Ericksoncobb0030

INTRODUCTION The forearm is a common donor site providing thin, pliable workhorse flaps for head and neck reconstruction. There are no prospective studies comparing the donor site morbidity of the radial forearm to the ulnar artery perforator (UAP) flap. this website METHODS All patients undergoing forearm free flaps were included for analysis and followed for a minimum of 1 year. Grip strength, sensation to light touch, temperature sensation and wound healing were assessed. RESULTS A total of 98 patients were enrolled (50 radial forearm vs. 48 UAP). There were three osteocutaneous radial forearm flaps performed. The donor site was closed primarily in one radial forearm patient and four UAP patients. The majority of donor sites were resurfaced with full-thickness skin grafts (radial 40 vs. ulnar 44), while the remaining were closed with split-thickness skin grafts. Average grip strength compared to baseline measured at 1, 3, 6, 12 months following surgery demonstrated no significant differences. All patients returned to baseline sensation to light touch with no long-term sensory deficits at 1 year. No patients suffered significant changes in temperature sensation or cold intolerance. Seven patients suffered partial skin graft loss (radial 5 vs. ulnar 2), all of whom healed secondarily with local wound care. There were no flap losses in the study. CONCLUSIONS The radial forearm and ulnar artery perforator flap are equivalent in terms of success and donor site morbidity. Selection of flap should be based on need for pedicle length, flap bulk, concerns with radial or ulnar dominance, and surgeon comfort.BACKGROUND Reports of neurodevelopmental delays in adolescents with metopic craniosynostosis (MC) have ranged from 15-61%. Previously, event-related potentials have correlated pre-operative radiographic severity with language deficiencies in infancy. This study sought to characterize neurocognitive testing at cranial maturity and correlate outcomes to pre-operative radiographic severity. MATERIALS AND METHODS Patients diagnosed with MC who underwent surgical correction in infancy completed a neurodevelopmental battery evaluating age-normalized intelligence quotient, academic achievement, and visual-motor integration. Data was stratified by pre-operative endocranial bifrontal angle (>124° "Moderate"; less then 124° "Severe"). Multiple variable regression was used to control measured intelligence and achievement for age at surgery, age at testing, parental education, and income. Significance was set at p less then 0.05. RESULTS Twenty patients completed neurodevelopmental testing. Mean intelligence quotient was 111.7 ± 13 and academic achievement was similar to national averages (53.4%, word reading; 53.4%, reading comprehension; 53.5%, reading composite; 44%, spelling; and 52.9% math). Radiographic measurements revealed 36% of patients with moderate phenotype and 64% were severe. Patients with severe phenotypes had lower I.Q. measures and scored more poorly in every academic measure tested. Word Reading (113 vs. 95; p=0.035) and reading composite (109 vs. 98; p=0.014) reached significance. CONCLUSION Overall, cranial mature patients with MC had above average IQ and academic achievement near the national mean. Long-term neurocognitive function was correlated to pre-operative radiographic severity in MC with more severe cases performing worse.The majority of cells comprising the inflammatory infiltrates in kidney allografts undergoing acute and/or chronic rejection are typically T cells and monocyte/macrophages with B cells, plasma cells, and eosinophils accounting for less than 5 %. In a significant minority of biopsies, B lineage cells (B cells and/or plasma cells) may be found more abundantly. Whereas plasma cell infiltrates tend to be more diffuse, B cells tend to aggregate into nodules that may mature into tertiary lymphoid organs. Given the ability to target B cells with anti-CD20 monoclonal antibodies and plasma cells with proteasome inhibitors and anti-CD38 monoclonal antibodies, it is increasingly important to determine the significance of such infiltrates. Both cell types are potential effectors of rejection, but both also have a tolerizing potential. B cell infiltrates have been associated with steroid resistance and reduced graft survival in some studies but not in others, and their presence should not prompt automatic depletional therapy. Plasma cell-rich infiltrates tend to occur later, may be associated with cell-mediated and/or antibody-mediated rejection, and portend an adverse outcome. Viral infection and malignancy must be ruled out. Randomized controlled trials are needed to determine the appropriateness of specific therapy when B cells and/or plasma cells are found. No strong therapeutic recommendations can be made at this time.Immunological memory is the ability of adaptive immune system to quickly and specifically recognize previously encountered antigens and initiate an effector response. Alloreactive memory cells can mount rapid and robust responses to the transplanted organ resulting in allograft injury.Thus preexisting humoral or cellular memory alloresponses are typically associated with poor graft outcomes in experimental and clinical transplantation. While both B and T lymphocytes exhibit memory responses, this review discusses recent updates on the biology of memory T cells and their relevance to the field of transplantation. Three major areas of focus are the emergence and characterization of tissue resident memory T cells, manipulation of T cell metabolic pathways and the latest promising approaches to targeting detrimental T cell memory in the settings of organ transplantation.Initially overlooked in favor of T-cell mediated rejection, the importance of the humoral alloimmune response has progressively emerged. As a result, antibody-mediated rejection (AMR) is now widely recognized as the main cause of late allograft loss in most (if not all) types of solid organ transplantation.Over the last 2 decades, vascularized composite allotransplantation (VCA) has appeared for replacing tissue defects in patients for whom no other satisfactory reconstructive options were available.Although it is now clear that VCA recipients can develop donor-specific antibodies, conclusions made in solid organ transplantation regarding AMR may not systematically apply to VCA.Here, we propose to use the experience gained in organ transplantation to shed light on the path that shall be followed to evaluate and manage humoral alloreactivity in VCA recipients.Comminuted intra-articular phalanx fractures are complicated injuries often treated with external fixation. The ideal external fixation system should be affordable, readily available, adaptable, and easy to use. The use of dynamic external fixation has advanced the care of these injuries but can be difficult to implement. The authors present a case example of a patient with a comminuted intra-articular phalangeal fracture of the left small finger treated using a syringe as a static uniplanar fixator that was converted to a dynamic fixator during postoperative recovery.BACKGROUND Despite the ongoing public health initiatives to increase pediatric influenza immunization rates to 80%, only a few US health centers have been able to meet this goal. The suboptimal immunity to influenza poses individual and societal risks for vaccine-preventable cases of influenza and its complications. LOCAL PROBLEM At a diverse, urban, family health center, its influenza immunization rate of 44% represented the lowest uptake rate compared with all other early childhood vaccines, increasing the risk of morbidity and mortality in young children, including hospitalization and death. METHODS To identify key barriers to influenza immunization, the investigators interviewed parents of children aged 6 through 24 months at this urban family health center via randomized sampling using an open-ended telephone survey. INTERVENTIONS Based on the concerns parents expressed through the survey, a program was designed and implemented that included reminder calls, parent education, proactive appointment scheduling, and social media reminders. RESULTS After implementing a parent-driven quality-improvement program for 6 months during influenza season, the health center's pediatric influenza immunization rates rose to 57% compared with 44% during the year before. CONCLUSIONS Childhood immunization is a critical priority to protect the health and wellness of children. Increasing parent engagement in discussions about increasing immunization rates not only promotes awareness surrounding vaccines but also allows primary care providers to learn from parents to create a patient-centered immunization program. Programs that specifically target immunization efforts toward parental concerns have the potential for increased vaccine acceptance and improved health outcomes.Poverty has detrimental effects on health outcomes. Doctorally prepared nurse practitioners are in a position to promote health for patients and communities experiencing poverty. To do so, they must be aware of their own attitudes and to have empathy toward the condition of poverty. Specialized poverty simulations have been successfully used to improve attitudes toward poverty among prelicensure nursing students, but there is a paucity of evidence exploring the effects of poverty simulations among Students in a Doctor of Nurse Practice (DNP) program. The purpose of this study was to evaluate the impact of a poverty simulation for students enrolled in a DNP program on their attitudes toward poverty. A quasi-experimental, pre-test and post-test survey design was used in this curriculum improvement project. A total of 29 DNP students participated in a 1-time, 4-hour Community Action Poverty Simulation© (CAPS). The simulations presented various challenges faced during 1 month of living in poverty. The Attitudes toward Poverty Scale-Short Form (ATPS-SF) was used to measure attitudes toward poverty both before and after the CAPS© experience. Descriptive statistics and paired t-tests were used to describe the participant group and measure the impact of the simulation on attitudes toward poverty. Attitudes toward poverty improved overall on all dimensions of the ATPS-SF after the CAPS© experience as compared to the pre-test, with particular improvement regarding stigmas related to poverty. Statistically significant improvements were detected on four items, and the overall favorable shift in attitudes presents clinically significant results. This poverty simulation experience should be considered for adoption into DNP curricula.BACKGROUND A common barrier to implementation of precision medicine is the lack of use of published clinical practice guidelines. Consequently, a user-friendly mechanism to easily adopt these guidelines is imperative. PURPOSE The purpose of this study was to evaluate the perceptions of a prototype of a clinical decision support tool through a mobile application for pharmacogenetics. METHODOLOGICAL ORIENTATION A case study on a patient requiring pharmacogenetic testing was provided to the participants. The participants were given up to 30 minutes to identify the correct dosing in the clinical decision support tool based on clinical evidence-based guidelines. Immediately after the utilization of the mobile app, focus group interviews were conducted to identify the perceptions of the tool, obstacles associated with the tool, and suggestions for improvement of the tool. SAMPLE Focus group interviews with 23 nurse practitioners and nurse practitioner students were conducted. Field notes and audio recordings were taken.