Browsing by Author "Ricci, Joseph A"
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Item Open Access Assessment of the Wisconsin Criteria at a Level I Trauma Center.(The Journal of craniofacial surgery, 2022-09) Gray, Megan C; Kollu, Tejas; Uppal, Priya A; Hanos, Christina; Heiman, Adee; Ricci, Joseph A; Patel, AshitAbstract
The Wisconsin Criteria was developed for physicians evaluating facial trauma to determine the likelihood of facial fractures. Subsequent studies have not consistently validated these criteria. This study seeks to validate the Wisconsin Criteria and determine its utility in predicting operative facial fractures.Retrospective chart review of the trauma database registry at a Level I Trauma Center was conducted from September 2011 to May 2019. Adult patients who had a complete facial examination by otolaryngology or plastic surgery as well as a head computed tomography scan completed, were included. Fisher exact test was utilized for statistical analysis ( P < 0.05) and positive predictive value, and negative predictive value (NPV) were calculated with a 95% confidence interval.After screening, 546 patients met eligibility, 448 had at least 1 finding of the Wisconsin Criteria, and 472 patients had facial fractures. The sensitivity of the Wisconsin Criteria for determining the presence of a facial fracture was 86.23%, the specificity was 44.59%, and the NPV was 33.67% ( P < .0001). Malocclusion was the criterion most specific in determining if a facial fracture was present (98.65%), and Glasgow Coma Score < 14 was the least specific (67.57%).The Wisconsin Criteria did aid in the identification of facial fractures in trauma patients with a comparable sensitivity, higher specificity, and much lower NPV than originally described. Further investigation should be done to validate the criteria in other large trauma centers.Item Open Access Can You Trust What You Watch? An Assessment of the Quality of Information in Aesthetic Surgery Videos on YouTube.(Plastic and reconstructive surgery, 2020-02) Gray, Megan C; Gemmiti, Amanda; Ata, Ashar; Jun, Brandon; Johnson, Philip K; Ricci, Joseph A; Patel, AshitBackground
Videos on YouTube can be posted without regulation or content oversight. Unfortunately, many patients use YouTube as a resource on aesthetic surgery, leading to misinformation. Currently, there are no objective assessments of the quality of information on YouTube about aesthetic surgery.Methods
YouTube was queried for videos about the 12 most common aesthetic surgical procedures, identified from the 2015 American Society of Plastic Surgeons procedural statistics between May and June of 2016. The top 25 results for each search term were scored using the modified Ensuring Quality Information for Patients criteria based on video structure, content, and author identification. Average Ensuring Quality Information for Patients score, view count, and video duration were compared between authorship groups.Results
A total of 523 videos were graded after excluding duplicates. The mean modified Ensuring Quality Information for Patients score for all videos was 13.1 (SE, 0.18) of a possible 27. The videos under the search "nose reshaping" had the lowest mean score of 10.24 (SE, 0.74), whereas "breast augmentation" had the highest score of 15.96 (SE, 0.65). Physician authorship accounted for 59 percent of included videos and had a higher mean Ensuring Quality Information for Patients score than those by patients. Only three of the 21 search terms had a mean modified Ensuring Quality Information for Patients score meeting criteria for high-quality videos.Conclusions
The information contained in aesthetic surgery videos on YouTube is low quality. Patients should be aware that the information has the potential to be inaccurate. Plastic surgeons should be encouraged to develop high-quality videos to educate patients.Item Open Access Systematic Review and Guidelines for Perioperative Management of Pediatric Patients Undergoing Major Plastic Surgery Procedures, with a Focus on Free Tissue Transfer.(Plastic and reconstructive surgery, 2022-08) Mountziaris, Paschalia M; Rudolph, Christina M; Fournier, Craig T; Haykal, Siba; Ricci, Joseph A; Rezak, Kristen M; Patel, AshitBackground
Microsurgical free tissue transfer has been successfully implemented for various reconstructive applications in children. The goal of this study was to identify the best available evidence on perioperative management of pediatric patients undergoing free tissue transfer and to use it to develop evidence-based care guidelines.Methods
A systematic review was conducted in the PubMed, Embase, Scopus, and Cochrane Library databases. Because a preliminary search of the pediatric microsurgical literature yielded scant data with a low level of evidence, pediatric anesthesia guidelines for healthy children undergoing major operations were also included. Exclusion criteria included vague descriptions of perioperative care, case reports, and studies of syndromic or chronically ill children.Results
Two hundred four articles were identified, and 53 met inclusion criteria. Management approaches specific to the pediatric population were used to formulate recommendations. High-quality data were found for anesthesia, analgesia, fluid administration/blood transfusion, and anticoagulation (Level I Evidence). Lower quality evidence was identified for patient temperature (Level III Evidence) and vasodilator use (Level IV Evidence). Key recommendations include administering sevoflurane for general anesthesia, implementing a multimodal analgesia strategy, limiting preoperative fasting, restricting blood transfusions until hemoglobin level is less than 7 g/dl unless the patient is symptomatic, and reserving chemical venous thromboembolism prophylaxis for high-risk patients.Conclusions
Pediatric-specific guidelines are important, as they acknowledge physiologic differences in children, which may be overlooked when extrapolating from adult studies. These evidence-based recommendations are a key first step toward standardization of perioperative care of pediatric patients undergoing plastic surgical procedures, including free tissue transfer, to improve outcomes and minimize complications.Item Open Access What's in a Name? Implicit Bias Affects Patient Perception of Surgeon Skill.(Plastic and reconstructive surgery, 2021-06) Bhat, Deepa; Kollu, Tejas; Ricci, Joseph A; Patel, AshitBackground
Implicit bias is the unconscious associations and beliefs held toward specific demographic groups. Instagram is commonly used by plastic surgeons to market their practice. This study investigates whether a surgeon's name on a social media platform influences perception of their competence and their likelihood of gaining a new patient.Methods
A mock Instagram post was created using before-and-after photographs of a breast augmentation patient. Eight different ethnicities were selected, and common female and male names were selected based on U.S. Census data for each ethnicity. Surveys using the Instagram post were distributed asking responders to evaluate the competency of the surgeon and how likely they are to become a patient of that plastic surgeon. The surgeon's name was the only variable in the survey.Results
A total of 2965 survey responses were analyzed. The majority of responders were Caucasian (57 percent); 55 percent were men and 45 percent were women. Overall, competence and recruitment likelihood scores between surgeons of different ethnicities were not significantly different. Caucasian and Latinx responders both assigned higher competence and recruitment likelihood scores to their own respective ethnicities.Conclusions
Implicit bias plays a role in whether or not a patient is likely to seek care from a surgeon with an ethnically identifiable name. The two most common cosmetic surgery demographic groups, Caucasians and Latinxs, were also the only two ethnic groups to display in-group favoritism. Public education should be directed toward surgeon qualifications and experience in an effort to reduce implicit bias on patient decision-making.