Does the Robotic Peritoneal Flap Method Create Equivalent Vaginal Canal Outcomes?

Blasdel, Gaines; Kloer, Carmen; Parker, Augustus; Shakir, Nabeel; Zhao, Lee C; Bluebond-Langner, Rachel
BACKGROUND:Insufficient genital tissue has been reported as a barrier to achieving depth in gender-affirming vaginoplasty. The authors sought to characterize vaginal depth and revision outcomes in patients with genital hypoplasia undergoing robotic peritoneal flap vaginoplasty. METHODS:Retrospective case-control analysis of patients undergoing robotic peritoneal vaginoplasty between September of 2017 and August of 2020 was used. All 43 patients identified as having genital hypoplasia (genital length <7 cm) were included with 49 random controls from the remaining patients with greater than 7 cm genital length. Baseline clinical characteristics and perioperative variables were recorded to identify potential confounders. Outcomes measured included vaginal size reported at last visit and undergoing revision surgery for depth or for vulvar appearance. RESULTS:Patients were well matched other than median body mass index at the time of surgery, which was greater in the hypoplasia cohort by 3.6 kg/m 2 ( P < 0.0001). Patients had a median of 1-year of follow-up, with a minimum follow-up of 90 days. No significant differences in outcomes were observed, with a median vaginal depth of 14.5 cm (interquartile range, 13.3 to 14.5 cm), and a median width of dilator used of 3.8 cm (interquartile range, 3.8 to 3.8 cm). No depth revisions were observed, and an 11% ( n = 10) rate of external revision occurred. CONCLUSIONS:Patients with genital hypoplasia had equivalent dilation outcomes in a case-control analysis with consistent follow-up past 90 days. The robotic peritoneal flap vaginoplasty technique provides vaginal depth of 14 cm or greater regardless of genital tissue before surgery. Further investigation with patient-reported outcome measures is warranted. CLINICAL QUESTION/LEVEL OF EVIDENCE:Risk, II.
PMID: 36729740
ISSN: 1529-4242
CID: 5466742

Does Brow Lift Add Risk to Blepharoplasty? Answers From a Multicenter Analysis of 6126 Patients Undergoing Aesthetic Eye Surgery

Wormer, Blair A; Rankin, Timothy M; Kaoutzanis, Christodoulos; Al Kassis, Salam; Gupta, Varun; Grotting, James C; Higdon, Kent K
BACKGROUND:Brow lift is frequently combined with blepharoplasty; however, the literature is lacking on their combined effect on complication rates. OBJECTIVES/OBJECTIVE:This study aims to evaluate major complication rates after blepharoplasty and brow lift and to determine if complication rates increase when blepharoplasty and brow lift were performed simultaneously. METHODS:A prospective cohort of patients who underwent cosmetic blepharoplasty, brow lift, or a combination of the 2 procedures between 2008 and 2013 was identified from the CosmetAssure Insurance database. The primary outcome was a postoperative major complication requiring emergency room evaluation, hospital admission, or reoperation within 30 days. Groups were compared with univariate analysis (significance, P < 0.05). RESULTS:A total of 6126 patients underwent aesthetic eye surgery, of which, 4879 (79.6%) underwent blepharoplasty, 441 (7.2%) brow lift, and 806 (13.2%) a combination the 2 procedures. Patients who underwent a combined procedure were older than patients who underwent isolated blepharoplasty or brow lift (55.5 ± 9.4 vs 54.6 ± 11.1 vs 53.3 ± 12.0 years; P < 0.01). In males, blepharoplasty was the most commonly performed procedure, followed by a combined procedure and brow lift (17.6% vs 12.9% vs 10.7%; P < 0.01). There were similar rates of smokers between the 3 groups (5.7% vs 8.0% vs 6.6%; P = 0.06). Between combined procedures, blepharoplasty, and brow lift there, were similar rates of major complications (0.4% vs 0.4% vs 0.7%; P = 0.65) and hematoma (0.2% vs 0.2% vs 0.5%; P = 0.49), which was the most common complication. CONCLUSIONS:Aesthetic eye surgery has a very low overall major complication rate (0.4%). When brow lift is combined with blepharoplasty, it poses no additional risk of major complications compared with either procedure alone.
PMID: 29369102
ISSN: 1536-3708
CID: 3215112

Technical Feasibility of Whole-eye Vascular Composite Allotransplantation: A Systematic Review

Laspro, Matteo; Chaya, Bachar F; Brydges, Hilliard T; Dave, Nikhil; Thys, Erika; Onuh, Ogechukwu C; Tran, David; Kimberly, Laura L; Ceradini, Daniel J; Rodriguez, Eduardo D
UNLABELLED:There are over 43 million individuals in the world who are blind. As retinal ganglion cells are incapable of regeneration, treatment modalities for this condition are limited. Since first incepted in 1885, whole-eye transplantation (WET) has been proposed as the ultimate cure for blindness. As the field evolves, different aspects of the surgery have been individually explored, including allograft viability, retinal survival, and optic nerve regeneration. Due to the paucity in the WET literature, we aimed to systematically review proposed WET surgical techniques to assess surgical feasibility. Additionally, we hope to identify barriers to future clinical application and potential ethical concerns that could be raised with surgery. METHODS/UNASSIGNED:We conducted a systematic review of PubMed, Embase, Cochrane Library, and Scopus from inception to June 10, 2022, to identify articles pertaining to WET. Data collection included model organisms studied, surgical techniques utilized, and postoperative functional outcomes. RESULTS/UNASSIGNED:Our results yielded 33 articles, including 14 mammalian and 19 cold-blooded models. In studies performing microvascular anastomosis in mammals, 96% of allografts survived after surgery. With nervous coaptation, 82.9% of retinas had positive electroretinogram signals after surgery, indicating functional retinal cells after transplantation. Results on optic nerve function were inconclusive. Ocular-motor functionality was rarely addressed. CONCLUSIONS/UNASSIGNED:Regarding allograft survival, WET appears feasible with no complications to the recipient recorded in previous literature. Functional restoration is potentially achievable with a demonstrated positive retinal survival in live models. Nevertheless, the potential of optic nerve regeneration remains undetermined.
PMCID:10129168
PMID: 37113307
ISSN: 2169-7574
CID: 5465502