Our study completes the development and estimates the psychometric properties of a novel, ventral hernia-specific patient reported outcomes (PRO) tool-the Abdominal Hernia-Q (AHQ).
A standardized ...method for measuring hernia-related PRO has not been identified. There remains a need for a broadly applicable, hernia-specific tool that incorporates patient viewpoints and offers pre- and postoperative forms.
Concept elicitation interviews, focus groups, and cognitive debriefing interviews were completed to define content. The preoperative AHQ was administered to patients scheduled to have a ventral hernia repair (VHR). The postoperative AHQ was administered to patients within 24 months post-VHR. The SF-12 and HerQLes were concurrently administered. Psychometric evaluation was performed. Subsequently, the AHQ (pre: 8 items; post: 16 items) underwent prospective testing.
Cross-sectional evaluations of patient responses to the AHQ (pre n = 104; post n = 261) demonstrated high internal consistency (Cronbach α pre = 0.86; post = 0.90) and moderate disattenuated correlations with the HerQLes (pre r = -0.71 and post r = -0.70) and the SF-12 domains (pre and post r ≥ 0.5 for 7 of 8 domains). Principal components analyses produced 2 factors preoperatively and 3 factors postoperatively. In prospective testing (n = 67), the AHQ scores replicated the cross-sectional psychometric results and suggested sensitivity to clinical outcomes.
Through patient involvement and rigorous, iterative psychometric evaluation, we have produced substantial data to suggest the validity and reliability of AHQ scores in measuring hernia-specific PRO. The AHQ advances the clinical management and treatment of patients with abdominal hernias by providing a more complete understanding of patient-defined outcomes.
This is the first paper in a series that presents a multiwavelength analysis of the archetype ultraluminous infrared galaxy IRAS F10214+4724, a gravitationally lensed, starburst/active galactic ...nucleus at z = 2.3. Here we present a new lens model and spatially resolved radio data, as well as a deep Hubble Space Telescope (HST) F160W map. The lens modelling employs a Bayesian Markov chain Monte Carlo algorithm with extended source, forward ray tracing. Using these high-resolution HST, Multi-Element Radio Linked Interferometer Network (MERLIN) and Very Large Array (VLA) maps, the algorithm allows us to constrain the level of distortion to the continuum spectral energy distribution resulting from emission components with differing magnification factors, due to their size and proximity to the caustic. Our lens model finds that the narrow-line region, and by proxy the active nucleus, is preferentially magnified. This supports previous claims that preferential magnification could mask the expected polycyclic aromatic hydrocarbon spectral features in the Spitzer mid-infrared spectrum which roughly trace the star-forming regions. Furthermore, we show that the arc-to-counter-image flux ratio is not a good estimate of the magnification in this system, despite its common use in the IRAS F10214+4724 literature. Our lens modelling suggests magnifications of μ ∼ 15-20 ± 2 for the HST
F814W, MERLIN 1.7 GHz and VLA 8 GHz maps, significantly lower than the canonical values of μ = 50-100 often used for this system. Systematic errors such as the dark matter density slope and colocation of stellar and dark matter centroids dominate the uncertainties in the lens model at the 40 per cent level.
We perform a stacking analysis of Herschel Astrophysical Terahertz Large Area Survey (H-ATLAS) data in order to obtain isothermal dust temperatures and rest-frame luminosities at 250 μm (L
250), for ...a well-defined sample of 1599 radio sources over the H-ATLAS Phase 1/Galaxy and Mass Assembly (GAMA) area. The radio sample is generated using a combination of NRAO VLA Sky Survey data and K-band United Kingdom Infrared Telescope Deep Sky Survey-Large Area Survey data, over the redshift range 0.01 < z < 0.8. The far-infrared (FIR) properties of the sample are investigated as a function of 1.4-GHz luminosity, redshift, projected radio-source size and radio spectral index. In order to search for stellar-mass-dependent relations, we split the parent sample into those sources which are below and above 1.5
.
After correcting for stellar mass and redshift, we find no relation between the 250-μm luminosity and the 1.4-GHz radio luminosity of radio active galactic nuclei. This implies that a galaxy's nominal radio luminosity has little or no bearing on the star formation rate (SFR) and/or dust mass content of the host system, although this does not mean that other variables (e.g. radio source size) related to the jets do not have an effect. The L
250 of both the radio detected and non-radio-detected galaxies (defined as those sources not detected at 1.4 GHz but detected in the Sloan Digital Sky Survey with r
′ < 22) rises with increasing redshift. Compact radio sources (<30 kpc) are associated with higher 250 μm luminosities and dust temperatures than their more extended (>30 kpc) counterparts. The higher dust temperature suggests that this may be attributed to enhanced SFRs in compact radio galaxies, but whether this is directly or indirectly due to radio activity (e.g. jet-induced or merger-driven star formation) is as yet unknown.
For matched samples in L
K
and g′-r′, sub-1.5
and super-1.5
radio-detected galaxies have 0.89±0.18 and 0.49±0.12 times the 250 μm luminosity of their non-radio-detected counterparts. Thus, while no difference in L
250 is observed in sub-1.5
radio-detected galaxies, a strong deficit is observed in super-1.5
radio-detected galaxies. We explain these results in terms of the hotter, denser and richer halo environments massive radio galaxies maintain and are embedded in. These environments are expected to quench the cold gas and dust supply needed for further star formation and therefore dust production. Our results indicate that all massive radio galaxies (>1.5
) may have systematically lower FIR luminosities (∼25 per cent) than their colour-matched non-radio-detected counterparts. Finally, no relation between radio spectral index and L
250 is found for the subset of 1.4-GHz radio sources with detections at 330 MHz.
The best methods to assess surgical knowledge are still debated. The authors used a non-multiple-choice test as a pre- and post-conference assessment to measure residents' knowledge gains with ...comparison to a standard summative assessment tool.
At one didactic conference, plastic surgery residents at a single institution were given a pre-test of drawing and labeling structures in the extensor mechanism of the finger and within the carpal tunnel. The quiz was followed by a lecture on the same material and a subsequent post-test. Scores were correlated with in-service exam performance.
Pre-test scores (n = 13) were positively correlated with postgraduate year (PGY) until PGY-3. Performance on labeling structures was higher than performance on the respective drawing prompt. Residents' ability to label structures increased more strongly with PGY than their ability to draw structures. The post-test (n = 8) demonstrated that teaching improves performance on labeling questions (pre-test score = 62%; post-test score = 87%). Improvement was observed across all PGYs. Pretest results were positively correlated with in-service exam performance.
Our study suggests that a knowledge test focused on drawing and labeling structures given to surgical residents is a valid, nontraditional method for assessing resident knowledge. Such a quiz would offer programs an alternative method for regularly evaluating residents aside from in-service questions, in order to identify residents who may need targeted training for the in-service exam and to inform teaching plans.Additionally, residents could use quiz feedback to guide study efforts and prime conference-related learning.
Dedicated research time is a component of certain plastic surgery programs, and yet, there is limited research examining its impact on academic productivity and career outcomes. This study aimed to ...assess the effect of dedicated research time on the academic productivity of residents and the likelihood of pursuing an academic career.
We conducted a cross-sectional study that examined bibliometric indices of integrated plastic surgery residency graduates from 2010 to 2020. Academic productivity was determined by the number of peer-reviewed publications and h-index 1 year after residency graduation. Results were analyzed using descriptive statistics, χ2 test, t test, and logistic regression.
Data on plastic surgery residency graduates were analyzed (N = 490 from 46 programs). The mean numbers of publications and h-index per research track graduate were 26.1 and 8.23, respectively. The mean numbers of publications and h-index per nonresearch track graduate were 15.9 and 5.97, respectively. After controlling for the University of Alabama research ranking through multilinear regression analysis, we found that pursuing dedicated research time was an independent predictor of increased h-index and publication output, although it did not predict an increased likelihood of pursuing an academic career.
Participating in dedicated research during residency increases academic productivity, irrespective of the residency program's research rank. Given this finding, offering research years can help support the mission of fostering academic opportunities within plastic surgery.
Cutaneous mold infections occur infrequently but can be life-threatening in immunocompromised children. The literature regarding its surgical management is limited. This study aims to describe the ...surgical management and outcomes of cutaneous mold infections in immunocompromised children.
Hospitalized patients receiving a skin biopsy at a single pediatric hospital in 2003 to 2017 were identified. Inclusion criteria were immunocompromised status, younger than 21 years, and surgical excision of a confirmed cutaneous mold infection. Patient information, details of immunosuppression, operative details, and 6-month postoperative and disease outcomes were collected.
Seventeen patients (21 lesions) were identified with an average age of 6.8 years (range = 0.2-19.5 years). Affected anatomic regions included limb (15, 71%), chest (2, 10%), axilla, back, abdomen, and head (1 or 5% each). Excisions occurred, on average, within 1.7 days of initial biopsy (range = 0-7 days). When specified, margins were 0.5 to 2.0 cm, and surgeons used intraoperative fungal detection techniques in 8 cases (47%). Definitive closure was achieved by secondary intention/dressings changes (9, 43%), skin graft (7, 33%), a skin substitute (2, 10%), immediate primary closure (2, 10%), and delayed primary closure (1, 5%). Overall, 14 patients were alive 6 months after resection (82%).
This study is the first to critically evaluate the methodology for surgical resection of cutaneous fungal infections in immunocompromised children. We suggest timely excision once diagnosed with, at minimum, 0.5-cm margins and intraoperative pathologic study when considering surgical treatment for this rare but serious infection.
The abdomen is a common donor site in autologous breast reconstruction. The authors aimed to determine whether pregnancy following autologous breast reconstruction increases the risk of incisional ...hernia repair.
All women younger than 50 years who underwent abdominally based autologous breast reconstruction between 2005 and 2016 were identified. Patients with less than 20 months of follow-up were excluded. Demographics, operative details, outcomes, incisional hernia repair occurrence, and pregnancy history were analyzed.
Five hundred nineteen patients underwent autologous breast reconstruction with 890 free flaps free transverse rectus abdominis musculocutaneous, n = 645 (72.5 percent); deep inferior epigastric perforator, n = 214 (24.0 percent); pedicled transverse rectus abdominis musculocutaneous, n = 18 (2.0 percent); and superficial inferior epigastric artery, n = 13 (1.5 percent). Average follow-up was 57.2 months (range, 9.5 to 312.8 months). Fourteen women became pregnant, with mean postpregnancy follow-up of 31.2 months (range, 5.4 to 70.8 months; pregnancies, n = 18). Age of nonpregnant patients (mean, 43.1 years; range, 20.6 to 50.0 years) was higher than that of pregnant patients (mean, 32.1 years; range, 27.1 to 37.9 years) (p < 0.0001); in univariate analysis, age was not associated with incisional hernia repair. Twelve pregnant patients (66.7 percent) underwent cesarean delivery. No statistically significant differences existed between groups regarding flap type and closure technique. Zero pregnant patients underwent incisional hernia repair, compared with a 6.1 percent incisional hernia repair rate in nonpregnant patients (p = 0.339). In multivariate analysis, prior incisional hernia, hematoma, fascial dehiscence, and reoperation predicted incisional hernia repair.
The authors' results demonstrate that there may not be an increased risk of incisional hernia repair associated with pregnancy following autologous breast reconstruction despite additional weakening of the abdominal wall.
Risk, II.
Background
Incisional hernias (IH) following abdominal surgery persist as morbid, costly, and multi-disciplinary surgical challenges. Using longitudinal, multi-state, administrative claims data (HCUP ...State Inpatient Databases (SID)); (HCUP State Ambulatory Surgery and Services Databases (SASD)), we aimed to characterize the epidemiology, outcomes, recurrence, and costs of IH.
Study design
529,108 patients undergoing abdominal surgery in 2010 across six specialties (colorectal, general/bariatric, hepatobiliary, obstetrics/gynecology, urology, and vascular) were identified within inpatient and ambulatory databases for Florida (FL), Iowa (IA), Nebraska (NE), New York (NY), and Utah (UT). IH repairs, complications, and expenditures were assessed through 2014. Predictive regression modeling was validated using a training set of 1000 bootstrapped repetitions.
Results
16,169 (3.1%) patients developed hernias requiring repair (4.3-year mean follow-up), 3176 (20%) underwent recurrent repair, and 731 (23%) underwent re-recurrent repair. Patients with IH had increased readmissions (6.6 vs. 2.4), morbidity (39 vs. 8% surgical and 22 vs. 7% medical), and costs ($46,000 vs. $25,000) when compared to patients without IH (
p
< 0.001). IH expenditures totaled $875 million: initial ($687 million), recurrent ($155 million), and re-recurrent hernias ($33 million). IH predominated in colorectal (10%), hepatobiliary (8%), and vascular (5%) procedures. Of 31 significant independent IH risk factors (
p
< 0.001), obesity, age, smoking, open surgery, and prior surgery were pervasive across surgical specialties.
Conclusion
IH represents an unremitting surgical epidemic associated with considerable morbidity, costs, and features consistent with a chronic disease state. We define critical pervasive risk factors (obesity, age, smoking open surgery, and prior surgery) independently associated with IH across surgical disciplines. With failed repairs, subsequent success becomes less likely, increasing morbidity and costs—underscoring the critical importance of optimal treatment and prevention.
Doximity has become integrated into the residency application process without any clear merit, comparing programs based on reputation and research. Our study aims to gather program directors’ and ...Chiefs/Chairs’ perspectives on the Doximity ranking system and to assess what a better system might entail.
A 16-question survey was sent to 177 program directors and Chief/Chairs of plastic surgery residency programs. The questions covered three categories: (1) demographic information; (2) Doximity ranking perceptions; (3) input on characteristics of a better tool. The responses were statistically analyzed.
Ninety-three questionnaires were received (53%). Twenty-nine (31%) respondents represented programs in the Northeast, 23 (25%) South, 20 (21%) Midwest, and 21 (23%) West. Seventy-three (79%) respondents were male and 16 (17%) female. 90% of respondents (n = 84) believe Doximity rankings are not accurate, all indicating their institution should be ranked higher. No significant association between program geography and ranking satisfaction was observed (p = 0.75). Only 33% (n = 31) of respondents were aware of Doximity methodology. Most respondents (95%; n = 88) do not recommend the use of Doximity to medical students. Most participants (87%; n = 81) are willing to share resident case logs to inform a future tool. “Strength of technical training/preparedness” was ranked most highly as important training program qualities.
The results of this program leadership survey show dissatisfaction with and a lack of understanding of the Doximity system. When considering future steps, program leadership support a strength-based categorization system and sharing case logs to guide student decision-making.
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