Search

Primary care physicians encounter many patients who present with lumps and bumps on their fingers, hands, and wrists. Some benign lesions including ganglion cysts, epidermal inclusion cysts, and giant cell tumors of the tendon sheath that are benign and can be managed by primary care clinicians most of the time in an outpatient setting.We conducted a narrative of review of literature on the clinical presentation, diagnosis, prognosis, and management of common types of lumps and bumps found on the fingers, hand, and wrist.Based on the literature review and our clinical practice, we provide indications for referral to plastic surgeons or other specialists for these lesions.

Primary care clinicians encounter many conditions during their day-to-day visits with patients. A few of these common presentations include burns, lacerations, trauma to the hand, and wounds, some of which do not require an evaluation by a specialist and can be managed outpatient by primary care clinicians. In this article, we share evidence-based tips to avoid common pitfalls in primary care recognition and management of such presentations as well as guide them to manage many of these conditions themselves. We also provide guidance in the decision to refer the patient to a plastic surgeon or other specialists.

Objective To identify characteristics of malpractice litigations involving skull deformity in infants (craniosynostosis and deformational plagiocephaly). Design Retrospective review of all lawsuits with jury verdicts or settlements involving infant skull deformity as the primary diagnosis using the Westlaw Legal Database. Setting United States. Patients, Participants Plaintiffs with skull deformity as the primary diagnosis. Main Outcome Measures Litigation outcome and indemnity payment amount. Results From 1990 to 2019, 9 cases involving infant skull deformity met our inclusion/exclusion criteria. Among these cases, 8 (88.9%) cases resulted in indemnity payments to plaintiffs, totaling $30,430,000. Failure to diagnose (n = 4, 44.4%) and surgical negligence (n = 3, 33.3%) were the most common reasons for litigations. Conclusions There were a small number of malpractice lawsuits involving infant skull deformity over three decades. When cases go to court, physicians and hospitals have a high likelihood of judgment against them, frequently resulting in high indemnity payments.

Extensor tendon lacerations (ETLs) are a common and debilitating injury for thousands of Americans annually. No study has attempted to estimate their economic impact. The objective of this study was to estimate the economic impact of ETLs in America.The cost of ETLs to society was estimated using a validated prevalence-based cost of illness model. The primary cohort was defined as all patients with complete ETLs in the United States undergoing surgical repair and, secondarily, the imputed number of patients requiring reoperation within 1 year. For these groups, both direct and indirect costs (lost income, missed workdays, and disability payments) were measured.The total annual direct medical costs amounted to $14,095.28 per injury and 100,000 population. The total annual indirect labor costs were found to range between $80,842.90 and $150,136.82 per injury and 100,000 population. Hence, the estimated total costs of ETLs are $307 million per year in the United States alone and could be as high as $531 million annually depending on the effects of worker absenteeism on the core production-based industries.Extensor tendon lacerations incur a significant economic burden to our health care system and are more costly when compared with many other common hand conditions. Specifically, indirect costs are the major contributor toward the total cost these injuries incur on society, accounting for an upward of 91% of the total cost. These results suggest efforts be focused on improving rehabilitation protocols and treatments.Level II-economic and decision analyses.

BACKGROUND: The COVID-19 pandemic has presented unprecedented challenges for surgical teaching programs, as operating rooms closed and resources were redirected for patient care. As a result, both educational challenges and opportunities emerged. The objective of this study was to assess the changes used by plastic surgery programs as a result of the pandemic. METHODS: A 34-question American Council of Academic Plastic Surgeons-approved survey was distributed on April 29, 2020, to attendings in academic plastic surgery programs in the United States. Variables were controlled whenever multiple attending responses were submitted from the same program. RESULTS: A total of 113 attendings, including 30 (27.8%) program directors, responded to the survey. Most respondents were located in the northeast (41.4%). The average percentage of elective case volume was 23% of pre-COVID states. Those who reported a decrease in emergent surgical case volume (55.2%) estimated it to be at an average of 45% of the normal. Almost all the respondents (95.6%) agreed that they were working fewer hours than usual, and 40.9% of those reported a decrease of more than 20 hours per week of work. Most attendings (82.1%) also reported a decrease in their monthly salary. The percentage projected current salary compared with normal was 85%. CONCLUSIONS: Our survey data suggest that academic plastic surgery programs have had impactful changes to their operative and educational schedules, teaching, revenue, and patient care. The data described in this study could be used as a baseline for future pandemics affecting plastic surgery programs to help strategize their operational and educational structures.

Gangrenous cholecystitis (GC) is a severe and potentially deadly complication of acute cholecystitis. We present a 83-year-old gentleman with a past medical history of type 2 diabetes mellitus with significant associated neuropathy, presenting to a community hospital in a major metropolitan area with 10 days nausea and vomiting and a benign abdominal exam. While the patient was admitted for hyperglycemia, he was subsequently found to have severe GC requiring urgent surgical intervention.

AIM To review the early and more recent studies of Bivalirudin, to assess the safety, effectiveness, and cost benefits of this drug. METHODS Literature search of MEDLINE and PubMed databases from 1990 to 2017 using keywords as "bivalirubin" and "angiomax", combined with the words "safety", "effectiveness", "efficiency", "side effects", "toxicity", "adverse effect", and "adverse drug reaction". RESULTS A total of 66 publications were reviewed. The changes in clinical practice and differences in clinical protocols make it difficult to do direct comparisons of studies among each other. However, most trials showed decreased bleeding complications with bivalirudin, although ischemic complications and mortality were mostly comparable, with some favor towards bivalirudin. CONCLUSION Bivalirudin and heparin are both acceptable options according to current ACA/AHA guidelines. Authors conclude however, that that due to bivalirudin safer bleeding profile, it should be the preferred medication for anticoagulation.

Obesity is a chronic disease and an increasing problem globally. The prevalence is increasing in all ages—children, adolescents, and adults—and is now considered an epidemic. Obesity affects almost all physiological functions of the body and has major health consequences including, but not limited to, mental health, cancer, cardiovascular disorders, and musculoskeletal disorders. All the above have negative effects on the individual, the economy, the quality of life, and work productivity.

Obesity is a global, complex, multifactorial, and generally preventable disease. The global prevalence of obesity has doubled in the past 40 years regardless of sex, age, ethnicity, or socioeconomic status. Today, more than one-third of the world’s population is classified as obese or overweight. If this trend continues, researchers estimate that by 2030, this number will surpass 50%.

With advances in manufacturing and global trade, mass-produced refined foods have globally increased in prevalence. Additionally, our understanding of neurobiological models of addiction has improved due to more advanced computation and neuroimaging technology. The analysis of the neurobiological and clinical frameworks for the consumption of refined foods has led to the exploration of addiction to refined foods and its association with the rise in global obesity.

Obesity is a multifactorial disease with personal, environmental, genetic, and social influences. While at its core obesity results from an excess of energy intake compared to output, the complex relationship between variables leading to both individual and population-level obesity should be better understood through an environmental lens. The way one interacts with the environment is critical to development, and understanding which factors are within one’s control can help guide personal and policy initiatives. Several neighborhood-level factors have been shown to be associated with obesity, such as food availability and safety. Environmental factors within the home have also been shown to influence dietary choices, physical activity, and obesity rates. In this chapter, we will depict the environmental factors related to the obesity epidemic.

Obesity is a condition that arises from multiple factors and results in multiple consequences. A useful model for framing the spectrum of obesity epidemiology research can be found in Kim and Popkin (2006). In this multilevel framework, overweight and obese lie in the middle as the product of many different potential causes and as a cause of many different potential health consequences. Designing research that accurately characterizes the nature of this extremely complex and chronic yet dynamic condition can be a challenging task. This chapter serves as an overview of the major research methods encountered in obesity research and common problems that researchers must be aware of in study design and interpretation.

Multiple large cross-sectional epidemiological studies have demonstrated the presence of an association between obesity and mental health disorders, including depression, anxiety, eating disorders, and substance abuse. This association has been seen for both adults and children in the United States and around the world. However, much work is still being done to further understand and elucidate this relationship. This chapter aims to describe the psychosocial contributions and consequences of obesity.

According to recent studies on the trends of BMI worldwide, the prevalence of obesity has doubled in more than 80 countries since 1980. Moreover, nearly every country—excluding parts of sub-Saharan Africa and Asia—has observed an increase in obesity every year since 1975. Worldwide, 10.8% of adult males and 14.8% of adult females have obesity. Overall, this represents 3.4- and 2.3-fold increases in obesity in adult males and females, respectively, in 40 years. However, these trends are heterogeneous across countries with regard to the steepness of increase. The prevalence of a BMI ≥ 30 varies by country from 58% in the Micronesian island of Nauru. This wide range reflects the economic, environmental, ethnic, and social differences throughout the world. Moreover, the tabulation of the prevalence of obesity in each country is not conducted annually, as in the United States and other high-income countries. As a result, this chapter will focus on the trends of obesity in the United States and other affluent countries—defined in this chapter as the top 25 countries according to gross national income.

The global obesity epidemic is worsening around the world and unless major interventions take place, the implications will be ominous. As stated previously, the prevalence of overweight and obesity is increasing, not only in the United States but also globally. Apart from tobacco, obesity is likely the biggest threat to collective health in America. Globally, it has a major health impact and the effects on individuals, communities, and nations are lasting not just today but for future generations as well.