Faculty Bibliography

BACKGROUND AND OBJECTIVES/OBJECTIVE:Dural arteriovenous fistula (dAVF) surgery is a microsurgical procedure that requires confirmation of obliteration using formal cerebral angiography, but the lack of intraoperative angiogram or need for postoperative angiogram in some settings necessitates a search for alternative, less invasive methods to verify surgical success. This study evaluates the use of indocyanine green videoangiography FLOW 800 hemodynamic intraoperatively during cranial and spinal dAVF obliteration to confirm obliteration and predict surgical success. METHODS:A retrospective analysis was conducted using indocyanine green videoangiography FLOW 800 to intraoperatively measure 4 hemodynamic parameters-Delay Time, Speed, Time to Peak, and Rise Time-across venous drainage regions of interest pre/post-dAVF obliteration. Univariate and multivariate statistical analyses to evaluate and visualize presurgical vs postsurgical state hemodynamic changes included nonparametric statistical tests, logistic regression, and Bayesian analysis. RESULTS:A total of 14 venous drainage regions of interest from 8 patients who had successful spinal or cranial dAVF obliteration confirmed with intraoperative digital subtraction angiography were extracted. Significant hemodynamic changes were observed after dAVF obliteration, with median Speed decreasing from 13.5 to 5.5 s-1 (P = .029) and Delay Time increasing from 2.07 to 7.86 s (P = .020). Bayesian logistic regression identified Delay Time as the strongest predictor of postsurgical state, with a 50% increase associated with 2.16 times higher odds of achieving obliteration (odds ratio = 4.59, 95% highest density interval: 1.07-19.95). Speed exhibited a trend toward a negative association with postsurgical state (odds ratio = 0.62, 95% highest density interval: 0.26-1.42). Receiver operating characteristic-area under the curve analysis using logistic regression demonstrated a score of 0.760, highlighting Delay Time and Speed as key features distinguishing preobliteration and postobliteration states. CONCLUSION/CONCLUSIONS:Our findings demonstrate that intraoperative FLOW 800 analysis reliably quantifies and visualizes immediate hemodynamic changes consistent with dAVF obliteration. Speed and Delay Time emerged as key indicators of surgical success, highlighting the potential of FLOW 800 as a noninvasive adjunct to traditional imaging techniques for confirming dAVF obliteration intraoperatively.

Increasing the vaginal birth after cesarean (VBAC) rate to 18% was a Healthy People 2020 goal. Detailed data on racial/ethnic differences in VBAC rates is lacking and can inform efforts to equitably increase VBAC rates. This study aimed to assess racial/ethnic variation in VBAC rates and to describe group trends in VBAC rates in California between 2011 and 2021.This retrospective cohort study used a database of birth certificates linked to hospital discharge records. We analyzed singleton, term live births among people who had a history of at least one prior cesarean birth, no identified contraindications to a vaginal birth, and self-identified their racial/ethnic group as Hispanic or non-Hispanic (American Indian-Alaskan Native (AIAN), Asian, Black, Hawaiian/Pacific Islander, or white). VBAC births were identified from birth certificate records. Differences between VBAC rates were assessed using univariable and multivariable Poisson log-linear regression while adjusting for potential confounders.A total of 607,808 birthing people were included (2,234 AIAN, 84,899 Asian, 34,217 Black, 2,559 Hawaiian/Pacific Islander, 334,116 Hispanic, 149,783 white). Over the study period, Hawaiian/Pacific Islander birthing people had the highest average VBAC rate at 11.5% (AIAN, 6.5%; Asian, 8.8%; Black, 8.0%; Hispanic, 7.4%; white, 9.5%). In adjusted models, Black (aRR = 1.06, 95% CI: 1.01-1.11) and Hawaiian/Pacific Islander (aRR = 1.43, 95% CI: 1.27-1.61) birthing people were more likely to have a VBAC compared with white birthing people, while Hispanic birthing people were less likely (aRR = 0.96, 95% CI: 0.93-0.98). VBAC rates increased significantly (p < 0.001) over time for all groups except AIAN birthing people.VBAC rates increased for most racial/ethnic groups in California. With the exception of the Hawaiian/Pacific Islander group, there were small and likely not clinically significant differences in the chances for a VBAC across groups. No group in California met the Healthy People 2020 goal VBAC rate of 18%. · VBAC rates increased for most racial/ethnic groups.. · The VBAC rate for AIAN birthing people did not increase.. · No group met the Healthy People 2020 goal VBAC rate of 18%..

Design thinking (DT) has evolved as a human-centered framework for solving problems in a number of industries including health care and education. Users of DT move through a multistep dynamic process involving five stages: empathy, problem identification, ideation, prototyping, and testing. This article highlights one program's efforts to operationalize DT into the undergraduate nursing curriculum as a project-based learning strategy in a senior class. This educational innovation works to develop advanced critical thinking and problem-solving competencies for approximately 450 nursing students each academic year and has been taking place since 2019.

BACKGROUND AND OBJECTIVES/OBJECTIVE:The middle fossa approach is commonly used for lesions of the internal auditory canal (IAC). Localization of the superior semicircular canal (SSCC) is key for adequate drilling of the postmeatal triangle and exposure of the posterior IAC. The only available anatomic landmark for the SSCC is the arcuate eminence, which has a variable relationship with the SSCC. This study assessed the potential use of the subarcuate canaliculus (SAC) as a landmark to localize the SSCC and help ensure the safe drilling the postmeatal triangle. METHODS:Sixteen cadaveric specimens of temporal bone were studied (7 fresh human temporal bones and 9 sides of 5 cadaveric heads). An extradural approach to the middle fossa was performed. The postmeatal triangle was drilled, and the SAC, IAC, and SSCC were exposed. Three points were identified along the SAC: the medial end, the lateral end, and a turning point where the SAC has a conspicuous change along its course. RESULTS:Identified in all specimens, the SAC started on the medial petrous face posterior to the IAC and coursed posteriorly and laterally toward the SSCC. The mean length of the SAC was 10.9 mm. The SAC made a mean superior turn of 42° at its turning point toward its lateral point. Avoiding drilling of the postmeatal triangle lateral to the turning point protected the SSCC while maximizing the exposure of the dura of the posterior IAC. CONCLUSION/CONCLUSIONS:The SAC may be used as a reliable ancillary landmark in addition to the arcuate eminence to safely localize the SSCC during the drilling of the postmeatal triangle and exposure of the IAC.

BACKGROUND/UNASSIGNED:Lateral epicondylitis (LE), commonly known as tennis elbow, is a condition involving inflammation of the extensor carpi radialis brevis tendon at its attachment to the lateral epicondyle of the humerus. In recent years, platelet-rich plasma (PRP) therapy, an ortho-biologic treatment, has emerged as a promising option for the treatment of LE. Despite promising results in clinical trials, variability in PRP preparation and administration is a barrier to consistent outcomes. To address this, the Minimum Information for Studies Evaluating Biologics in Orthopedics (MIBO) guidelines were created in 2017 to establish a standardized approach for reporting findings in PRP-based studies. The objective of this study was to analyze and compare the rate of adherence of the MIBO guidelines in the use of PRP in treating LE. METHODS/UNASSIGNED:This systematic review evaluates the adherence of studies on PRP for LE to MIBO guidelines using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Adherence was determined by calculating the total percentage of checklist items that each study adequately and clearly reported from the 46-point checklist. RESULTS/UNASSIGNED:A total of 26 studies (954 patients) were included. Overall, only 52.2% of the 46-point MIBO checklist was reported per article on average with 0 articles displaying adherence rates of 100%. There was no significant difference in the mean adherence rates between studies prior to publication of the MIBO guidelines (45.2%) and after (53.7%). CONCLUSIONS/UNASSIGNED:This review demonstrated that studies evaluating the outcomes and procedures of the use of PRP in the setting of LE have poor adherence to MIBO guidelines. There was no difference in the adherence rates in studies published before and after the creation of MIBO guidelines in 2017. Level of evidence: II.

This article provides a focused update to the clinical practice guideline on the treatment and management of patients with COVID-19, developed by the Infectious Diseases Society of America. The guideline panel presents a recommendation on the use of vilobelimab in hospitalized adults with critical COVID-19. The recommendation is based on evidence derived from a systematic literature review and adheres to a standardized methodology for rating the certainty of evidence and strength of recommendation according to the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach.

AIM/OBJECTIVE:The aim of this study was to determine how family care is implemented in the care of women with gynaecological cancer from the perspective of health professionals in Finland. DESIGN/METHODS:Multiphase convergent mixed-methods research. METHODS:This study is based on two datasets collected from one Finnish university hospital. The first dataset was collected from health professionals (n = 20) in one Finnish university hospital inpatient unit in 2023. The second dataset is based on non-participant observational cases (n = 137) of health professionals in the spring of 2024. The quantitative data were analysed using both parametric and non-parametric tests. The qualitative data were analysed using thematic analysis. RESULTS:The quantitative results of the first and second phases together confirm the gap between the lack of competence and the attitudes of health professionals towards their own communication skills. The qualitative results revealed two main themes: (1) increasing competence towards a more comprehensive patient care process and (2) increasing the sense of safety by sharing timely information between professionals, patients, and relatives. CONCLUSION/CONCLUSIONS:Family-oriented working and communication between professionals is incidental and individual-dependent. Increased competence and more effective sharing and exchange of care information between professionals can improve the quality of care. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE/UNASSIGNED:The study was able to identify important areas of family care for professionals to improve their clinical practice. IMPACT/CONCLUSIONS:This study addressed clinical competence, as demonstrated by the family care perspective. Family care is recognised as an important part of the care of gynaecological cancer patients and requires increased competence. This study aims to raise awareness among health professionals and policymakers about the current state of family care in Finland. REPORTING METHOD/UNASSIGNED:This study was prepared and reported according to the STROBE checklist. PATIENT OR PUBLIC CONTRIBUTION/UNASSIGNED:No patient or public contribution.