Blepharoplasty Online: Critical Analysis of Content and Patient Comprehensibility.

INTRODUCTION: Patients frequently turn to online information for decision-making factors about aesthetic procedures. The quality of online medical content is an essential supplement to clinical education. These resources assist patients in understanding the risks, benefits, and appropriateness of their desired procedure. This study examines the breadth and readability of online blepharoplasty information, elucidating its educational utility. METHODS: A depersonalized Google search was conducted using the Startpage Search Engine, investigating key phrases, "blepharoplasty decision making factors", "eye lift decision making factors", and "eyelid lift decision making factors". The first three pages of results for each search term, totaling 90 links were screened. Data were extracted for various decision-making factors, subspecialty, gender, and readability. RESULTS: Twenty-six websites met inclusion for analysis. Thirteen websites were plastic surgery based, five otolaryngology (ENT), five ophthalmology/oculoplastic, one oral-maxillofacial (OMFS), and two mixed-based practices. Most blepharoplasty webpages identified were that of private practice and male surgeons. Half were subspecialties other than plastic surgery. Thirteen common decision-making factors were identified. The most common factors addressed across all texts were recovery followed by cosmetic and functional goals. The least discussed were genetic factors. Average Readability exceeded the 12th grade. There were no significant differences in readability means among subspecialties. CONCLUSION: This study examines the online blepharoplasty sphere among US-based practices providing clinical education to patients. No appreciable differences among gender, subspecialty, and readability on decision-making factors were found, highlighting a consistency among surgeons. Most websites fell short of readability standards, however, emphasizing a need for clearer information to patients. NO LEVEL ASSIGNED: This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Almond Consumption Modestly Improves Pain Ratings, Muscle Force Production, and Biochemical Markers of Muscle Damage Following Downhill Running in Mildly Overweight, Middle-Aged Adults: A Randomized, Crossover Trial.

Background: Almonds promote cardiometabolic health benefits; however, the ergogenic effect of almond supplementation on exercise recovery is less explored. Objectives: We evaluated the impacts of raw, shelled, almonds on pain, muscle force production, and biochemical indices of muscle damage and inflammation during recovery from eccentrically biased exercise. Methods: Using a randomized, crossover design, 26 healthy adults (37 ± 6 y) ran downhill (-10%) for 30 min at a heart rate corresponding to 65%-70% of maximal oxygen consumption followed by 3-d recovery periods after 8-wk adaptations to either ALMOND (2 oz/d) or isocaloric pretzel (CONTROL) feedings. Volunteers consumed the study food immediately following the run and each day during recovery. Fasted blood samples were collected, and pain and muscle function were tested before the downhill run and over 72 h of recovery. Results: Downhill running elicited moderate muscle damage (Time: P < 0.001; η2 = 0.395) with creatine kinase (CK) peaking after 24 h (CONTROL: Δ + 180% from baseline compared with ALMOND: Δ + 171% from baseline). CK was reduced after 72 h in ALMOND (Δ - 50% from peak; P < 0.05) but not CONTROL (Δ - 33% from peak; P > 0.05). Maximal torque at 120°/s of flexion was greater (Trial: P = 0.004; η2 = 0.315) in ALMOND compared with CONTROL at 24 h (Δ + 12% between trials; P < 0.05) and 72 h (Δ + 9% between trials; P < 0.05) timepoints. Pain during maximal contraction was lower (Trial: P < 0.026; η2 = 0.225) in ALMOND compared with CONTROL after 24 h (Δ - 37% between trials; P < 0.05) and 48 h (Δ - 33% between trials; P < 0.05). No differences (P > 0.05) in vertical jump force, C-reactive protein concentrations, myoglobin concentrations, and total antioxidant capacity were observed between trials. Conclusions: This study demonstrates that 2.0 oz/d of almonds modestly reduces pain, better maintains muscle strength, and reduces the CK response to eccentric-based exercise. This apparent effect of almond ingestion on exercise recovery has the potential to promote increased exercise adherence, which should be investigated in future studies.This trial was registered at the clinicaltrials.gov as NCT04787718.

Rapid Cycle Quality Improvement of Telemedicine Protocols in a Skilled Nursing Facility During the COVID-19 Pandemic.

Prior to the COVID-19 pandemic, telemedicine was not well adopted in US nursing facilities. Many nursing facilities have since acknowledged its value due to the need for stricter infection control and reduction of exposure risk from face-to-face visits. A quality improvement project was conducted to improve telemedicine protocols in a high-volume post-acute care nursing facility, enhance provider and facility capability for visits, improve attitudes and skills toward telemedicine, and expand patient access to medical care during the pandemic. Process improvement was facilitated through identifying core areas of need and implementing interventions to address them. Project impact was measured by a retrospective pre-post survey of 7 questions to evaluate process improvement, attitudes, skills, and perceptions using a 5-point Likert scale (5=strongly agree, 1=strongly disagree) completed by 22 respondents (8 medical providers and 14 staff). Scores from before and after implementation were compared using paired t-tests. Respondents expressed improvement in perceived value (3.2 vs 4.8), personal skill/efficiency (2.3 vs 4.2), comfort level (2.3 vs 4.5), and scheduling process (2.3 vs 3.9) for telemedicine visits (all P≤.001). Respondents expressed increased awareness of barriers/benefits of telemedicine (2.8 vs 4.7, P<.001) and improved leadership commitment (2.6 vs 4.4, P<.001). The weekly average number of telemedicine visits per respondent increased significantly after protocol implementation (6.5 vs 25.6, P=.002). With support of facility leadership, interdisciplinary team members and engagement of key stakeholders, a telemedicine protocol was implemented in a single, high-volume, post-acute care skilled nursing facility during the COVID-19 pandemic, allowing patients to receive needed care.

Content and Readability of Online Recommendations for Breast Implant Size Selection.

Breast augmentation is one of the most frequently performed aesthetic procedures in the United States. Online information is often used by patients to make decisions when undergoing cosmetic procedures. It is vital that online medical information includes relevant decision-making factors and uses language that is understandable to broad patient audiences. Ideally, online resources should aid patient decisions in aesthetic surgical planning, especially implant size selection for breast augmentation. We describe patient decision-making factors and readability of breast implant size selection recommended by private practice plastic surgery webpages. Methods: Using a depersonalized, anonymous query to Google search engine, the terms "breast implant size factors" and "breast implant size decision" were searched, and 52 plastic surgery private practice webpages were identified. Webpages were analyzed for reported decision-making factors of implant size selection. Readability analyses of webpages were performed with Readability Studio and Hemingway Editor. Results: The two major decision-making factors for implant size selection reported by webpages were body/tissue-based measurements and surgeon input. Ten factors related to patient lifestyle, surgical goals, and procedural options were also identified. Average webpage scores for five readability measures exceeded recommended levels for medical information. Conclusions: Reported decision-making factors for implant size selection emphasize a plastic surgeon's expertise but may enhance the patient's role in preoperative planning. Webpages describing breast implant size selection exceed the sixth and eighth grade reading levels recommended by the AMA and NIH, respectively. Improving the readability of webpages will refine the role of online medical information in preoperative planning of breast augmentation.

Pistachios as a recovery food following downhill running exercise in recreational team-sport individuals.

We aimed to investigate the impact of pistachio nut consumption on muscle soreness and function following exercise-induced muscle damage. Using a randomised cross-over design, male team-sport players (n = 18) performed a 40-minute downhill treadmill run to induce muscle damage, which was conducted after 2-wks of consuming either control (CON, water), a standard dose of daily pistachios (STD, 42.5 g/d) or a higher dose of daily pistachios (HIGH, 85 g/d). Lower limb muscle soreness (visual analogue scale), muscle function (maximal voluntary isokinetic torque and vertical jump), and blood markers of muscle damage/inflammation (creatine kinase, C-reactive protein, myoglobin, superoxide dismutase) were measured pre (baseline) and post (24, 48, and 72 h) exercise. No trial order effects were observed for any outcome measurement across trials. Mean quadriceps soreness (non-dominant leg) during exercise recovery was reduced (p < 0.05) in HIGH vs. CON (mean difference (95%CI): 13(1-25) mm). Change in soreness in the dominant quadriceps was not different between HIGH vs. CON (p = 0.06; mean difference (95%CI): 13(-1 to 26 mm)). No main effects of time or trial were observed for mean soreness of hamstrings, or on isokinetic torque of knee extensors or knee flexors, during recovery. Serum creatine kinase concentration peaked at 24 h post-damage (mean(SEM): 763(158)µg/L) from baseline (300(87)µg/L), but had returned to baseline by 72 h post (398(80)µg/L) exercise in all trials, with no trial or trial × time interaction evident. These data suggest that high dose pistachio nut ingestion may provide some alleviation of muscle soreness, but no effect on muscle function, following modest muscle damage.

Pistachio nuts are considered a rich source of leucine and other essential amino acids, as well as being a good source of antioxidants. These properties suggest that pistachio ingestion could potentially influence recovery from exercise induced muscle damage.Ingestion of 85 g/d of pistachios, for 2-wks prior to and during recovery from exercise-induced muscle damage, significantly reduced muscle soreness in the non-dominant limb knee extensors, in comparison to 0 g/d control.No effects of pistachio ingestion were observed on muscle function or blood markers of damage suggesting that a mechanism of action on soreness is likely related to blunting of the inflammation response. However, further work is required to explore these effects in a larger sample when greater damage is induced.

Increasing Geriatric Care Capability in Hawai'i's Healthcare Systems through the Pacific Islands Geriatrics Workforce Enhancement Program (GWEP) at the University of Hawai'i.

There is an increasing shortage of skilled healthcare workers to provide care to the aging US population. In response, the Geriatrics Workforce Enhancement Program (GWEP) was developed in 2015 by the Health Resources and Services Administration (HRSA). This article describes the objectives, accomplishments, and lessons learned by the Pacific Islands GWEP at the University of Hawai'i (UH) over the past 5 years. The program's multi-pronged approach includes: (1) Developing partnerships between academia, primary care delivery sites/systems, and community-based organizations to educate a geriatrics workforce; (2) Training providers and students in medicine and allied health professions to address the primary care needs of older adults; (3) Transforming clinical training environments to become age-friendly health systems that incorporate the principles of value-based care and alternative-payment models; (4) Delivering community-based programs for patients, families, caregivers, and direct care workers to provide knowledge and skills to improve health outcomes for older adults; and (5) Providing training in Alzheimer's Disease and related dementias (ADRD), including the value of dementia-friendly communities. The GWEP provided education to over 3000 providers, 700 healthcare trainees, and 1000 patients and caregivers each year in a wide variety of care settings (eg, outpatient, home care, nursing facilities, care home, and hospice). Caregivers feel better able to care for themselves and/or others, find resources, and improve their practice of caregiving. The program is also transforming primary care delivery in underserved areas (eg, Community Health Centers, Family Medicine clinic, and the GRACE Team Care™ model). Outreach included rural areas, neighbor islands, and Pacific Islands.

Effects of short-term pistachio consumption before and throughout recovery from an intense exercise bout on cardiometabolic markers.

Although pistachios have been shown to improve cardiometabolic biomarkers in diseased and at-risk populations, less research has been conducted on young, healthy individuals. Furthermore, some but not all research indicates that exercise acutely improves cardiometabolic markers; however, it remains unclear as to why outcomes vary among studies. This research evaluated secondary aims of a study designed to assess the impacts of pistachios on recovery from vigorous eccentrically-biased exercise. Here we examined the short-term (two weeks) effects of two different doses (1.5 oz/d and 3.0 oz/d) of pistachios and a water-only control on the biomarkers of metabolic health in young adult men. This was followed by daily blood collection for three consecutive days after a 40-min downhill run. Twenty-seven participants completed each of three conditions in a counterbalanced randomized order. Plasma biomarkers (lipid profile, glucose, and insulin) were measured at the end of each 2-week feeding period immediately before the exercise bout and again 24, 48, and 72 h thereafter. Two weeks of pistachio consumption failed to elicit changes in any biomarker (p < .05).. Exercise reduced LDL-cholesterol at the end of the recovery period; however, positive effects were limited to when subjects were consuming the higher dose of pistachios. Follow up t-tests revealed significant reductions in LDL-C in the high dose group at 72-H compared to that at 0-H (8.2 ± 19.4; p < .04), 24-H (8.0 ± 18.6; p < .04), and 48-H (9.3 ± 15.8; p < .005) post exercise within the same trial. Overall, in healthy young men with normal blood lipid and glucose metabolism, little effect of either pistachios or intense exercise on cardiometabolic risk indicators was detected. More research is needed to determine the influence of usual diet consumption on outcomes following an acute exercise bout.

Influence of pistachios on force production, subjective ratings of pain, and oxidative stress following exercise-induced muscle damage in moderately trained athletes: A randomized, crossover trial.

Although previous studies have focused on the role of pistachios on metabolic health, the ergogenic effects of the nut must be elucidated. This study evaluated the impact of ingesting raw, shelled, unsalted pistachios on subjective pain ratings, force production, vertical jump, and biochemical indices of recovery from eccentrically biased exercise. Using a crossover design, 27 moderately trained, male athletes completed 3 trials in a randomized counterbalanced fashion. Control received water only, low dose (1.5 oz/d; PL) and high dose (3.0 oz/d; PH) consumed pistachios for 2 weeks with a 3-4-week washout between trials. PH had lower pain ratings in most muscles after 72 h of recovery (p < 0.05). PH prevented a decrease in force production at 120°/s of knee flexion (p > 0.05); whereas force was diminished in the other trials. Creatine kinase, myoglobin, and C-reactive protein increased over time following exercise (p < 0.05); however, there were no advantages following pistachio consumption. No significant changes in vertical jump or superoxide dismutase were elicited during any trial. This study demonstrates that 3.0 oz/d of pistachios can reduce delayed onset of muscle soreness and maintain muscle strength, potentially promoting exercise tolerance and training adaptations. ClinicalTrialsgov Identifier: NCT03698032.

Preventive Care and Outcomes of Interprofessional Medicare Annual Wellness Visits for Older Adults.

As we anticipate a growing population of older adults, we will see an increase in chronic conditions such as dementia and falls. To meet these public health needs, we must systematically provide screening, education, preventive care, and supportive care for older patients and their caregivers in a primary care setting. This will require a workforce trained in providing for the complex medical and psychosocial needs of an older adult population in an interprofessional and collaborative fashion. By integrating geriatric screening tools into an interdisciplinary Annual Wellness Visit teaching clinic, we were able to successfully improve rates of geriatric screening for dementia, depression, falls, medication reconciliation and advance care planning. We also saw improvements in patient care and satisfaction and provided the opportunity for interprofessional collaboration and education for students in medicine, nursing, pharmacy and social work.

Evolving Palliative Care Practices among Marshall Islanders in Hawai'i: Generational Comparisons.

Little is known about Marshallese palliative care practices. We explored traditional and contemporary Marshallese palliative care practices and examined generational differences. We performed three focus groups in 2011-2012 among Marshall Islanders in Hawai'i. A native speaking interpreter assisted group facilitators. Data were analyzed using classical thematic triangulation methods to identify specific Marshallese palliative care practices, the effect of economic and social challenges in Hawai'i, and generational differences comparing young and old. Nineteen persons (10 men and 9 women, youth aged 17-27 years, and elders as defined in Marshallese culture, aged 46-79) participated. A "good death" was defined as "peaceful and pain free," occurring from natural causes. Factors associated with a "good death" included gathering of family to absolve conflicts, and proper and timely cultural practices. Factors associated with "bad deaths" included young age, active suffering, accidents, suicides, "black magic/curses," or lack of timely or proper burial. Comparing generational differences, older Marshallese had differing opinions regarding preferred place of death, burial site, cultural practice preservation, artificial prolongation of life, and cremation. Barriers included mortuary fees, cost of transporting bodies, United States (US) government policies, and wait times for death certificates. Many cultural factors contribute to "good" or "bad" deaths. Attitudes toward palliative care practices differ by generation. Having previously documented different approaches by Yapese, a generalized "one size fits all" approach to Micronesians is inappropriate. Overcoming identified barriers may facilitate practices necessary for a good death in Micronesian populations in their home nations and as they migrate to communities throughout the US.