The use of photography in plastic surgery has become standard of practice in recent years. Patient photographs have diverse utility and can be used to visualize medical progression, and as an ...educational and marketing tool. With increased publication of patient photographs outside the healthcare records, it is important to understand patient privacy rights and how they pertain to images. Additionally, it is valuable to understand the legal consequences associated with dissemination of patient photographs without proper consent.
A retrospective analysis of the Lexis+ legal database was conducted to obtain cases that involved the improper dissemination of patient photographs or videos by surgeons. Inclusion criteria included civil cases in which the defendant was a surgeon being sued for the improper use of patient photographs. Criminal cases were excluded from analysis.
A total of 23 cases met the inclusion criteria for our study. On average, 2.13 defendants were listed per case, often including the accused surgeon and their employer. Prior photographic consent was obtained in 69.57% (n = 16) of cases. In the remaining seven cases, the defendant did not obtain consent. In all seven of these cases, either the court ruled in favor of the plaintiff or both parties reached a settlement outside court.
To mitigate risk, surgeons should maintain two separate photographic consent forms for internal and external use. Additionally, a formal audit process should be established to ensure proper consent has been established before publishing patient photographs external to the electronic medical records.
Hyponatremia has been shown to be associated with gait disturbances, decreased mentation, and falls. The study objective was to determine the incidence of hyponatremia in patients who experienced a ...substantial skeletal fracture (hip/pelvis/femur). During an 18-month period from March 2007 to August 2008 serum sodium levels were evaluated in 364 cases of bone fracture in patients aged 65 years or older and in 364 nonfracture patients aged 65 years and older seen in an urban emergency room setting. The incidence of hyponatremia in patients with fractures was more than double that of nonfracture patients (9.1% and 4.1%, respectively;
P
= 0.007). The degree of hyponatremia was noted to be mild to moderate. Mean serum sodium of the entire fracture group was 131 ± 2 mEq/L. In the fracture group the patients were 75.3% female, while females comprised 66.2% of the nonfracture group (
P
= 0.02). Of fracture patients with hyponatremia, 24.2% were taking antidepressants 3/4 of which were selective serotonin receptor inhibitors (SSRIs), while none were taking these medications in the nonfracture group. Attention regarding careful follow-up of serum sodium levels in elderly patients seems appropriate.
Trisomy 21 often leads to cardiac complications, usually associated with congenital heart disease, such as atrial septal defects, ventricular septal defects, and patent ductus arteriosus. This case ...describes an unexpected instance of infective endocarditis (IE) in a middle-aged patient with an incidentally discovered patent foramen ovale (PFO). The common risk factors for IE include previous valve surgery, artificial heart valves, pacemakers, prior IE, congenital defects like bicuspid aortic valve, IV drug use, and the congenital defects mentioned earlier.
Background:
Immediate alloplastic breast reconstruction was traditionally performed as an inpatient procedure. Despite several reports in the literature demonstrating comparable safety outcomes, ...there remains hesitancy to accept breast reconstruction performed as an outpatient procedure.
Methods:
A retrospective review of National Surgical Quality Improvement Program data from 2014 to 2018 was utilized to evaluate recent trends and 30-day postoperative complication rates for inpatient versus outpatient immediate prosthetic-based breast reconstruction. Propensity score matching was used to obtain comparable groups.
Results:
During the study period, 33,587 patients underwent immediate alloplastic breast reconstruction. Of those, 67.5% of patients were discharged within 24 hours, and 32.4% of patients had a hospital stay of more than 24 hours. Immediate alloplastic reconstruction had an overall growth rate of 16.9% from 2014 to 2018. After propensity score matching, intraoperative variables that correlated with significantly increased inpatient status included increased work relative value units (16.3 ± 2.3 versus 16.2 ± 2.6;
P
< 0.001), longer operative times (228 ± 86 versus 206 ± 77;
P
< 0.001), and bilateral procedure (44.0% versus 43.5%;
P
< 0.001). There were higher rates of pulmonary embolism, wound dehiscence, urinary tract infection, transfusions, sepsis, readmissions, and reoperations in the group with the longer hospital stay.
Conclusion:
Based on increased complication rates and costs in the inpatient setting, we propose outpatient reconstructive surgery as a safe and cost-effective alternative for immediate alloplastic breast reconstruction.
Global increases in cancer, coupled with a shortage of cancer specialists, has led to an increasing role for primary care providers (PCP) in cancer care. This review aimed to examine all extant ...cancer curricula for PCPs and to analyze the motivations for curriculum development.
A comprehensive literature search was conducted from inception to October 13, 2021, with no language restrictions. The initial search yielded 11,162 articles and 10,902 articles underwent title and abstract review. After full-text review, 139 articles were included. Numeric and thematic analyses were conducted and education programs were evaluated using Bloom's taxonomy.
Most curricula were developed in high-income countries (HICs), with 58% in the United States. Cancer-specific curricula focused on HIC priority cancers, such as skin/melanoma, and did not represent the global cancer burden. Most (80%) curricula were developed for staff physicians and 73% focused on cancer screening. More than half (57%) of programs were delivered in person, with a shift toward online delivery over time. Less than half (46%) of programs were codeveloped with PCPs and 34% did not involve PCPs in the program design and development. Curricula were primarily developed to improve cancer knowledge, and 72 studies assessed multiple outcome measures. No studies included the top two levels of Bloom's taxonomy of learning (evaluating; creating).
To our knowledge, this is the first review to assess the current state of cancer curricula for PCPs with a global focus. This review shows that extant curricula are primarily developed in HICs, do not represent the global cancer burden, and focus on cancer screening. This review lays a foundation to advance the cocreation of curricula that are aligned to the global cancer burden.
Since the identification of SARS-CoV-2 or COVID-19 in Wuhan, several case reports have proposed a possible association between Guillain-Barre syndrome (GBS) and COVID-19. We describe a case of a ...59-year-old female who initially presented with shortness of breath, tested positive for COVID-19, and subsequently developed acute hypoxic respiratory failure requiring mechanical ventilation. Her recovery was complicated by acute polyneuropathy. Clinical exam and lumbar puncture showing an albuminocytologic dissociation were consistent with GBS. The prevalence and association of GBS following COVID-19 infection require further research to understand the short and long-term neurological effects of COVID-19, as well as the management of these various neurological manifestations.
Concussion is a common injury among Canadian children and adolescents that leads to a range of neurobehavioral deficits. However, noticeable gaps continue to exist in the management of pediatric ...concussion, with poor health outcomes associated with the inadequate application of best practice guidelines.
The aim of this study was to describe the development and assess the usability of a mobile phone app to aid youth in the self-management of concussion. A secondary objective was to assess the usefulness of the app.
An agile user-centered design approach was used to develop the technology, followed by a formative lab-based usability study for assessment and improvement proposals. Youths aged 10 to 18 years with a history of concussion and health care professionals involved in concussion management were recruited. This study included participants performing 12 tasks with the mobile phone app while using the think aloud protocol and the administration of the System Usability Scale (SUS), posttest questionnaire, and a semistructured interview.
A mobile phone app prototype called NeuroCare, an easily accessible pediatric concussion management intervention that provides easy access to expert-informed concussion management strategies and helps guide youth in self-managing and tracking their concussion recovery, was developed. A total of 7 youths aged between 10 and 18 years with a history of concussion and 7 health care professionals were recruited. The mean SUS score was 81.9, mean task success rates were greater than 90% for 92% (11/12) of the tasks, 92% (11/12) of tasks had a total error frequency of less than 11 errors, and mean task completion times were less than 2 min for 100% of the tasks.
Results suggest that participants rated this app as highly usable, acceptable to users, and that it may be useful in helping youth self-manage concussion.
PDF
