Hashtags in Plastic Surgery: A Sentiment Analysis of over 1 Million Tweets.

BACKGROUND: Current literature has sparse recommendations that guide social networking practices in plastic surgery. To address this, we used natural language processing and sentiment analysis to investigate the differences in plastic surgery-related terms and hashtags on Twitter. METHODS: Over 1 million tweets containing keywords #plasticsurgery, #cosmeticsurgery, and their non-hashtagged versions plastic surgery and cosmetic surgery were collected from the Twitter Gardenhose feed spanning from 2012 to 2016. We extracted the average happiness/positivity (h-avg) using hedonometrics and created word-shift graphs to determine influential words. RESULTS: The most popular keywords were plastic and cosmetic surgery, comprising more than 90% of the sample. The positivity scores for plastic surgery, cosmetic surgery, #plasticsurgery, and #cosmeticsurgery were 5.72, 6.00, 6.17, and 6.18, respectively. Compared to plastic surgery, the term cosmetic surgery was more positive because it lacked antagonistic words, such as "fake," "ugly," "bad," "fails," and "wrong." For similar reasons, #plasticsurgery and #cosmeticsurgery were more positively associated than their non-hashtagged counterparts. CONCLUSION: Plastic surgery-related hashtags are more positively associated than their non-hashtagged versions. The language associated with such hashtags suggests a different user profile than the public and, given their underutilization, remain viable channels for professionals to achieve their diverse social media goals. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. 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 .

Examination of Sleep and Injury Among College Football Athletes.

Burke, TM, Lisman, PJ, Maguire, K, Skeiky, L, Choynowski, JJ, CapaldiII, VF, Wilder, JN, Brager, AJ, and Dobrosielski, DA. Examination of sleep and injury among college football athletes. J Strength Cond Res 34(3): 609-616, 2020-The purpose of this study was to characterize subjective sleep metrics in collegiate football players at the start of the season, determine the relationship between preseason subjective sleep measures and in-season objective sleep characteristics, and examine the association between subjective and objective sleep metrics and incidence of time-loss injury during the competitive season. Ninety-four Division I football players completed 5 validated sleep-related questionnaires to assess sleep quality, insomnia severity, daytime sleepiness, sleep apnea risk, and circadian preference before the start of the season. Clinical thresholds for sleep questionnaires were used to determine risk of sleep disorders. Continuous wrist actigraphy was collected throughout the season to generalize sleep behaviors. Time-loss injury incidence data were recorded and used for analysis. Results indicated that 67.4% (60 of 89) of athletes scored above clinical threshold in at least 1 questionnaire to indicate sleep disorder risk. At the start of the season, players subjectively reported an average sleep duration of 7:16 ± 1:18 hours:minutes, which was in contrast to the 6:04 ± 0:41 hours:minutes measured through actigraphy during the season. Logistic regression models adjusted for age and body mass index revealed no significant associations between injury and subjective (odds ratio [OR] = 1.00; 95% confidence interval [CI] = 0.99-1.01) and objective (OR = 1.01; 95% CI = 0.99-1.02) sleep duration or measures attained from sleep questionnaires (ORs ranged from 1.01 to 2.87). Sleep metrics (quantity and quality) were not associated with increased risk of injury in this cohort of collegiate football players.

Reducing Phlebotomy Utilization With Education and Changes to Computerized Provider Order Entry.

INTRODUCTION: Daily phlebotomy is often a standard procedure in hospitalized patients. Recently, this practice has begun receiving attention as a potential target for efforts focused on eliminating overuse. Several organizations have published their efforts in this arena. Interventions have included education, feedback, and changes to computerized provider order entry (CPOE) but have yielded mixed results. METHODS: A quality improvement initiative to reduce the utilization of daily phlebotomy was conducted at a 505-bed Academic Medical Center. This project involved a combination of educational interventions and changes to CPOE. The primary end point evaluated was the daily performance of complete blood counts (CBCs) and basic metabolic profiles (BMPs) on medical and surgery units relative to the corresponding hospital census. RESULTS: Over the course of this project from August 1, 2013, to September 23, 2016, there was a 15.2% reduction in CBCs (p < .001 for linear trend) and 13.1% reduction in BMPs. DISCUSSION: Our results suggest that layering multimodal interventions that involve both "hard-wired" changes to CPOE and education and performance feedback can result in decreased utilization of phlebotomy.

Plastic Surgery and Social Media: Examining Perceptions.

BACKGROUND: Social media play an important role in plastic surgery, yet there are limited studies in the literature to guide plastic surgeons' social networking practices. To address this deficiency and provide further insight, the authors set out to investigate the public's attitude toward plastic surgery using Twitter, a popular social media platform. The authors examined a large body of messages (tweets) related to plastic surgery using novel techniques of natural language processing and sentiment analysis. METHODS: The authors collected over 1 million tweets with the keywords "plastic," "cosmetic," "aesthetic," and "reconstruction" surgery spanning from 2012 to 2016 from the Twitter Gardenhose feed. Using hedonometrics, the authors extracted the average happiness/positivity (havg) of tweets and created word-shift graphs to determine the most influential words. RESULTS: The positivity scores for keywords "plastic," "cosmetic," "aesthetic," and "reconstruction" surgery were 5.72, 6.00, 6.16, and 6.09, respectively. In relation to "plastic," keywords "cosmetic" and "aesthetic" were more positive because they lacked antagonistic words, such as "fake," "ugly," "bad," "fails," or "wrong." The keyword "reconstruction," however, was more positively associated than the term "plastic" because of an increase in positive words, such as "honor," "amazing," "successful," and "respect." CONCLUSIONS: Tweets containing the term "plastic" surgery trended toward negativity, and may be explained by the increase in unfavorable, associative words. Conversely, related terms such as "aesthetic," "cosmetic," and "reconstruction" were more favorably regarded because of the lack of antagonistic words and the presence of supportive words. The authors' results are informative and may serve to guide plastic surgeons' social media practices.

A Novel Innovation for Surgical Flap Markings Using Projected Stencils.

Despite the vast amount of technological advancement seen in the operating room, surgical markings are still drawn as "best estimates" the same way Susruta drew them in the sixth century BC. Many of the flaps used in plastic surgery have precise geometries that are hard to replicate by hand. In this article, the authors describe a novel approach in making surgical markings more accurate by using a pico-projector to project a prefabricated flap, designed on Google Sketchup, as a stencil. Projected and hand-drawn rhomboid and bilobed flaps were tested on cadavers, with both quantitative and qualitative outcomes favoring the projected flaps. This unique concept can not only be used in the operating room but also serve as an educational tool for training plastic and reconstructive surgeons. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.

Injuries caused by the attenuated energy projectile: the latest less lethal option.

OBJECTIVES: To review the injuries resulting from the attenuated energy projectile (AEP) in patients who present to emergency departments. METHOD: Review of case notes of patients presenting with injuries caused by the AEP after three episodes of serious civil disturbance in Northern Ireland from July to September 2005. RESULTS: 14 patients with 18 injuries were identified and included in the study. All patients were male, with an average age of 26.3 years. There were six injuries above the level of the clavicle, to the head, face or neck. There were three chest injuries, seven lower limb injuries and two upper limb injuries. There were no abdominal injuries. Seven patients required hospital admission. Five patients required surgical intervention. One patient required protective, elective intubation and one patient required the insertion of a chest drain. DISCUSSION: Although the study numbers were small, 33.33% of injuries were to the head and neck and 16.67% of the injuries were to the chest. The AEP was introduced as a replacement for its predecessor, the L21A1 plastic baton round, because of a theoretical risk of serious or even life threatening head injury from this projectile in certain circumstances. However, in this first survey of its usage, 50% of the injuries presenting to hospital were to the face, neck, head or chest. This injury pattern was more in keeping with older plastic baton rounds than with the L21A1.