Utilizing international consensus panel recommendations and a clinical decision tree to guide selection of negative pressure wound therapy.

INTRODUCTION: A variety of NPWT products have become commercially available in the last 30 years. Utilizing advanced wound therapies appropriately can improve patient outcomes and decrease health care expenditures. Due to the increasing number of available product options, Hurd and colleagues published 10 Consensus Statements and a clinical decision tree to provide guidance on how and when to use NPWT and when to transition between device types. OBJECTIVE: To demonstrate the applicability of the consensus panel's statements and the clinical decision tree, 2 clinicians in the United States and Canada explored the benefits of applying these recommendations into their routine wound management practice. MATERIALS AND METHODS: Case studies were collected and reviewed in accordance with the Consensus Statements and clinical decision tree. RESULTS: Case presentations illustrate the application of the consensus panel's guidance through the prescribing of the NPWT products utilized as standard of care within both facilities. CONCLUSION: Utilizing NPWT devices according to the consensus panel recommendations and the clinical decision tree may assist in optimizing care delivery to patients and address logistical and economic efficiencies.

International Consensus Panel Recommendations for the Optimization of Traditional and Single-Use Negative Pressure Wound Therapy in the Treatment of Acute and Chronic Wounds.

INTRODUCTION: Currently, there are no international standardized guidelines or recommendations to guide the clinical decision-making process on when to initiate various negative pressure wound therapy (NPWT) systems for acute and chronic wounds. Specifically, no established recommendations or guidance exists regarding the type of NPWT system to use, traditional (tNPWT) or single-use (sNPWT), and how to transition between the 2 systems. METHODS: An expert panel was convened to (1) provide recommendations to clinicians on when to consider NPWT use in acute and chronic wound management and (2) develop a practical decision-making tool to guide on the appropriateness of the different NPWT modalities (tNPWT or sNPWT) and when they should be utilized. RESULTS: The panel made recommendations and designed a clinical decision-making tool to aid the consideration for initiating NPWT and the optimal system to be utilized based on (1) therapeutic goals, (2) wound-related factors, (3) patient satisfaction and quality of life, (4) care setting-related factors, (5) economic-related factors, and (6) NPWT system-related factors. CONCLUSIONS: The panel recommendations took into consideration the clinical, operational, and financial factors in the clinical decision-making process of NPWT use to enable optimal patient and health care system outcomes.

Implementation of an Elastomeric Mask Program as a Strategy to Eliminate Disposable N95 Mask Use and Resterilization: Results from a Large Academic Medical Center.

BACKGROUND: The COVD-19 global pandemic has placed a large demand on personal protective equipment for healthcare workers. N-95 respirators, required to perform aerosolizing procedures, are in short supply and have increased significantly in cost. The lack of a clear end to the pandemic requires hospitals to create a long-term, cost effective solution to the N95 shortage. We initially used previously described methods to reuse and resterilize N95 masks; however, we found they did not solve the issues related to just-in-time fit-testing and cost. STUDY DESIGN: We initiated a program with the aim to reduce our dependence on N95 masks by initiating a phased program to acquire industrial style elastomeric P100 masks as a substitute for reuse and resterilization of disposable N95s. We created an allocation strategy based on availability of the masks, as well as an operational plan to fit test, educate, and disinfect the masks. RESULTS: Within 1 month, we were able to reduce the number of N95s needed by our network by 95%. We also found that the cost was, conservatively, 10 times less per month than purchasing disposable N95s, and the cost benefit increases the longer they are needed. CONCLUSIONS: Establishment of an elastomeric mask program is feasible and less expensive than programs focused on reusing and disinfecting disposable N95 masks. A well thought out elastomeric distribution and disinfection program does not pose greater operational challenges than an N95 reuse and resterilization program. In addition, elastomeric masks can be stored for future surges and should be considered an essential part of all healthcare facilities' supply of personal protective equipment. Implementation of the program has eliminated our dependence on disposable N95s to maintain normal operations during the global pandemic.

Ingesta alimentaria y composición corporal asociadas a síndrome metabólico en estudiantes universitarios / Dietary intake and body composition associated with metabolic syndrome in university students

Resumen El objetivo de este estudio fue conocer la relación de la ingesta alimentaria (IA) y la composición corporal (CMC) con el síndrome metabólico (SM) entre estudiantes universitarios. Participaron 50 alumnos (56% mujeres) de entre 19 y 25 años de edad (M = 20.58, DE = 1.86), quienes completaron un cuestionario dirigido a evaluar IA, además se recabaron parámetros bioquímicos y de CMC. De acuerdo con el porcentaje de grasa corporal (PG), se identificó una alta ocurrencia de sobrepeso (22%) y obesidad (38%). Además, la grasa visceral incrementó conforme aumentó el PG. En ambos sexos existió un consumo bajo de hidratos de carbono y alto en lípidos, mayormente de origen animal, así como alto consumo de grasas saturadas, pero bajo de omegas 3 y 6. El SM fue identificado en 20% de la muestra, principalmente mujeres. El criterio de riesgo más frecuente fue los bajos niveles séricos de colesterol HDL, seguido de la obesidad abdominal; en tanto que la dislipidemia más frecuente fue la hipertrigliceridemia. En este estudio, aunque no se encontró relación directa entre IA y SM, si de éste con indicadores de CMC. Resulta inminente la necesidad de implementar estrategias que permitan a los estudiantes universitarios adquirir hábitos alimentarios y de actividad física saludables.

Abstract The objective of this study was to know the relationship between dietary intake (DI) and body composition (BC) with the metabolic syndrome (MS) among university students. A total of 50 students (56% female) among 19 and 25 years of age (M = 20.58, SD = 1.86), completed a questionnaire aimed at assessing DI, in addition biochemical and BC parameters were collected. According to the percentage of body fat (BF), a high prevalence of overweight (22%) and obesity (38%) was identified. In addition, visceral fat increased as the BF increased. In both sexes, there was a low consumption of carbohydrates and high in lipids, mostly of animal fat as well as high consumption of saturated fats, but low omegas 3 y 6. The MS was identified in 20% of the sample, mainly in women. The most frequently risk criteria were low levels of HDL cholesterol, followed by abdominal obesity; whereas the most frequent dyslipidemia was hypertriglyceridemia. In this study, although no direct relationship was found between DI and MS, it was found between MS and BC indicators. It is imminent the need to implement strategies that allow university students to acquire healthy eating and physical activity habits.

Ceftriaxone-Resistant Aeromonas hydrophila Infection Following Leech Therapy: A New Resistant Strain.

We report a case of ceftriaxone-resistant Aeromonas hydrophila infection in a 32-year-old man after medicinal leech therapy. The patient underwent a free gracilis muscle flap for dorsal foot soft tissue reconstruction. Because of persistent congestion after venous revision, medicinal leech therapy was initiated to aid in flap salvage. Intravenous ceftriaxone was administered prior to application of leeches for prophylaxis against A. hydrophila. Leech therapy was discontinued after 1 week, and ceftriaxone was discontinued 24 hours thereafter. An infection developed despite being on appropriate antibiotics. Culture sensitivities indicated that A. hydrophila was resistant to ceftriaxone.

Factors Influencing American Plastic Surgery Residents Toward an Academic Career.

BACKGROUND: Plastic surgery residency program directors have an interest in recruiting applicants who show an interest in an academic practice. Medical school achievements (ie, United States Medical Licensing Examination® scores, publications, and Alpha Omega Alpha status) are metrics assessed to grade applicants but may not correlate with ultimately choosing an academic career. OBJECTIVE: This study was designed to investigate factors influencing residents' choices for or against academic careers. METHODS: A 25-item online questionnaire was designed to measure baseline interest in academic plastic surgery and factors that influence decisions to continue on or abandon that career path. This questionnaire was disseminated to the integrated/combined plastic surgery residents during the 2013 to 2014 academic year. RESULTS: One hundred twenty-five respondents indicated that they were currently interested in pursuing academic practice (n = 78) or had lost interest in academic practice (n = 47). Among all respondents, 92.8% (n = 116) stated they were interested in academic careers at the time of residency application, but one-third (n = 41) subsequently lost interest. Those residents who retained interest in academic careers indicated resident/medical student educational opportunities (57%) and complexity of patients (52%) as reasons. Those who lost interest cited a lack of autonomy (43%), publishing requirements (32%), and income discrepancy (26%) as reasons. DISCUSSION: Many residents report losing interest in academics during residency. Traditional metrics valued in the recruitment process may not serve as positive predictors of an academic career path. CONCLUSION: Reasons why residents lose interest are not easily correctable, but mentorship, adequate career counseling, and research opportunities during training remain factors that can be addressed across all residency programs.

HISTORIQUE: Les directeurs des programmes de résidence en chirurgie plastique ont intérêt à recruter des candidats qui souhaitent mener une carrière en milieu universitaire. Les réalisations en faculté de médecine (indices de l'USMLE, publications et statut à l'AOA) sont des mesures utilisées pour classer les candidats, mais elles ne sont peut-être pas corrélées avec le choix d'une carrière en milieu universitaire. OBJECTIF: La présente étude visait à évaluer les facteurs qui influent sur les choix des résidents à opter ou non pour une carrière en milieu universitaire. MÉTHODOLOGIE: Les chercheurs ont conçu un questionnaire en ligne de 25 questions pour mesurer l'intérêt de départ envers une carrière en chirurgie plastique en milieu universitaire et les facteurs qui influent sur la décision de poursuivre en ce sens ou non. Ils l'ont distribué aux résidents en chirurgie plastique intégrés ou combinés pendant l'année scolaire 2013-2014. RÉSULTATS: Au total, 125 répondants ont affirmé s'intéresser à une carrière en milieu universitaire (n = 78) ou avoir perdu leur intérêt envers la pratique universitaire (n = 47). Dans l'ensemble, 92.8 % d'entre eux (n = 116) ont affirmé qu'ils envisageaient de mener une carrière en milieu universitaire au moment de leur demande de résidence, mais le tiers (n = 41) a ensuite perdu cet intérêt. Parmi leurs raisons, les résidents qui continuaient de vouloir mener une carrière en milieu universitaire ont cité les possibilités d'enseignement aux résidents et aux étudiants en médecine (57 %) et la complexité des cas (52 %). Ceux qui avaient perdu l'intérêt ont invoqué le manque d'autonomie (43 %), les exigences en matière de publication (32 %) et l'écart du revenu (26 %). EXPOSÉ: De nombreux résidents ont déclaré perdre leur intérêt envers une carrière en milieu universitaire pendant leur résidence. Les mesures habituelles utilisées pendant le processus de recrutement ne sont peut-être pas des prédicteurs positifs d'un cheminement de carrière universitaire. CONCLUSION: Les raisons pour lesquelles les résidents perdent l'intérêt envers la carrière en milieu universitaire ne sont pas faciles à corriger, mais le mentorat, une bonne orientation de carrière et des occasions de recherche pendant la formation font partie des facteurs qui peuvent être abordés dans tous les programmes de résidence.

Interés de estudiantes de la licenciatura en nutrición de universidades latinoamericanas y su formación en el campo de la nutrición comunitaria / Interest of students of the degree in nutrition of latinamerican universities and their training in the field of the community nutrition

Fundamentos: El campo profesional Nutrición Comunitaria es reconocido por su relación con una necesidad social de coadyuvar en la solución de los problemas de alimentación y nutrición, existen evidencias de su escaso desarrollo en la formación y mercado laboral, el objetivo del presente estudio fue conocer su importancia en los planes de estudio de la licenciatura en nutrición, así como el interés de los estudiantes por realizar estudios de posgrado en este campo. Métodos: Estudio transversal, la muestra se conformó de dos universidades, una pública y una privada de: Argentina, Uruguay, Paraguay, Chile, México y Perú. Se encuestó a estudiantes del primero y último año y se entrevistó al director y dos profesores de cada licenciatura. Para el análisis se utilizó Excel y SPSS. Resultados: El campo profesional de mayor interés para realizar estudios de posgrado fue Nutrición Clínica, seguido de Nutrición Comunitaria, situación semejante se presentó en la importancia de cada campo en los planes de estudio. No se encontraron diferencias a valores de P≤0.05, entre los estudiantes del primero y último año. Conclusiones: Aunque la Nutrición Comunitaria se ubicó en segundo nivel de importancia, con base en la situación epidemiológica, se considera conveniente impulsar un mayor desarrollo en la licenciatura y ofertar más oportunidades de estudios de posgrado

Background: Community Nutrition professional field is recognized by its relationby a social need to contributein the solution of food-supply and nutrition problems, there exist evidences of scanty development in the student formation and labor market area, for the aim of the present study was to know about its importance in the study plans of the nutrition degree, as well as the interest of the students to realice postgraduate studies. Methods: Transversal study, the sample was conformed of two universities of each country, a private and a public one from: Argentina, Uruguay, Paraguay, Chile, Mexico and Peru. Students were polled of firstly and last year and one interviewed the director and two teachers of every program, for the analysis we used Excel and SPSS. Results: The professional field of major interest to realize postgraduate studies was Clinic Nutrition, followed by Community Nutrition, a similar situation appeared in the importance of every field in the study plans. There was not differences to values of P≤0.05 among the students of the firstly and last year. Conclusions: Though the Community Nutrition was located in the second level of importance, with base in the epidemiological situation, it is considered suitable to stimulate a major development in the master and to offer more opportunities of postgraduate studies

Biomechanical Analysis of Internal Fixation Methods for Distal Interphalangeal Joint Arthrodesis.

BACKGROUND: The biomechanical performance of distal interphalangeal joint (DIPJ) fixation techniques in response to cyclic and load-to-failure bending loads is generally unknown. The purpose of this study is to assess the performance of 4 commonly used techniques for DIP arthrodesis. METHODS: Phalanges were fixed by one of the following techniques: (1) 2 parallel Kirschner wires (K-wires), (2) 1 longitudinal K-wire and 1 oblique K-wire, (3) an Acutrak® 2 Micro headless compression screw, or (4) 90-90 wiring. The phalanges were loaded in cantilever bending on the palmar side of the phalange for 3000 cycles, then loaded-to-failure. RESULTS: The 90-90 wiring was significantly worse than the other 3 methods in 9 of 10 parameters analyzed. Both K-wire methods and the screw produced similar results in nearly all parameters. CONCLUSIONS: Given the lack of difference in biomechanical performance between K-wires and compression screws, consideration should be given to other factors such as cost and complication profiles when choosing an implant for DIPJ fusion.

A Comprehensive Guide on Restoring Grasp Using Tendon Transfer Procedures for Ulnar Nerve Palsy.

Ulnar nerve paralysis results in classic stigmata, including weakness of grasp and pinch, poorly coordinated flexion, and clawing of digits. Restoration of grasp is a key portion of the reconstructive efforts after loss of ulnar nerve function. Improving flexion at the metacarpophalangeal joint can be done by static and dynamic means, although only the latter can improve interphalangeal extension. Deformity and digital posture are more predictably corrected with surgical intervention. Loss of strength from intrinsic muscle paralysis cannot be fully restored with tendon transfer procedures. Preoperative patient education is paramount to success if realistic expectations are to be met.

Mortality trends and the effects of débridement timing in the management of mediastinitis in the United States, 1998 to 2010.

BACKGROUND: The authors examined the relationship between débridement delay and mortality for mediastinitis patients. The authors also assessed mortality trends for mediastinitis patients between 1998 and 2010. METHODS: The authors conducted a retrospective cross-sectional study with data from the Nationwide Inpatient Sample, 1998 to 2010. They studied adult patients, 18 years of age or older, who were surgically treated for mediastinitis. They used a logistic regression model adjusted for patient demographic and clinical characteristics to evaluate the association between timing of first operative débridement and in-hospital mortality. Using their logistic model, they calculated the adjusted probability of in-hospital mortality for each year of the study. RESULTS: Results showed that initial débridement after the fourth day of admission increased the odds of in-hospital mortality by 50 percent (odds ratio, 1.5; 95 percent confidence interval, 1.0 to 2.1). In addition, the adjusted probability of in-hospital mortality for an average patient treated for mediastinitis decreased from 10.6 percent in 1998 to 3.1 percent in 2010. CONCLUSION: There is a survival advantage from timely initial débridement in mediastinitis patients. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.

Current management of metacarpal fractures.

Metacarpal fractures are common, and many can be managed nonoperatively with appropriate reduction and immobilization. As with any hand fracture, the primary goals are to achieve anatomic and stable reduction, bony union, and early mobilization to minimize disability. Appropriate treatment requires a keen understanding of the types of fractures, their inherent stability, and the available treatment options. Functional outcomes depend on appropriate treatment and early range of motion whenever possible.

An alternative mucosal flap for nasal lining: the superior labial artery mucosal flap-an anatomic study.

Reconstruction of nasal lining and septal defects is a challenging problem. An ideal reconstructive option provides ample thin, like tissue with reliable perfusion in a relatively short, single-staged procedure. The purpose of this study is to describe the vascular anatomy of the superior labial artery and an axial mucosal flap, the superior labial artery mucosal flap, based on this vascular pedicle, proposed for a single-stage reconstruction of nasal lining and septal defects.Dissection of the 10 facial arteries and their branches with a focus on the superior labial arteries was performed in a total of 5 fresh human cadavers. Objective findings on the vascular anatomy were assessed and upper lip mucosal flaps, medially based on the superior labial artery, were elevated. The case of a 30-year-old man who sustained a dog bite to the nose with a resulting full-thickness loss of his entire nasal tip and partial loss of his alar subunits is presented.In complex cases of nasal reconstruction in which nasal lining of associated defects cannot be accomplished with local flaps, we describe the anatomic basis for a regional single-staged, axial flap alternative for reconstruction.

The evolution of distal radius fracture management: a historical treatise.

Distal radius fractures (DRFs) have been a common affliction for millennia, but their treatment is a more recent development resulting from human erudition. Although immobilization has served as the only available treatment for most of our history, many advances have been made in the management of DRFs over the last century as orthopedics has grown. Yet the topic remains hotly contested in the literature and, given the frequency of the injury, research continues to focus on it. This article traces the evolution of DRF treatment to provide a context for the future.

Common myths and evidence in the management of distal radius fractures.

Distal radius fractures (DRFs) are the most common fracture treated by physicians, but questions remain regarding optimal management. Fracture patterns, biomechanics, and treatment strategies have been debated for more than 200 years, and research shows many controversies regarding long-held beliefs. Although these common myths have been propagated and considered fact, they are not based on the best-available evidence. This article illustrates some of the major controversies regarding the management of DRFs. To provide optimal care in a world of evidence-based medicine, clinicians must shift their thinking and accept that some of the indoctrinated ideas may represent a flawed heuristic approach.

A systematic review of outcomes and complications of treating unstable distal radius fractures in the elderly.

PURPOSE: As the population in developed countries continues to age, the incidence of osteoporotic distal radius fractures (DRFs) will increase as well. Treatment of DRF in the elderly population is controversial. We systematically reviewed the existing literature for the management of DRFs in patients aged 60 and over with 5 common techniques: the volar locking plate system, nonbridging external fixation, bridging external fixation, percutaneous Kirschner wire fixation, and cast immobilization (CI). METHODS: We reviewed articles retrieved from MEDLINE, Embase, and CINAHL Plus that met predetermined inclusion and exclusion criteria in 2 literature reviews. Outcomes of interest included wrist arc of motion, grip strength, functional outcome measurements, radiographic parameters, and the number and type of complications. We statistically analyzed the data using weighted means and proportions based on the sample size in each study. RESULTS: We identified 2,039 papers and selected 21 papers fitting the inclusion criteria in the primary review of articles with a mean patient age of 60 and older. Statistically significant differences were detected for wrist arc of motion, grip strength, and Disabilities of the Arm, Shoulder, and Hand score, although these findings may not be clinically meaningful. Volar tilt and ulnar variance revealed significant differences among groups, with CI resulting in the worst radiographic outcomes. The complications were significantly different, with CI having the lowest rate of complications, whereas the volar locking plate system had significantly more major complications requiring additional surgical intervention. CONCLUSIONS: This systematic review suggests that despite worse radiographic outcomes associated with CI, functional outcomes were no different from those of surgically treated groups for patients age 60 and over. Prospective comparative outcomes studies are necessary to evaluate the rate of functional recovery, cost, and outcomes associated with these 5 treatment methods.