St. John's Pleasant Valley Hospital

Nonhealing foot ulcers in patients with diabetes are the leading cause of complications such as infection and amputation. This is a review of the traditional methods of good wound care for the diabetic foot ulcer. We also introduce newer methods for the treatment of these ulcers including hyperbaric oxygen therapy, bioengineered tissue, and recombinant platelet-derived growth factor-BB. By using a multidisciplinary team approach to care and integrating traditional and new wound-healing technologies, the goal of the US Department of Health and Human Services to lower the diabetic amputation rate by 40% may be achieved.

SUMMARY: Although robotic surgery has been routinely established in other surgical disciplines, robotic technologies have been less readily adopted in plastic surgery. Despite a strong demand for innovation and cutting-edge technology in plastic surgery, most reconstructive procedures, including microsurgery, have continued to necessitate an open approach. Recent advances in robotics and artificial intelligence, however, are gaining momentum and have shown significant promise to improve patient care in plastic surgery. These next-generation surgical robots have the potential to enable surgeons to perform complex procedures with greater precision, flexibility, and control than previously possible with conventional techniques. Successful integration of robotic technologies into clinical practice in plastic surgery requires achieving key milestones, including implementing appropriate surgical education and garnering patient trust.

SUMMARY: Artificial intelligence (AI) has been a disruptive technology within health care, from the development of simple care algorithms to complex deep-learning models. AI has the potential to reduce the burden of administrative tasks, advance clinical decision-making, and improve patient outcomes. Unlocking the full potential of AI requires the analysis of vast quantities of clinical information. Although AI holds tremendous promise, widespread adoption within plastic surgery remains limited. Understanding the basics is essential for plastic surgeons to evaluate the potential uses of AI. This review provides an introduction of AI, including the history of AI, key concepts, applications of AI in plastic surgery, and future implications.

Background: Plastic surgeons comprise the minority of practicing surgeons, with an even smaller minority practicing in an academic setting. As the practice of medicine and the systems in which we operate continue to evolve, it is essential that plastic surgeons have a say in the changing landscape. This study conducted a strengths, weaknesses, opportunities, and threats (SWOT) analysis of plastic surgery to identify unifying strengths and common threats. Methods: An electronic survey was distributed to American Council of Academic Plastic Surgeons' Winter Meeting attendees on three separate occasions preceding the meeting. Respondents were asked to provide demographic information and to identify the top three strengths, weaknesses, opportunities, and threats (SWOT analysis) for the specialty. Subgroup analyses were performed based on demographic characteristics. Results: A total of 187 responses were received from meeting attendees, representing an 89.0% response rate. Most respondents were non-Hispanic (78.6%), White (66.8%), women (59.5%), and faculty/independent physicians (65.8%). The most identified strength in plastic surgery was our problem-solving abilities (62.0%). The most identified weakness was poor public perception of plastic surgery (54.0%). The most identified opportunity was demonstration of value to health systems (67.9%), and the most identified threat was scope of practice creep by other specialties (78.1%). The SWOT analysis identified lack of surgeon diversity as a key weakness, improvement of surgeon diversity as a key opportunity, and lack of diversity among plastic surgeons as a key threat to the specialty. Conclusion: Only through a diverse but united front can we effectively use our strengths to face our threats and employ opportunities to overcome our weaknesses.

SUMMARY: Blockchain technology has attracted substantial interest in recent years, most notably for its effect on global economics through the advent of cryptocurrency. Within the health care domain, blockchain technology has been actively explored as a tool for improving personal health data management, medical device security, and clinical trial management. Despite a strong demand for innovation and cutting-edge technology in plastic surgery, integration of blockchain technologies within plastic surgery is in its infancy. Recent advances and mainstream adoption of blockchain are gaining momentum and have shown significant promise for improving patient care and information management. In this article, the authors explain what defines a blockchain and discuss its history and potential applications in plastic surgery. Existing evidence suggests that blockchain can enable patient-centered data management, improve privacy, and provide additional safeguards against human error. Integration of blockchain technology into clinical practice requires further research and development to demonstrate its safety and efficacy for patients and providers.

SUMMARY: Plastic surgery offices are subject to a wide variety of cybersecurity threats, including ransomware attacks that encrypt the plastic surgeon's information and make it unusable, as well as data theft and disclosure attacks that threaten to disclose confidential patient information. Cloud-based office systems increase the attack surface and do not mitigate the effects of breaches that can result in theft of credentials. Although employee education is often recommended to avoid the threats, a single error by a single employee has often led to security breaches, and it is unreasonable to expect that no employee will ever make an error. Recognition of the 2 most common vectors of these breaches-compromised email attachments and surfing to compromised websites-allows the use of technical networking tools to prevent both email attachments from being received and employee use of unsanctioned and potentially compromised websites. Furthermore, once compromised code has been allowed to run within the office network, that code must necessarily make outbound connections to exploit the breach. Preventing that outbound traffic can mitigate the effects of a breach. However, most small office network consultants design firewalls to only limit incoming network traffic and fail to implement technical measures to stop the unauthorized outbound traffic that is necessary for most network attacks. The authors provide detailed techniques that can be used to direct information technology consultants to properly limit outbound network traffic as well as incoming email attachments.

BACKGROUND: Direct-acting oral anticoagulants (DOACs) have become the preferred drugs for managing venous thromboembolism (VTE). Despite their advantages over vitamin K antagonists such as warfarin, their use in obese patients remains controversial with many providers reluctant to switch patients managed on warfarin. Outcome research that opts to increase provider confidence when prescribing DOACs for patients with obesity will be invaluable. OBJECTIVE: or greater who were prescribed a DOAC had a higher risk for a recurrent VTE or bleed event relative to warfarin. METHODS: The study was conducted in West Virginia which has the highest rate of obesity in the United States. RESULTS: Of the total study population (1633), 2.3% (37) had a recurrent thrombotic event, 5.5% (89) had a major bleed event, and 10.7% (174) had some type of bleeding event. No individual patient characteristic was associated with recurrent thrombosis-including BMI. Older age, antiplatelet use, and taking a medication with a theoretical risk of increasing the effect of DOACs were associated with any and major bleeding events. The use of warfarin was associated with major bleeding events more frequently versus a DOAC. Body mass index was not a predictor for recurrent VTE or any bleed or major bleed events. CONCLUSIONS: These findings support the conclusion that DOACs are an appropriate and effective drug class for the management of VTE in patients with obesity.

In preparing to investigate the influence of lower temperatures (below 68°F) on rate of fermentation, it was necessary in the absence of available data to first determine the effects of specific materials and conditions. At 68°F, white cuvées attained near-maximum CO₂ within 16 days, as compared to 38 days for red cuvées. Yeast food and tannin did not influence the rate or volume of CO₂ produced. Different vaults at the same temperature and different cuvées in the same vault, produced similar fermentations. A laboratory experiment at the higher fermentation temperatures of 68-78°F indicates no difference in fermentation time, or amount of CO₂ formed. It is suggested that light transmission readings may be used as a measure of yeast growth.

Time of fermentation of tierage wine is proportional to the drop in temperature at the time of yeast inoculation to the consequent, fermentation temperature. Yeast cultures composed of multiple strains require longer fermentation periods than those of lesser number. At temperatures below 60°F, time of fermentation becomes greater, and is more significant as temperature is lowered. When SO₂ is added in amounts of 20 ppm or less, the effect on fermentation is slight. At 40 ppm the effect becomes quite measurable, with a 7-day prolongation of fermentation time. Wet compressed yeast offers many advantages over traditional culture. In use, propagation or preparation systems may be simple, or entirely eliminated, with considerable savings in time and control program. A vigorous end fermentation is secured, this being essential for cold fermentations below 60°F.

SUMMARY: A biosensor uses a biological molecule to measure a chemical reaction. Wearable biosensors that attach to the body externally, including tooth enamel biosensors, contact lens biosensors, sweat biosensors, and skin tattoo biosensors, are in development. Nanoparticle-based biosensors are being developed to allow for the early detection of cancerous biomarkers. Applications relevant to plastic surgery include the development of biosensors that can detect metastatic breast cancer cells, bioimpedance spectroscopy, and intraoperative point-of-care diagnostics.

Long-term dementia care is often shaped by fragmented documentation practices that fail to capture the relational and evolving nature of caregiving. We present CareInsights, an AI-enabled infrastructure that supports caregivers by passively capturing interaction data, enriching it with contextual and clinical signals, and generating narrative-based feedback to support day-to-day person-centered care. Our system was developed through a two-year collaboration with seven long-term care facilities and integrated into existing electronic health record systems and memory therapy platforms to minimize disruption and streamline uptake. We evaluated CareInsights through a combination of system performance analysis, content assessments, caregiver surveys, and interviews. Our model demonstrated expert-level performance, and caregivers reported outcomes consistent with more effective person-centered dementia care. Adoption was supported by integration into existing staff workflows and design choices that mirrored caregiver reasoning. We conclude with design implications for “narrative AI infrastructure,” offering guidance for scaling person-centered, AI-enabled support in real-world care environments.

A valve lifting device is described which causes the valve to hang perfectly vertical for ease of removal or installation and to swivel easily on a hoisting sling for alignment. The device can be easily handled and hooked up by one person using one hand, which leaves the other handle free to signal the operator of the hoisting equipment. Method of construction and cost are detailed.

Breast cancer is one of the most prevalent and deadly cancers affecting women globally. It is characterized by the uncontrolled proliferation of epithelial cells originating in the ducts of breast tissue. It is one of the leading causes of death in women. Despite advances and continued development in conventional treatment options, like chemotherapy and endocrine therapy, drug resistance and recurrence remain longstanding obstacles. Therefore, CRISPR-Cas9 emerges as a promising treatment due to its high precision and effectiveness. This study reviews the mechanism by which CRISPR- Cas9 functions to correct and remove parts of the human genome. It also examines how CRISPR-Cas9 combats drug resistance: the major challenge in breast cancer treatment. The review highlights challenges in the applications of CRISPR-Cas9, focusing on off-target effects and ethical concerns. The review also addresses the future research areas for the further development of CRISPR-Cas9 including combating problems with off-target effects, delivery systems, and pre-existing immunity. Ultimately, while CRISPR-Cas9 has great potential in breast cancer treatment, there are still future steps needed to be taken to ensure a better prognosis for patients.