Patient Reported Outcomes of Transperineal Prostate Biopsy With Tumescent Local Anesthesia.

OBJECTIVE: To report the outcomes of performing transperineal prostate biopsy in the office setting using the novel anesthetic technique of tumescent local anesthesia. We report anxiety, pain, and embarrassment of patients who underwent this procedure compared to patients who underwent a transrectal prostate biopsy using standard local anesthesia. MATERIALS AND METHODS: Consecutive patients undergoing either a transperineal prostate biopsy under tumescent local anesthesia or a transrectal prostate biopsy with standard local anesthetic technique were prospectively enrolled. The tumescent technique employed dilute lidocaine solution administered using a self-filling syringe. Patients were asked to rate their pain before, during, and after their procedure using a visual analog scale. Patient anxiety and embarrassment was assessed using the Testing Modalities Index Questionnaire. RESULTS: Between April 2021 and June 2022, 430 patients underwent a transperineal prostate biopsy using tumescent local anesthesia and 65 patients underwent a standard transrectal prostate biopsy. Patients who underwent a transperineal biopsy had acceptable but significantly higher pain scores than those who underwent a transrectal prostate biopsy (3.9 vs 1.6, P-value <.01). These scores fell to almost zero immediately following their procedure. Additionally, transperineal biopsy patients were more likely to experience anxiety (71% vs 45%, P < .01) and embarrassment (32% vs 15%, P < .01). CONCLUSION: Transperineal biopsy using local tumescent anesthesia is safe and well-tolerated. Despite the benefits, patients undergoing a transperineal prostate biopsy under tumescent anesthesia still experienced worse procedural pain, anxiety, and embarrassment. Additional studies examining other adjunctive interventions to improve patient experience during transperineal prostate biopsy are needed.

A Three-Dimensional-Based Morphometric Analysis of a Standardized Overcorrection Technique for Fronto-Orbital Advancement in Metopic Craniosynostosis.

INTRODUCTION: The concept of "overcorrection" for trigonocephaly has been reported to achieve both anterior cranial fossa expansion and normalization of craniofacial form. The purpose of this study is to describe in detail a standardized technique to fronto-orbital advancement utilizing the concept of "overcorrection" and objectively evaluate intermediate results. METHODS: This retrospective study included patients with isolated metopic synostosis who underwent surgery via the proposed surgical technique and age and sex-matched unaffected controls. Craniofacial morphometric analysis was performed on pre-, immediate post-, and intermediate postoperative (>2 years) three-dimensional (3D)-rendered computed tomographic (CT) scans and photographs. Key CT-based measurements included interzygomaticofrontal suture distance (IZFS), endocranial bifrontal angle (ECA), and temporal expansion. 3D photogrammetry was performed using established measurements and associated Z-scores converted. A Paired t-test and analysis of variance were performed when appropriate. RESULTS: Forty-one patients were included. A comparison of pre- and immediate postoperative CT scans demonstrated statistically significant increases in all measurements. Subset analysis of 12 patients with intermediate follow-up (age: 39.6 ± 3.6 months) demonstrated significant differences from preoperative values except for IZFS, which decreased from immediate postoperative values and was smaller than age- and sex-matched controls. 3D photogrammetry demonstrated a mean Z-score above the norm for frontal breath. 3D photogrammetry is also positively correlated with CT-based measurements. CONCLUSIONS: This standardized "overcorrection" approach for trigonocephaly can provide the appropriate changes to maintain a normal ECA despite a reduction in bifrontal width over time. 3D photogrammetry positively correlated with CT-based measurements and may provide useful information when following patients clinically. Long-term follow-up assessment to determine the necessary degree of overcorrection at skeletal mature is needed.

HIV awareness, pre-exposure prophylaxis perceptions and experiences among people who exchange sex: qualitative and community based participatory study.

BACKGROUND: People who exchange sex for money, favors, goods or services, combat higher risk of acquiring sexually transmitted diseases (STDs) and human immunodeficiency virus (HIV). Understanding barriers to STD and HIV related healthcare from the perspective of this stigmatized and marginalized community may improve access to sexual health services including pre-exposure prophylaxis (PrEP).  METHODS: We used community-partnered participatory and qualitative methods to conduct anonymous one-on-one interviews with people who exchange sex to understand their perspectives and experiences related to pre-exposure prophylaxis (PrEP) to prevent HIV acquisition. We conducted twenty-two interviews and coded them to perform thematic analysis.  RESULTS: We identified five themes: (1) Appreciation of HIV risk and prevention strategies grew from information accumulated over time. (2) PrEP information came from a variety of sources with mixed messages and uncertain credibility. (3) Decision-making about use of PrEP was relative to other behavioral decisions regarding exchange sex. (4) The multi-step process of obtaining PrEP presented multiple potential barriers. (5) Healthcare providers were seen as powerful facilitators to PrEP utilization. CONCLUSIONS: Our findings suggest that PrEP education and care needs to be made more relevant and accessible to individuals who exchange sex.

Stroke Network of Wisconsin (SNOW) Scale Predicts Large Vessel Occlusion Stroke in the Prehospital Setting.

Purpose: In previous trials, the Stroke Network of Wisconsin (SNOW) scale accurately predicted large vessel occlusion (LVO) stroke in the hospital setting. This study evaluated SNOW scale performance in the prehospital setting and its ability to predict LVO or distal medium vessel occlusion (DMVO) in patients suspected of having acute ischemic stroke (AIS), a scenario in which transport time to an endovascular treatment-capable facility (ECSC) is critical. Methods: All potential AIS patients with last-known-well time of ≤24 hours were assessed by Milwaukee County Emergency Medical Services for LVO using SNOW. Patients with a positive SNOW score were transferred to the nearest ECSC. One such facility, Aurora St. Luke's Medical Center (ASLMC), was the source of all patient data analyzed in this study. LVO was defined as occlusion of the intracranial carotid artery, middle cerebral artery (M1) segment, or basilar artery. Results: From March 2018 to February 2019, 345 AIS-suspected patients were transported to ASLMC; 19 patients were excluded because no vascular imaging was performed. Of 326 patients, 32 had confirmed LVO and 21 DMVO. For identifying LVO, SNOW scale sensitivity was 0.88, specificity 0.40, positive predictive value (PPV) 0.14, negative predictive value (NPV) 0.97, and area under the curve (AUC) 0.64. Ability to predict DMVO was similar. Overall, the SNOW scale showed sensitivity of 0.83, specificity of 0.39, PPV of 0.10, NPV of 0.97, and AUC of 0.60 in identifying candidates for endovascular thrombectomy. Conclusions: In a prehospital setting, the SNOW scale has high sensitivity in identifying candidates for endovascular thrombectomy and proved highly reliable in ruling out stroke due to LVO.

Steroid Use in Palatoplasty: A Single Surgeon Comparative Retrospective Cohort Study.

BACKGROUND: Fistula rates in cleft palate repair vary by technique, surgeon, and institution. Although steroids are commonly used in airway surgery, many plastic surgeons are reluctant to use steroids because of concerns with wound healing. This study aims to assess outcomes and safety of steroid use in Furlow palatoplasty and determine its impact on fistula formation. METHODS: A retrospective cohort study was done of all cleft palate surgeries performed by a single surgeon between 2010 and 2014. Data reviewed included demographics, type of cleft, steroid use, length of surgery, length of stay, and fistula formation rate. RESULTS: One hundred thirty-five patients underwent palatoplasty, of which 101 received steroids and 34 did not. The mean age was 4.6 years. A total of 42.2% of patients underwent primary palatoplasty, 48.1% underwent submucous cleft palatoplasty, and 9.7% underwent conversion palatoplasty. The overall fistula rate was 1.5% and was comparable between the 2 groups (steroids = 2.0%, no steroids = 0.0%, P = 0.558), and all occurred in primary palatoplasty patients. The average length of stay in the hospital was shorter among patients receiving steroids (steroids = 2.0 days, no steroids = 2.5 days, P < 0.05). CONCLUSIONS: Steroid use in cleft palate surgery appears to be safe and likely not associated with impaired wound healing or increased fistula formation. It may also shorten length of hospitalization.

Independent or Integrated Plastic Surgery Residency Pathways: Trends in Representation in Academic Plastic Surgery in the United States.

INTRODUCTION: The training pathway for plastic surgery has evolved in recent years with the adoption and rise in popularity of the integrated model. Studies have demonstrated that there may be differences between integrated graduates and independent graduates, specifically in career choices and type of practice. This study seeks to understand if there are differences in representation at academic and leadership positions between graduates of the 2 pathways. METHODS: A cross-sectional study was conducted in June of 2018 to assess integrated and independent pathway graduate's representation in academic plastic surgery in the United States. Factors examined were career qualifications, academic productivity, faculty positions, and influence of pathway on career advancement. RESULTS: A total of 924 academic plastic surgeons were analyzed, 203 (22.0%) of whom were integrated graduates and 721 (78.0%) of whom were independent graduates. Independent graduates had greater National Institutes of Health funding (integrated, $40,802; independent, $257,428; P = 0.0043), higher h-index (integrated, 7.0; independent, 10.0; P < 0.001), and higher publication number (integrated, 17; independent, 25; P = 0.0011). Integrated graduates were more likely to be assistant professors (integrated, 70%; independent, 40.7%; P < 0.001) and required a shorter postresidency time to reach all positions examined compared with independent graduates. CONCLUSIONS: Residency training pathway influences academic plastic surgeons in research output, qualifications, and academic positions. This is likely due to the relatively new nature of the integrated program compared with the independent, as well as the shorter length of training for integrated graduates. However, trends are moving toward integrated graduates showing increased interest and productivity in academic medicine.

Interdisciplinary Representation of Burn Surgery Journal and Society Leadership.

Burn care is a complex craft that requires an interdisciplinary approach. It includes a diverse array of specialty providers to provide holistic, specialized care to burn victims. This study aims to evaluate the diverse array of subspecialties involved in burn surgery journal and society leadership. A cross-sectional study was conducted in July 2019 by examining the characteristics of society and journal leaders. Current governance and committee members of the American Burn Association (ABA) and International Society of Burn Injuries (ISBI) were determined, as well as the editors of five major burn journals. Information gathered included occupation, advanced degrees obtained, and type of residency training. Of 384 editorial board members identified, 76% were physicians (n = 291), with specialties including burn surgery (n = 208, 54%) and anesthesiology (n = 22, 6%). Among nonphysicians (n = 78, 20%), 76% were medical researchers (n = 59), 8% physical therapists (n = 6), and 5% nurses (n = 4). Looking at ABA and ISBI governance (n = 29), 82% were physicians (n = 24). Nonphysician ABA and ISBI leaders were nurses (n = 2, 7%) and occupational therapists (n = 2, 7%). Of 467 identified ABA and ISBI committee members, half were physicians (n = 244, 52%). There was a wide array of nonphysician occupations among committee members, from nurses (n = 99, 21%), to occupational therapists (n = 25, 5%), and even firefighters (n = 6, 1%). Burn surgery journal and society leadership reflect the interdisciplinary nature of burn care by including an array of subspecialties. Yet, physicians tend to dominate academic burn leadership in comparison to other disciplines, highlighting the need for more nonphysician representation in leadership positions.

A Systematic Review on Airbag-Induced Burns.

Airbags significantly reduce fatalities and injuries in automobile crashes, but they have been found to be associated with burns. Specifically, airbags can cause burns through thermal or chemical mechanisms and commonly affect the arms, hands, face, and eyes. While most airbag-induced burns are minor, some may cause unfavorable outcomes. Our study aimed to systematically review airbag-induced burns to assess etiology, type, and treatment of these injuries. A systematic review of case reports pertaining to airbag-induced cutaneous and ocular burns was conducted. Data reviewed included type/location of burns, severity of burn, total number of patients, treatment, complications, and outcome after treatment. We identified 21 case reports that met our inclusion criteria with a total of 24 patients reported in the studies. Of the studies identified, 38% were chemical burns and 25% were thermal burns. Most commonly the upper extremities were burned in 42% of cases, followed by eyes (25%) and face (21%). Most burns identified were superficial partial thickness (58%). Treatment outcomes were good for cutaneous burns, with 95% healing without complication. However, ocular injuries lead to permanent impaired eye function in 71% of cases. In our systematic review, we highlighted the common risk factors, prognosis, and treatment for thermal, chemical, and ocular burns. Airbag-induced burns have a relatively good prognosis but must be recognized and treated immediately to reduce the risk of serious sequelae.

Does the method of visualization impact the performance of a new surgical task in novice subjects?

INTRODUCTION: Evolution of optical technology from two-dimensional to three-dimensional (3D) systems has come with an associated loss of stereoscopy and 3D depth perception. This report compares performance of surgical tasks in unbiased subjects using these systems. METHODS: Untrained subjects were randomized into two groups, robotically operated video optical telescopic-microscope (ROVOT) or surgical microscope (microscope). Subjects sutured and tied knots. Completion time, NASA-Task Load Index (TLX), and galvanic skin responses were analyzed. RESULTS: Intergroup analysis of suture completion time indicated that microscope use was significantly faster compared to ROVOT, whether used first or second. Regardless of which methodology was used first, the second modality was faster, indicating a transfer effect. NASA-TLX indicated that mental, performance, effort, and frustration were all greater with ROVOT. CONCLUSION: Task completion time and perceived effort were greater with ROVOT. Task completion times improved with repetition regardless of visual modality.