The Usage of Intravenous Tranexamic Acid in Reduction Mammaplasty Safely Reduces Hematoma Rates.

BACKGROUND: Bleeding complications are not uncommon after breast reduction surgery, and recently, tranexamic acid (TXA) as an antifibrinolytic agent has been used in various surgical specialties as a way to minimizes such adverse outcomes. We elected to evaluate the effectiveness of intravenous (IV) intraoperative TXA in reduction mammoplasty patients. METHODS: This is a retrospective chart review of clinical charts of all patients who received reduction mammoplasty by a single surgeon at Emory University Hospital or its affiliated Aesthetic Center from January 1, 2020, to March 1, 2022. Seventy-four consecutive breast reduction patients received 1-g IV TXA intraoperatively compared with 117 consecutive controls. The outcome of interest included 30-day postoperative bleeding complications. RESULTS: There was no significant difference in age ( P = 0.92), body mass index ( P = 0.98), percentage of smokers ( P = 0.56), operating time ( P = 0.87), estimated blood loss ( P = 0.90), or weight removed ( P = 0.98) between patients in each arm. There were 19 bleeding events (16.2%) in the non-TXA arm compared with 1 bleeding event (1.4%) in the TXA arm ( P = 0.0143). Of the 19, 6 (5.1%) were major events, and 13 were minor events (11.1%); the only bleeding event in the TXA arm was minor. Number needed to treat all bleeding events with use of TXA was 7, and the number needed to treat minor hematomas was 11. There was no significant difference in the rate of seroma, wound healing complications, infection, or nipple necrosis between the 2 arms ( P > 0.05). CONCLUSIONS: The use of IV TXA is a safe and effective way to reduce hematoma rates in patients receiving reduction mammoplasty.

COVID-19 and the Integrated Plastic Surgery Match: An Update on Match Trends by Applicant Location.

COVID-19 significantly impacted the residency match process. Away rotations and in-person interviews were canceled in 2021, resulting in a geographic shift in integrated plastic surgery match results. Although several of these limitations were lifted during the 2022 cycle, the resulting geographic outcomes have yet to be described. This study aims to determine whether the changes seen during the previous cycle persisted despite loosened restrictions. Methods: Integrated plastic surgery match results and applicants' home institutions from the 2022 match cycle were determined using publicly available data. Geographic data from this cycle were then compared with pre-COVID-19 match cycles (2016-2020) and the COVID-19-affected 2021 match cycle. Results: Eighty percent (n = 68) of US integrated plastic surgery programs were included in this study. In 2022, 18.42% of applicants matched at their home institution compared with 25.12% in 2021. There was no significant difference in home, state, or regional match rates between 2022 and the five cycles preceding the pandemic (2016-2020). Combining these data to reflect the non-COVID-19-affected cycles (2016-2020 and 2022) and comparing to the COVID-19-affected cycle (2021), a significant difference in rates of home matches (P = 0.0395) was identified. Conclusions: A significant increase in home institution match rates was not noted during the 2022 cycle. This return to pre-COVID-19 rates is likely attributed to the loosening of restrictions and more opportunities for interaction between applicants and programs outside of their home institution.

Advocacy in Action: a Comprehensive Student-Led Proactive Outreach to Patients at Highest Risk.

INTRODUCTION: COVID-19 disrupted access to critical healthcare and resources for many, especially affecting patients at safety-net hospitals who rely on regular care for multiple complex conditions. Students realized they could support patients from the sidelines by helping navigate abrupt healthcare changes and proactively addressing needs at home. AIM: To comprehensively identify and meet the clinical and social needs of Atlanta, Georgia's patients at highest risk, left without their usual access to healthcare, through proactive telephonic outreach. SETTING AND PATIENTS: Medical and Physician's Assistant students from Emory and Morehouse Schools of Medicine partnered with Grady Health System, Atlanta's safety-net hospital. Artificial intelligence prioritized over 15,000 patients by risk of morbidity and mortality from COVID-19. PROGRAM DESCRIPTION: In this novel program, students performed telephonic outreach to thousands of patients at highest risk of poor outcomes from COVID-19. Students used a custom REDCap form that served as both a call script and data collection tool. It provided step-by-step guidance to (1) screen for COVID-19 and educate on prevention; (2) help patients navigate health system changes to fill gaps in care; and (3) identify and address social needs. Based on patients' responses, the form prompted tailored reminders for next steps and connections to medical and social resources. PROGRAM EVALUATION: In the program's first 16 months, students made 7,988 calls, of which 3,354 were answered. Over half (53%) of patients had at least one need requiring action: 48% health and 16% social. DISCUSSION: This proactive, novel initiative identified substantial clinical and social need among patients at highest risk for poor outcomes and filled a pressing health system gap exacerbated by COVID-19. Simultaneously, interprofessional students gained applied exposure to health systems sciences. This program can serve as a model for rapid, cost-effective, high-yield outreach to promote patient health at home both during and beyond the pandemic.

Effect of COVID-19 on Geographic Distribution of the Integrated Plastic Surgery Match.

BACKGROUND: COVID-19 had significant impact on the 2021 integrated plastic surgery match, most notably through cancellation of away rotations and virtual interviews. While previous studies have analyzed geographic outcomes of the match in prior years, the effects of COVID-19 have not been determined. This study aims to contribute 2021 match data to determine the effects of COVID-19 on the geographic distribution of the integrated plastic surgery match. METHODS: Official match results for each program were populated by searching official program institutional websites and social media pages. Trainees' home medical institutions and current integrated plastic surgery residency programs were noted. Statistical analysis compared geographic distribution in COVID-19 affected (2021) and non-COVID-19 affected (2015-2020) match years. RESULTS: Of 85 integrated plastic surgery programs, 80% (n = 68) of programs and 1,015 matched trainees were included in this study. The average percentage of institutional matches in COVID-19-affected match year was 25.12%, compared to 16.67% for non-COVID-19-affected match years (p = 0.0012). The odds ratio of matching at a home institution in 2021 compared to prior years was 1.68 (95% CI 1.11-2.53). CONCLUSIONS: Our study is consistent with previous studies that demonstrate strong match preferences for affiliated medical students but also adds that this trend may be amplified in the post-COVID-19 era. While multiple factors may be involved in geographic distributions of residency match outcomes, the results of this study suggest that COVID-19 restrictions on travel and exposure to outside programs may have contributed to an even higher percentage of matches within the same institution.

Analyzing the Quality of Aesthetic Surgery Procedure Videos on TikTok.

BACKGROUND: TikTok is one of the most popular and fastest-growing social media apps in the world. Previous studies have analyzed the quality of patient education information on older video platforms, but the quality of plastic and cosmetic surgery videos on TikTok has not yet been determined. OBJECTIVES: The aim of this study was to analyze the source and quality of certain cosmetic procedure videos on TikTok. METHODS: The TikTok mobile application was queried for content related to 2 popular face procedures (rhinoplasty and blepharoplasty) and 2 body procedures (breast augmentation and abdominoplasty). Two independent reviewers analyzed video content according to the DISCERN scale, a validated, objective instrument that assesses the quality of information on a scale of 1 to 5. Quality scores were compared between videos produced by medical and nonmedical creators and between different content categories. RESULTS: The included videos attracted 4.8 billion views and 76.2 million likes. Videos were created by medical doctors (56%) and laypersons (44%). The overall average DISCERN score out of 5 corresponded to very poor video quality for rhinoplasty (1.55), blepharoplasty (1.44), breast augmentation (1.25), and abdominoplasty (1.29). DISCERN scores were significantly higher among videos produced by doctors than by laypersons for all surgeries. Comedy videos consistently had the lowest average DISCERN scores, whereas educational videos had the highest. CONCLUSIONS: It is increasingly important that medical professionals understand the possibility of patient misinformation in the age of social media. We encourage medical providers to be involved in creating quality information on TikTok and educate patients about misinformation to best support health literacy.

Prevalence of Contact Allergens in Best-Selling Ophthalmic Products.

BACKGROUND: Ophthalmic products are a common but often overlooked contributor to allergic contact dermatitis. Frequency of allergenic ingredients in over-the-counter ophthalmic products has not been well characterized. OBJECTIVE: The purpose of this study was to determine the prevalence of allergenic ingredients in most commonly bought eye lubricants and contact lens solutions. METHODS: A product list of Amazon.com's best-selling ophthalmic products was curated by searching for "Best Sellers in Eye Drops, Lubricants & Washes" and "Best Sellers in Contact Lens Care Products." For exploratory analysis, indication, price, consumer ratings, number of reviews, and US Food and Drug Administration approval status were recorded. The products' ingredients were compiled using NLM DailyMed, and products that had 1 or more allergens or relevant cross-reactors on either the 2018 American Contact Dermatitis Society Core Allergen Series or the 2015-2016 North American Contact Dermatitis Group Standard Allergen Series were noted. RESULTS: Forty-eight percent (n = 49) of the total products, (57.8% [n = 37] of eye lubricants, and 31.6% [n = 12] of contact lens solutions) had 1 or more allergens or associated cross-reactors. Identified allergens were benzalkonium chloride, propylene glycol, sorbic acid, amidoamine, sorbitan sesquioleate, chlorhexidine digluconate, lanolin alcohol, parabens, benzyl alcohol, and butylated hydroxytoluene. CONCLUSIONS: Awareness of potential allergens is crucial to diagnosing allergic contact dermatitis to ophthalmic products and helping patients navigate online pharmacological chaos.

Integrating the Integumentary System with the Arts: A Review of Dermatologic Findings in Artwork.

The objectives of this review are to demonstrate that portraits, in their visual reflections of subjects faces and expressions, offer significant representations relevant to the field of dermatology and bring attention to an underappreciated aesthetic of dermatological conditions. The review comprises paintings that purposefully or inadvertently depict dermatological conditions. The findings were substantiated by searching PubMed using the keywords art, painting, and dermatology, as well as combinations of these terms. The "Notable Notes" section of JAMA Dermatology proved especially useful. The review is subdivided by disease category, including portraits that display infectious diseases, neoplastic conditions, genetic dermatoses, rosacea and/or acne, and autoimmune disorders. The breadth of examples of dermatology represented in art suggest that portraits might serve as an unintentional atlas of dermatological conditions. By implication, it seems that the arts might be more interconnected to the sciences than traditionally acknowledged.