Annals of plastic surgery
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Annals of plastic surgery · Jun 2015
Patient perception of postoperative pain after administration of liposomal bupivacaine in plastic surgery.
Since obtaining FDA approval for postsurgical pain management in 2011, a number of well-designed studies have reported favorably on the safety and efficacy of liposomal bupivacaine (LB). However, the literature lacks adequate reports of patient perception of postoperative pain and subjective satisfaction. ⋯ Patient perception of efficacy after the injection of LB correlates with previous clinical findings. Our experience with LB injections for cosmetic and reconstructive breast procedures indicates that patients experienced low postoperative pain scores with high overall patient satisfaction. Additional studies comparing the use of LB to standard narcotic regimens and its use in multimodality pain management are warranted.
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Annals of plastic surgery · Jun 2015
Increasing value in plagiocephaly care: a time-driven activity-based costing pilot study.
Process management within a health care setting is poorly understood and often leads to an incomplete understanding of the true costs of patient care. Using time-driven activity-based costing methods, we evaluated the high-volume, low-complexity diagnosis of plagiocephaly to increase value within our clinic. ⋯ This pilot study effectively demonstrates the novel use of time-driven activity-based costing in combination with the value equation as a metric for continuous process improvement programs within the health care setting.
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Annals of plastic surgery · Jun 2015
ReviewNerve Transfers in the Upper Extremity: A Practical User's Guide.
Nerve injuries above the elbow are associated with a poor prognosis, even with prompt repair and appropriate rehabilitation. The past 2 decades have seen the development of numerous nerve transfer techniques, by which a denervated peripheral target is reinnervated by a healthy donor nerve. Nerve transfers are indicated in proximal brachial plexus injuries where grafting is not possible or in proximal injuries of peripheral nerves with long reinnervation distances. ⋯ For ulnar intrinsic function, the distal anterior interosseous nerve to ulnar motor branch transfer has yielded excellent functional results. Nerve transfers form a therapeutic triad with traditional tendon transfers and functional motor unit rehabilitation which, when applied appropriately, can yield excellent functional results in complex nerve injuries. Nerve transfers are a powerful yet underused tool for proximal nerve injuries, which offer hope for traditionally discouraging injuries.
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Annals of plastic surgery · Jun 2015
Clinical TrialPatient access in plastic surgery: an operational and financial analysis of service-based interventions to improve ambulatory throughput in an academic surgery practice.
Inefficient patient throughput in a surgery practice can result in extended new patient backlogs, excessively long cycle times in the outpatient clinics, poor patient satisfaction, decreased physician productivity, and loss of potential revenue. This project assesses the efficacy of multiple throughput interventions in an academic, plastic surgery practice at a public university. ⋯ Implementation of a PAcE initiative, focusing on outpatient clinic throughput, yields significant improvements in access to care, patient satisfaction as measured by complaints, physician productivity, and financial performance. An academic, university-based, plastic surgery practice can use throughput interventions to deliver timely care and to enhance financial viability.
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Annals of plastic surgery · Jun 2015
Randomized Controlled TrialEvaluation of 2 novel devices for calculation of fluid requirements in pediatric burns.
The Parkland formula for maintenance and resuscitation fluid requirements in the first 24 hours after pediatric burns is widely used, but calculation errors frequently occur. Two different novel aids to calculation, a dedicated electronic device and a mechanical disc calculator, are described and compared with the conventional method of calculation (pen and paper, assisted by a general purpose calculator). ⋯ Both novel devices provide safer and faster alternatives to conventional methods for calculation of fluid requirements in pediatric burns.