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  • Anti-Vascular Endothelial Growth Factor and Panretinal Photocoagulation Use After Protocol S for Proliferative Diabetic Retinopathy. Ophthalmology. Retina Azad, A. D., Chen, E. M., Hinkle, J., Rayess, N., Wu, D., Eliott, D., Mruthyunjaya, P., Parikh, R. 2020

    Abstract

    PURPOSE: To characterize the rates of pan-retinal laser photocoagulation (PRP) and anti-vascular endothelial growth factor (anti-VEGF) medications before and after publication of the DRCR.net Protocol S.DESIGN: A retrospective, cross-sectional study from January 1, 2012 to September 30, 2019 using a nationally representative claims-based database, Clinformatics Data Mart Database (OptumInsight, Eden Prairie, MN). Subjects, Participants, and/or Controls: Eyes newly diagnosed with proliferative diabetic retinopathy (PDR), continuous enrollment, and no prior treatment with PRP or anti-VEGF. Methods, Intervention, or Testing: Interrupted time series regression analysis was performed to identify the annual change in treatment rates before and after the publication of Protocol S (November 24, 2015).MAIN OUTCOME MEASURES: Annual rates of anti-VEGF or PRP treatments per 1,000 treated eyes with PDR.RESULTS: From 2012 to 2019, 10035 PRP or anti-VEGF treatments were given to 3685 PDR eyes. 63.6% (6379) of these were anti-VEGF agents and 36.4% (3656) were PRP treatments. 88.7% of eyes treated with anti-VEGF received the same agent throughout treatment and 7.7% were treated with both PRP and anti-VEGF agents. PRP rates declined from 784/1,000 treated eyes in 2012 to 566/1,000 in 2019 (pre-Protocol S: beta = -32 vs. post-Protocol S: beta = -77, p=0.005) while anti-VEGF rates increased from 876/1000 in 2012 to 1583/1000 in 2019 (beta = -48 vs. beta = 161, p=0.001). PRP rates in DME eyes did not significantly change from 474/1000 in 2012 to 363/1000 in 2019 (beta = -9 vs. beta = -58, p=0.091), but anti-VEGF rates increased significantly from 1533/1000 in 2012 to 2096/1000 in 2019 (beta = -57 vs. beta = 187, p=0.043). In eyes without DME, PRP use declined from 1017/1000 in 2012 to 707/1000 in 2019 (beta = -31 vs. beta = -111, p<0.001) and anti-VEGF use increased from 383/1000 in 2012 to 1226/1000 in 2019 (beta = -48 vs. beta = 140, p<0.001).CONCLUSIONS: Following the publication of Protocol S, PRP rates decreased while anti-VEGF rates increased largely from increases in bevacizumab use. PRP rates significantly declined among eyes without DME. Our findings indicate the impact that randomized controlled trials can have on real-world practice patterns.

    View details for DOI 10.1016/j.oret.2020.07.018

    View details for PubMedID 32693033

  • Progress Towards Parity: Female Representation in the American Society of Ophthalmic Plastic and Reconstructive Surgery. Ophthalmic plastic and reconstructive surgery Azad, A. D., Rosenblatt, T. R., Chandramohan, A., Fountain, T. R., Kossler, A. L. 2020

    Abstract

    PURPOSE: To report female representation within the American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS) at all levels of career achievement over 50 years.METHODS: Data were extrapolated from published ASOPRS directories and the 50th anniversary booklet. Fellowship, membership, leadership, and awards data were evaluated over 5 decades. Comparisons were made between the first and second 25 years, proportions of early and late career achievements, and time to career progression between males and females.RESULTS: During the first decade, 5.6% of ASOPRS fellows were female (n = 2), which rose to 6.6% (n = 8), 17.6% (n = 32), 22.4% (n = 35), and 39.4% (n = 97) in the second, third, fourth, and fifth decades, respectively. These patterns were echoed in ASOPRS membership. When comparing the first half (1969-1994) to the second half (1995-2018), fellowship (10.5% vs. 30.0%, p < 0.001), membership (8.0% vs. 30.3%, p < 0.001), early career awards (5.6% vs. 28.9%, p = 0.047), program directorship (0.0% vs. 15.7%, p = 0.017), and executive committee female representation (4.5% vs. 16.8%, p < 0.001) increased significantly. However, females were proportionally underrepresented as program directors (p = 0.003), late career award winners (p = 0.001), executive committee members (p < 0.001), and presidents (p = 0.020). Among those reaching leadership positions, females took longer than males to become program directors by a median of 4 years (p = 0.025).CONCLUSIONS: There has been a steady increase in female representation in ASOPRS fellowship training and membership. While significant progress has been made, growth in female leadership and award recognition is still needed.

    View details for DOI 10.1097/IOP.0000000000001764

    View details for PubMedID 32675720

  • Intraocular Pressure Changes after Cataract Surgery in Patients with and without Glaucoma: An Informatics-Based Approach. Ophthalmology. Glaucoma Wang, S. Y., Azad, A. D., Lin, S. C., Hernandez-Boussard, T., Pershing, S. 2020

    Abstract

    PURPOSE: To evaluate changes in intraocular pressure (IOP) after cataract surgery among patients with or without glaucoma using automated extraction of data from electronic health records (EHRs).DESIGN: Retrospective cohort study.PARTICIPANTS: Adults who underwent standalone cataract surgery at a single academic center from 2009-2018.METHODS: Patient information was identified from procedure and billing codes, demographic tables, medication orders, clinical notes, and eye examination fields in the EHR. A previously validated natural language processing pipeline was used to identify laterality of cataract surgery from operative notes and laterality of eye medications from medication orders. Cox proportional hazards modeling evaluated factors associated with the main outcome of sustained postoperative IOP reduction.MAIN OUTCOME MEASURES: Sustained post-cataract surgery IOP reduction, measured at 14 months or the last follow-up while using equal or fewer glaucoma medications compared with baseline and without additional glaucoma laser or surgery on the operative eye.RESULTS: The median follow-up for 7574 eyes of 4883 patients who underwent cataract surgery was 244 days. The mean preoperative IOP for all patients was 15.2 mmHg (standard deviation [SD], 3.4 mmHg), which decreased to 14.2 mmHg (SD, 3.0 mmHg) at 12 months after surgery. Patients with IOP of 21.0 mmHg or more showed mean postoperative IOP reduction ranging from -6.2 to -6.9 mmHg. Cataract surgery was more likely to yield sustained IOP reduction for patients with primary open-angle glaucoma (hazard ratio [HR], 1.19; 95% confidence interval, 1.05-1.36) or narrow angles or angle closure (HR, 1.21; 95% confidence interval, 1.08-1.34) compared with patients without glaucoma. Those with a higher baseline IOP were more likely to achieve postoperative IOP reduction (HR, 1.06 per 1-mmHg increase in baseline IOP; 95% confidence interval, 1.05-1.07).CONCLUSIONS: Our results suggest that patients with primary open-angle glaucoma or with narrow angles or chronic angle closure were more likely to achieve sustained IOP reduction after cataract surgery. Patients with higher baseline IOP had increasingly higher odds of achieving reduction in IOP. This evidence demonstrates the potential usefulness of a pipeline for automated extraction of ophthalmic surgical outcomes from EHR to answer key clinical questions on a large scale.

    View details for DOI 10.1016/j.ogla.2020.06.002

    View details for PubMedID 32703703

  • Retinopathy of prematurity and neurodevelopmental outcomes in premature infants. Eye (London, England) Al-Moujahed, A., Azad, A., Vail, D., Ludwig, C. A., Callaway, N. F., Moshfeghi, D. M. 2020

    View details for DOI 10.1038/s41433-020-0941-x

    View details for PubMedID 32398837

  • Applied Online Crowdsourcing in Plastic and Reconstructive Surgery: A Comparison of Aesthetic Outcomes in Unilateral Cleft Lip Repair Techniques. Annals of plastic surgery Suchyta, M., Azad, A., Patel, A. A., Khosla, R. K., Lorenz, H. P., Nazerali, R. S. 2020; 84 (5S Suppl 4): S307?S310

    Abstract

    BACKGROUND: Aesthetic outcomes of unilateral cleft lip repairs have important psychosocial implications for patients who are heavily influenced by social perceptions. Online crowdsourcing offers the unique potential to efficiently recruit large numbers of laypeople to assess public perception. The aim of this study was to use the online crowdsourcing platform Mechanical Turk to compare the postoperative outcomes of Fisher, Millard, and Mohler cleft lip repair techniques.METHODS: Two hundred fifty-four participants were recruited through Mechanical Turk to evaluate 29 cropped and deidentified photographs of children, 8 photographs were controls without cleft lips and 21 were children with unilateral cleft lips who had undergone Fisher, Millard, or Mohler repairs (7 in each group). Respondents were asked whether a scar was present, whether they would be personally satisfied with the surgical result and used a Likert scale from 1 to 5 to rate overall appearance, scar severity, and nasal symmetry.RESULTS: Fewer respondents reported that a scar was present when assessing postoperative photographs of Fisher repairs (70.3 ▒ 8.6%) compared with Millard (92.0 ▒ 1.5%) or Mohler (88.8 ▒ 3.1%) repairs. Average rating of scar severity was also lower for Fisher (1.9) compared with Millard (2.6) or Mohler (2.6) repairs. Average ratings of nose symmetry, general appearance, and satisfaction with operative result were not statistically significantly different between the repair groups.CONCLUSIONS: This study demonstrates the potential of online crowdsourcing to assess public perception of plastic surgery outcomes. The Mechanical Turk platform offers a reduction in selection bias, ease of study design, and enhanced efficiency of large-scale participant recruitment. Results indicate that the Fisher repair led to the most favored aesthetic outcomes compared with the Millard and Mohler techniques, particularly with regard to scar severity. Crowdsourcing is a powerful tool to assess layperson perception of plastic surgery outcomes and can be used to better guide surgical decision-making.

    View details for DOI 10.1097/SAP.0000000000002389

    View details for PubMedID 32282397

  • Reply: Where Do We Look? Assessing Gaze Patterns in Cosmetic Face-Lift Surgery with Eye Tracking Technology. Plastic and reconstructive surgery Cai, L. Z., Kwong, J. W., Azad, A. D., Kahn, D., Lee, G. K., Nazerali, R. S. 2020; 145 (2): 451e?452e

    View details for DOI 10.1097/PRS.0000000000006437

    View details for PubMedID 31985679

  • Use of vital signs in Predicting surgical intervention in a South African population: A cross-sectional study. International journal of surgery (London, England) Azad, A. D., Kong, V. Y., Clarke, D. L., Laing, G. L., Bruce, J. L., Chao, T. E. 2020

    Abstract

    While vital signs are widely obtained for trauma patients around the world, the association of these signs with need for surgical intervention has yet to be defined. Early detection of preventable outcomes is essential to timely intervention and reduction of morbidity and mortality.The aim of this study was to determine the association of vital signs and surgical intervention in a population of patients in South Africa.This retrospective cohort included 8722 trauma patients admitted at **** Hospital in Pietermaritzburg, South Africa over a five-year period December 2012-April 2018. Exclusion criteria included missing key data points. Variables for analysis included sex, mechanism of injury, admission Glasgow Coma Scale (GCS), systolic blood pressure, diastolic blood pressure, temperature, heart rate, and respiratory rate. Surgical intervention was defined by the need for treatment requiring time in the operating room. Data were analyzed using a univariate and multivariate logistic regression to determine an association between admission vital signs and surgical intervention and compared to the association of the Revised Trauma Score to surgical intervention.Of the 8722 trauma patient records available, exclusion of patients with incomplete data resulted in 7857 patient records available for analysis. Two thousand two hundred and ninety-six (29.2%) patients required surgical intervention in the operating room. Multivariate analysis revealed that male sex [odds ratio (OR) 1.25, 95% confidence interval (CI) 1.06-1.48], stab wound (OR 3.42, CI 2.99-3.09), gunshot wound (OR 4.27, CI 3.58-5.09), systolic hypotension (OR 1.81, CI 1.32- 2.48), hypothermia(OR 1.77, CI 1.34-2.34), tachycardia (OR 1.84, CI 1.61- 2.10), and tachypnea (OR 1.26, CI 1.08-1.45) as factors ssociated withan increased likelihood of surgical intervention.In this cohort of patients, the need for surgical intervention was best predicted by penetrating mechanisms of injury, tachycardia, and systolic hypotension. These data show that rapid and focused patient assessments should be used to triage patients foremergency surgery to avoid delays at any stage.

    View details for DOI 10.1016/j.ijsu.2020.05.013

    View details for PubMedID 32413507

  • Assessing Gaze Patterns in Common Cosmetic Procedures With Eye-Tracking Technology. Annals of plastic surgery Peterson, D. J., Azad, A. D., Gkorila, A., Patel, A. A., Boudreault, M. S., Nazerali, R. S. 2020; 84 (5S Suppl 4): S268?S272

    Abstract

    Understanding the salient features that draw focus when assessing aesthetics is important for maximizing perceived outcomes. Eye-tracking technology provides an unbiased method for determining the features that draw attention when evaluating aesthetic plastic surgery. This study aimed to characterize viewing patterns of plastic surgery patients and laypeople when assessing facial cosmetic procedure images.Twenty women who previously underwent cosmetic procedures and twenty women without a history of cosmetic procedures were shown sixteen pairs of preprocedure and postprocedure images of patients who underwent laser resurfacing or lip augmentation. Image pairs were randomized to whether preprocedural or postprocedural images came first. Participants viewed each image until they decided upon an aesthetic rating (scored 1-10), while an eye-tracking device recorded participants' gaze.The patient group's average ratings were 8.2% higher for preprocedural images and 13.3% higher for postprocedural images (P < 0.05 for both). The patient group spent 20.4% less time viewing images but spent proportionally more time evaluating the relevant features of each procedure (41.7% vs 23.3%, P < 0.01), such as the vermillion border of the upper lip, labial commissure, or periorbital region (P < 0.05 for each). For both groups, the most common site of first fixation was the nose for laser resurfacing images (26.6%) and the labial commissure for lip augmentation images (37.7%). Both groups spent more time fixated on nasolabial folds, marionette lines, and the periorbital region when viewing pre-laser resurfacing images than postprocedural images. Overall, each group had similar viewing patterns for time to first fixation on and frequency of fixations for a particular feature.Women who previously underwent cosmetic procedures view postprocedural images more favorably and require less time to assess images, likely related to familiarity with aesthetic procedures. These women spend more time fixated on relevant features, such as the vermillion border of the upper lip, the labial commissure, and the periorbital region, than the control group. Notably, each group spent less time focused on regions associated with wrinkles, such as the marionette and periorbital areas in post-laser resurfacing images, suggesting that the procedure reduces attention-drawing features in these areas.

    View details for DOI 10.1097/SAP.0000000000002387

    View details for PubMedID 32294074

  • Continued nursing education in low-income and middle-income countries: a narrative synthesis. BMJ global health Azad, A., Min, J., Syed, S., Anderson, S. 2020; 5 (2): e001981

    Abstract

    Introduction: Continued nursing education and development can reduce mortality and morbidity of patients and can alleviate the shortage of healthcare workers by training of nurses for high-demand skill sets. We reviewed patterns of educational interventions and strategies in initiating behaviour change, improving patient outcomes or knowledge for nurses in low- and middle-income countries (LMICs).Methods: The study searched the MEDLINE (PubMed), Embase, CINAHL, Google Scholar and Web of Science databases. The study included interventional studies on continued nursing education from 2007 to 2017. Of the 6216 publications retrieved, 98 articles were included and analysed by three independent reviewers.Results: Of the 98 studies that met inclusion criteria, five were randomised controlled trials, two were qualitative in design and the remaining 91 were quasi-experimental, before-and-after studies. Of these studies, the median sample size of participants was 64, and the majority were conducted in Asia (53.1%). During the 10-year study period, 20.4% was conducted in 2015, the highest proportion, with a general increase in number of studies over time from 2007 to 2017. Main themes that arose from the review included train-the-trainer models, low-dose/high-frequency models, use of multiple media for training, and emphasis on nurse empowerment, strong international partnerships, and the integration of cultural context. Overall, the studies were limited in quality and lacked rigorous study design.Conclusion: Continued nursing education in LMICs is essential and effective in improving nurses' knowledge base, and thus patient outcomes and quality of care. Long-term, randomised studies are needed to understand how training strategies compare in impact on nurses and patients.

    View details for DOI 10.1136/bmjgh-2019-001981

    View details for PubMedID 32181001

  • Systemic Corticosteroid Use after Central Serous Chorioretinopathy Diagnosis. Ophthalmology Azad, A. D., Zhou, M., Afshar, A. R., Bakri, S. J., Pershing, S. 2020

    Abstract

    To analyze frequency of systemic corticosteroid prescriptions before and after central serous chorioretinopathy (CSC) diagnosis.Retrospective claims-based analysis.A nationally-representative sample of commercial insurance beneficiaries who received care between 2007-2015.We limited the study population to beneficiaries with incident CSC diagnosed by an eye care provider, excluding those with other major ophthalmologic comorbidities. We developed a non-CSC comparison cohort matched to CSC patients on age, sex, general health (Charlson Comorbidity Index), and geographic region. We compared systemic corticosteroid prescriptions before and after CSC diagnosis and by diagnosing provider type (optometrist versus ophthalmologist), and evaluated likelihood of receiving steroids among CSC patients versus matched controls using logistic and Cox proportional hazard regression models.Frequency of systemic corticosteroid prescriptions among CSC patients within 12 months pre-diagnosis and at 6, 12, and 24 months post-diagnosis; median time to steroid initiation and discontinuation and odds of receiving post-diagnosis steroids among CSC patients and controls.We identified 3418 CSC patients. Nearly 39% (n=1326) were prescribed systemic steroids at some point during the analysis period, compared to 23% of matched controls (4033 of 17,178 patients). Over 12% of CSC patients (n=430) received steroids within a year pre-diagnosis, and nearly 12% (n=404) received steroids within 1 year post-diagnosis. Most patients who received post-diagnosis steroids were steroid-na´ve (n=231). The most common steroid prescribed was oral prednisone (an approximately 1-month supply). Among those receiving steroids, CSC patients had longer median time to first post-diagnosis steroid prescription (1.82 years versus 0.50 years for controls) and longer time to last steroid prescription (1.62 years versus 0.35 years for non-CSC patients). Although CSC patients were significantly less likely to receive steroids at 6 months post-diagnosis compared to matched non-CSC patients (OR=0.72, 95%CI=0.59-0.89), they were significantly more likely to receive steroids by 2 years post-diagnosis. Prescribing patterns were similar for patients diagnosed by an ophthalmologist versus optometrist.Despite evidence showing steroids contribute to CSC development, many patients continue to be prescribed systemic corticosteroids after CSC diagnosis. Our results suggest a need for greater communication and collaboration among providers to ensure clinical practice reflects evidence-based recommendations.

    View details for DOI 10.1016/j.ophtha.2020.06.056

    View details for PubMedID 32619546

  • Acute pain after breast surgery and reconstruction: A two-institution study of surgical factors influencing short-term pain outcomes. Journal of surgical oncology Azad, A. D., Bozkurt, S., Wheeler, A. J., Curtin, C., Wagner, T. H., Hernandez-Boussard, T. 2020

    Abstract

    Acute postoperative pain following surgery is known to be associated with chronic pain development and lower quality of life. We sought to analyze the relationship between differing breast cancer excisional procedures, reconstruction, and short-term pain outcomes.Women undergoing breast cancer excisional procedures with or without reconstruction at two systems: an academic hospital (AH) and Veterans Health Administration (VHA) were included. Average pain scores at the time of discharge and at 30-day follow-up were analyzed across demographic and clinical characteristics. Linear mixed effects modeling was used to assess the relationship between patient/clinical characteristics and interval pain scores with a random slope to account for differences in baseline pain.Our study included 1402 patients at AH and 1435 at VHA, of which 426 AH and 165 patients with VHA underwent reconstruction. Pain scores improved over time and were found to be highest at discharge. Time at discharge, 30-day follow-up, and preoperative opioid use were the strongest predictors of high pain scores. Younger age and longer length of stay were independently associated with worse pain scores.Younger age, preoperative opioid use, and longer length of stay were associated with higher levels of postoperative pain across both sites.

    View details for DOI 10.1002/jso.26070

    View details for PubMedID 32563208

  • Reply: Where Do We Look? Assessing Gaze Patterns in Cosmetic Face-Lift Surgery with Eye Tracking Technology. Plastic and reconstructive surgery Cai, L. Z., Kwong, J. W., Azad, A. D., Kahn, D., Lee, G. K., Nazerali, R. S. 2020; 145 (6): 1104e

    View details for DOI 10.1097/PRS.0000000000006825

    View details for PubMedID 32464032

  • Response to Letter to the Editor: Where Do We Look? Assessing Gaze Patterns in Cosmetic Facelift Surgery with Eye Tracking Technology. Plastic and reconstructive surgery Cai, L. Z., Kwong, J. W., Azad, A. D., Kahn, D., Lee, G. K., Nazerali, R. S. 2019

    View details for DOI 10.1097/PRS.0000000000006437

    View details for PubMedID 31834272

  • Assessing the Fisher, Mohler, and Millard Techniques of Cleft Lip Repair Surgery With Eye-Tracking Technology ANNALS OF PLASTIC SURGERY Kwong, J. W., Cai, L. Z., Azad, A. D., Lorenz, H., Khosla, R. K., Lee, G. K., Nazerali, R. S. 2019; 82: S313?S319
  • Where Do We Look? Assessing Gaze Patterns in Cosmetic Facelift Surgery with Eye Tracking Technology. Plastic and reconstructive surgery Cai, L. Z., Kwong, J. W., Azad, A. D., Kahn, D., Lee, G. K., Nazerali, R. S. 2019

    Abstract

    PURPOSE: Aesthetics plays a central role in determining success in plastic surgery. Understanding perceptions of favorable aesthetics is critical to ensure patient satisfaction. Eye-tracking technology offers an objective way to evaluate attention and understand how viewers direct their focus in patients who undergo cosmetic facelift procedures.METHODS: Thirty-six subjects ranging from layperson to attending plastic surgeon viewed 15 sets of photos before and after patients underwent an elective facelift procedure. They were instructed to evaluate the aesthetic quality on a Likert scale, while eye-tracking equipment tracked their gaze and analyzed their distribution of attention.RESULTS: Post-operative images showed a Likert score improvement of 0.51▒0.26, with the greatest difference in attending cosmetic plastic surgeons (1.36▒0.22; p<0.05). The nose was the most common first fixation location (31% of first fixations) and the most viewed area (16▒3% of fixation time) for all subjects. Experienced subjects spent less time in non-relevant areas (30▒11% for attending cosmetic plastic surgeons and 37▒10% for attending non-cosmetic plastic surgeons) compared to less experienced subjects (50▒15% for laypersons).CONCLUSIONS: This study demonstrates that viewers with greater experience in cosmetic surgery focus quickly on the cheeks, chin, and neck and have evenly distributed gaze across the entire face. These results suggest that laypersons' gaze are drawn to the center of the face - due to both unfamiliarity with the facelift procedure and the natural tendency to look at the central face - while attending plastic surgeons exhibit holistic gaze patterns and are more aware of the impact of the procedure.

    View details for PubMedID 30998662

  • Assessing the Fisher, Mohler, and Millard Techniques of Cleft Lip Repair Surgery With Eye-Tracking Technology. Annals of plastic surgery Kwong, J. W., Cai, L. Z., Azad, A. D., Lorenz, H. P., Khosla, R. K., Lee, G. K., Nazerali, R. S. 2019

    Abstract

    BACKGROUND: Cleft lip repair is essential to restoring physiologic function and ensuring social and psychological well-being in children with orofacial clefts. It is important to critically study various techniques to understand the elements of the lip and nasal repair that contribute to favorable results. Here, we use eye-tracking technology to evaluate how viewers analyze images of cleft lips repaired by the Fisher, Millard, or Mohler techniques.METHODS: Thirty viewers were shown 5 images without deformity and 5 images each of unilateral cleft lips repaired by the Fisher, Millard, or Mohler techniques. Viewers assessed the esthetic quality of images on a Likert scale while eye-tracking technology analyzed their gaze patterns.RESULTS: Of the 3 repair techniques, viewers found Fisher repairs most esthetically pleasing (mean ▒ standard error, 6.91 ▒ 0.13). Mohler repairs were next most attractive at (6.47 ▒ 0.13), followed by Millard repairs at (5.60 ▒ 0.14). The proportion of time spent in fixed gaze on the nose and upper lip was greatest for Millard repairs (58.3% ▒ 0.4%) and least for Fisher repairs (51.9% ▒ 0.5%). Viewers fixated most frequently on the nose and upper lip in Millard repairs (83.2% ▒ 0.5%) and least frequently in Fisher repairs (75.3% ▒ 0.5%). When examining the Millard compared with Fisher and Mohler repairs, viewers spent more time and fixations on the ipsilateral lip, nose, and repair scar than on the contralateral lip.CONCLUSIONS: The esthetics of the Fisher repair appear to be favored as measured by Likert scores and gaze data. Eye-tracking technology may be a useful tool to assess outcomes in plastic surgery.

    View details for PubMedID 30882421

  • Quality of Randomized Controlled Trials for Surgical Treatment of Carpal Tunnel Syndrome: A Systematic Review. Plastic and reconstructive surgery Long, C., Azad, A. D., desJardins-Park, H. E., Fox, P. M. 2019; 143 (3): 791?99

    Abstract

    BACKGROUND: Randomized controlled trials are considered the gold standard in evidence-based medicine. The authors conducted a systematic review to evaluate the quantity, quality, and trends of randomized controlled trials that assess surgical treatment of carpal tunnel syndrome.METHODS: The authors identified randomized controlled trials comparing two or more surgical interventions for carpal tunnel syndrome in PubMed, Cochrane, Scopus, Google Scholar, and Clinicaltrials.gov. Two independent reviewers evaluated articles for inclusion, extracted data, and assessed randomized controlled trial quality using the Jadad score.RESULTS: Of 2253 identified studies, 58 met full inclusion criteria. They were published between 1985 and 2015, with a significant increase over time (p = 0.003). They were most frequently published in Journal of Hand Surgery (European Volume) [n = 15 (25.9 percent)]. Most randomized controlled trials were single-center studies [n = 54 (93.1 percent)] conducted in the United Kingdom [n = 13 (22.4 percent)] or the United States [n = 10 (17.2 percent)], with a mean study size of 80.1 ▒ 55.5 patients. Funding source was unknown in 62.1 percent (n = 36). Three-quarters [n = 44 (75.9 percent)] of randomized controlled trials did not define the primary outcome measure(s). Less than 30 percent (n = 17) of randomized controlled trials conducted a power analysis. Only four studies with patients reported lost to follow-up provided an explanation for each patient. Six randomized controlled trials (10.3 percent) conducted intention-to-treat analysis. The mean Jadad score was 2.14 ▒ 1.26, with no significant improvement over time (p = 0.245).CONCLUSIONS: Despite the significant increase in the number of randomized controlled trials published studying surgical treatment of carpal tunnel syndrome over time, a mean Jadad score of 2.14 with no change over time indicates a need for improvement in quality. Proper study design is key to avoiding introduction of bias and ensuring the validity of conclusions drawn.

    View details for PubMedID 30822284

  • Where Do We Look? Assessing Gaze Patterns in Cosmetic Face-Lift Surgery with Eye Tracking Technology. Plastic and reconstructive surgery Cai, L. Z., Kwong, J. W., Azad, A. D., Kahn, D., Lee, G. K., Nazerali, R. S. 2019; 144 (1): 63?70

    Abstract

    Aesthetics plays a central role in determining success in plastic surgery. Understanding perceptions of favorable aesthetics is critical to ensure patient satisfaction. Eye-tracking technology offers an objective way of evaluating attention and understanding how viewers direct their focus on patients who undergo cosmetic face-lift procedures.Thirty-six subjects ranging from layperson to attending plastic surgeon viewed 15 sets of photographs before and after patients underwent an elective face-lift procedure. They were instructed to evaluate the aesthetic quality on a Likert scale while eye-tracking equipment tracked their gaze and analyzed their distribution of attention.Postoperative images showed a Likert score improvement of 0.51 ▒ 0.26, with the greatest difference in attending cosmetic plastic surgeons (1.36 ▒ 0.22; p < 0.05). The nose was the most common first fixation location (31 percent of first fixations) and the most viewed area (16 ▒ 3 percent of fixation time) for all subjects. Experienced subjects spent less time in nonrelevant areas (30 ▒ 11 percent for attending cosmetic plastic surgeons and 37 ▒ 10 percent for attending noncosmetic plastic surgeons) compared with less experienced subjects (50 ▒ 15 percent for laypersons).This study demonstrates that viewers with greater experience in cosmetic surgery focus quickly on the cheeks, chin, and neck and have evenly distributed gaze across the entire face. These results suggest that a layperson's gaze is drawn to the center of the face (because of both unfamiliarity with the face-lift procedure and the natural tendency to look at the central face), whereas attending plastic surgeons exhibit holistic gaze patterns and are more aware of the impact of the procedure.

    View details for DOI 10.1097/PRS.0000000000005700

    View details for PubMedID 31246802

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