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Becker DB. Aligning Incentives for Surgical Innovation: Review of the Literature and Best Practices. Plast Surg (Oakv) 2023. [DOI: 10.1177/22925503221151186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Background: Innovation in the clinical surgical space is often generated by the insight and ideas of practicing surgeons whose ideas solve direct and relevant clinical problems with both novel products and reimagined processes. Despite some successes in both product and process development, innovation in the practicing surgical space does not occur with the frequency one might expect and does not consistently result in adoption of profitable or health-improving new products or processes. One barrier to successful innovation is the misalignment of incentives for early-stage innovation in the clinical surgical enterprise. This project was undertaken to determine best innovation practices for clinical Divisions and Departments. Methods: Best practices for innovation in industry were determined by company-specific examples, as well as literature review in the business and medical literature. Concepts were then integrated to determine a viable model that aligns incentives to encourage early-stage innovation. Proposal: The centralized Moderated Innovation Database (MID) of early-stage exploratory ideas integrates best practices of innovation in a low-cost, sustainable model. The MID must be executed in 3 phases to ensure viability in implementation. This model is likely to encourage innovation by both improving stakeholder satisfaction with and engagement in the process, and by increasing capture of early-stage innovation. Conclusion: Infrastructure for early-stage ideas will help align incentives for early-stage innovation, and the MID is consistent with best practices for innovation.
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Affiliation(s)
- Devra B. Becker
- Division of Plastic Surgery, University of Tennessee Health Sciences Center, Memphis, TN, USA
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Williams BA, Ibinson JW, Cellurale M, Nalepka T, Becker DB. Same-Day and Next-Day Pain and Nausea Parameters after Intrathecal Morphine for Abdominal Panniculectomy and Mastectomy Post-Bariatric Surgery. Pain Med 2021; 22:3114-3116. [PMID: 34015119 DOI: 10.1093/pm/pnab171] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Brian A Williams
- Professor of Anesthesiology and Perioperative Medicine, University of Pittsburgh and VA Pittsburgh Healthcare System
| | - James W Ibinson
- Assistant Professor of Anesthesiology and Perioperative Medicine, University of Pittsburgh and VA Pittsburgh Healthcare System
| | | | | | - Devra B Becker
- Associate Professor of Plastic Surgery, University of Pittsburgh and VA Pittsburgh Healthcare System
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Becker DB. The Paisley Pattern Breast Reduction. Plast Surg (Oakv) 2019; 27:189-194. [PMID: 31106179 DOI: 10.1177/2292550319828797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Skin resection patterns inform the shape and scars after breast reduction. The 2 most commonly performed skin resection patterns, the Wise pattern and vertical pattern, each have limitations. The most common challenge is addressing excess lateral skin while avoiding medial scars. The Paisley Pattern breast reduction addresses this by incorporating lateral dogear excision in the skin resection design. Methods Thirty consecutive patients received a Paisley Pattern breast reduction. After institutional review board approval, a chart review was performed to evaluate resection weight, operative time, American Society of Anesthesiologists class, flap necrosis, and seroma. Results Operative times were comparable to published times for the Wise and vertical pattern techniques. No patients had lateral flap necrosis, and no patients required a return to the operating room during the follow-up period. One patient developed a unilateral seroma that was drained by interventional radiology. Conclusions This report of a novel skin resection design demonstrates a proof of concept that the skin resection pattern can be performed safely in a wide variety of patients. Although there is a learning curve to the technique to prevent over-resection laterally, it provides efficient and aesthetically acceptable alternative to the Wise and vertical skin resection patterns for both large and small reductions.
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Wu-Fienberg Y, Henzel MK, Richmond MA, Becker DB. Impact of interdisciplinary rounds in the spinal cord injury unit on relational coordination for patients with pressure injury: A pilot study. J Spinal Cord Med 2019; 42:245-250. [PMID: 29509096 PMCID: PMC6419645 DOI: 10.1080/10790268.2018.1443418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
CONTEXT/OBJECTIVE Multiple medical specialties are often involved in the management of patients with both spinal cord injuries (SCI) and pressure injuries (PIs), sometimes leading to inadequate communication. Our Veterans Affairs (VA) hospital has an interdisciplinary team for PI patients in the SCI unit. This team conducts monthly bedside rounds and journal clubs; there is no similar team for patients with PIs outside the SCI unit. This pilot study aims to determine whether such an interdisciplinary team improves care coordination among practitioners. DESIGN Survey-based study. SETTING VA hospital. PARTICIPANTS Healthcare providers who participate in interdisciplinary SCI rounds and who also care for patients with PIs outside the SCI unit. INTERVENTIONS Interdisciplinary rounds, including monthly bedside rounds and journal clubs with variety of specialists take place within the SCI unit. There are no similar interdisciplinary rounds for patients with PIs outside of the SCI unit. OUTCOME MEASURES The Relational Coordination (RC) survey is a validated tool for gauging team performance. Survey results quantified relational dynamics inside and outside the SCI unit across four communication domains (frequent communication, timely communication, accurate communication, and problem-solving communication) and three relationship domains (shared knowledge, mutual respect, and shared goals). RESULTS Interdisciplinary rounds in the SCI unit was associated with significantly better RC with hospitalists, surgical specialists, infectious diseases, nursing, and pharmacy. This effect was primarily due to improvements in communication domains, without significant difference in relationship domains. CONCLUSIONS Interdisciplinary rounds in the SCI unit significantly improves RC in the care of PI patients.
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Affiliation(s)
- Yuewei Wu-Fienberg
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, USA
| | - Mary K. Henzel
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, USA
| | - Mary Ann Richmond
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, USA
| | - Devra B. Becker
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, USA,Correspondence to: Devra B. Becker, MD, Louis Stokes Cleveland Veterans Affairs Medical Center, 10701 East Boulevard Cleveland, OH44106, USA; Ph: 216-791-3800.
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Sun HH, Pourtaheri N, Janis JE, Becker DB. Do Academic Health Care Systems Really Value Education? A Survey of Academic Plastic Surgeons. Plast Reconstr Surg Glob Open 2018; 6:e1948. [PMID: 30534496 PMCID: PMC6250485 DOI: 10.1097/gox.0000000000001948] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 07/27/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although education is critical to the mission of academic medical centers in the United States, it is often not quantified and monetized as are their research and clinical missions. We undertook this survey to assess the perceived valuation of educational endeavors of plastic surgeon faculty at the U.S. academic medical centers. METHODS A survey using Qualtrics software (Qualtrics, Provo, UT) was distributed to faculty members of the American Council of Academic Plastic Surgeons by electronic mail in February 2015. A total of 16 questions included both demographic information and Likert-item questions of perception of valuation of educational activities. For analysis, responses were grouped according to an adapted Net Promoter Score including "unsupportive" (0-6), "neutral" (7-8), and "supportive" (9-10). RESULTS Sixty-five surveys were completed out of a total of 406, with an overall response rate of 16%. Kruskal-Wallis statistical analysis demonstrated that region and rank were not significant in perception of hospital or departmental support for educational activities. Respondents rated their departments as more supportive than their institutions (P < 0.05), and average perceived value rating of institutions was "unsupportive." Financial support was associated with higher ratings with respect to support of institutions and departments. Mid-career faculty displayed a trend toward lower ratings of perception of support. CONCLUSIONS The majority of respondents perceived their institutions and departments as unsupportive of educational effort. Direct compensation to physicians for teaching efforts may improve faculty retention in academia and reduce physician burnout.
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Affiliation(s)
- Helen H. Sun
- From the Case Western Reserve University School of Medicine, Department of Plastic Surgery, Cleveland, Ohio
| | - Navid Pourtaheri
- Department of Plastic Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Jeffrey E. Janis
- Department of Plastic Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Devra B. Becker
- From the Case Western Reserve University School of Medicine, Department of Plastic Surgery, Cleveland, Ohio
- Department of Plastic Surgery, University of Pittsburgh Medical Center; Pittsburgh, Pa
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Ko JS, Zwiebel S, Wilson B, Becker DB. Perioperative antibiotic use in diabetic patients: A retrospective review of 670 surgeries. J Plast Reconstr Aesthet Surg 2017; 70:1629-1634. [DOI: 10.1016/j.bjps.2017.06.042] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Revised: 06/01/2017] [Accepted: 06/25/2017] [Indexed: 11/16/2022]
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Becker DB, Lee F, Hill S, Nissen R, Huebener D, Scheve S, Gordon S, Kane AA. A survey of cleft team patient experience in obtaining dental care. Cleft Palate Craniofac J 2009; 46:444-7. [PMID: 19642764 DOI: 10.1597/07-187.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To assess patient experiences in obtaining dental care in a team setting without an affiliated dental school. DESIGN AND PARTICIPANTS Three hundred seventy-four patients in the cleft team database met inclusion criteria of diagnosis of cleft lip and/or palate, and current age of 7 to 12 years. Demographic information and experiences in obtaining dental care were ascertained using a standardized series of questions. A callback protocol was employed to maximize response rate. Results were analyzed with t-tests using contingency tables. OUTCOME MEASURES AND RESULTS One hundred seventy-one parents/caregivers were interviewed of a possible 374 (response rate 45.7%). Mean age was 9.87 years. The insurance distribution was as follows: 113 private insurance (66.1%), 35 Medicaid (20.5%), and 23 had no insurance (13.5%). The dental checkup distribution was as follows: 145 regular dental checkups (84.8%) and 26 no regular checkups (15.2%). Patients with private insurance were more likely to obtain dental care than were patients with Medicaid (p = .002) or patients without insurance (p = .0027). Patients with Medicaid were more likely to report provider refusal of care than were patients with private insurance (p = .0001) or patients without insurance (p = .0001). Patients with private insurance were more likely to report satisfaction with their dental care than were patients with Medicaid (p = .0003). CONCLUSIONS We report an 84.8% regular checkup rate among our study population and a significantly different reported experience in obtaining care depending on insurance type. The reasons underlying the differences between privately insured patients and Medicaid patients appear multifactorial.
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Affiliation(s)
- Devra B Becker
- Washington University School of Medicine, St. Louis, Missouri 63110, USA
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Abstract
This study evaluates the neurologic profiles of infants with deformational plagiocephaly. Forty-nine infants with deformational plagiocephaly between the ages of 4 and 13 months (mean age, 8.1 months) are evaluated, along with 50 age-matched control subjects (mean age, 8.1 months). A modified version of the Hammersmith infant neurologic assessment was performed on each infant. A caregiver completed a questionnaire regarding the infant's prematurity, development, and health to date. Results are analyzed using t test. There is a statistically significant difference in overall neurologic assessment scores of infants with deformational plagiocephaly vs their healthy peers (P = .002). This difference is predominately in tone, whereby infants with deformational plagiocephaly have significantly more abnormal tone than nonplagiocephalic infants (P = .003). This abnormality is not one of decreased tone but one of variable tone, deflecting abnormally high and low tone. Infants with deformational plagiocephaly are more likely to have altered tone but not exclusively decreased tone.
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Affiliation(s)
- Elizabeth A Fowler
- Cleft Palate and Craniofacial Institute, Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Missouri, USA
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Seidenstricker-Kink LM, Becker DB, Govier DP, DeLeon VB, Lo LJ, Kane AA. Comparative osseous and soft tissue morphology following cleft lip repair. Cleft Palate Craniofac J 2008; 45:511-7. [PMID: 18788869 DOI: 10.1597/07-001.1] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To quantify comparative improvement between osseous and soft tissue asymmetry following primary lip repair. DESIGN Retrospective analysis of preoperative and postoperative computed tomography scans of infants with unilateral cleft lip and palate. Sixteen soft tissue landmarks were placed using an exploratory two-/three-dimensional image processing system and compared for asymmetry. PATIENTS Computed tomography scans were obtained on 26 patients (13 boys, 13 girls) of Chinese ethnicity (mean age = 0.25 years) prior to Millard lip repair. Nineteen of these contributed to follow-up comparative studies prior to palatoplasty at a mean age of 0.92 years. There were 18 left-sided and eight right-sided clefts. MAIN OUTCOME MEASURE Euclidean distance matrix asymmetry analysis was used to determine the amount of soft tissue asymmetry pre- and postlip repair. Similar analyses of the same scans were performed for 41 osseous landmarks. RESULTS Soft tissue landmarks had 36/39 (92%) preoperative and 13/39 (33%) postoperative asymmetric pairs. Osseous distances demonstrated 77/125 (61%) asymmetric pairs preoperatively and 60/125 (48%) postoperatively. Soft tissue and osseous distances of the lip region demonstrated 32% and 39% postoperative asymmetry, respectively. Soft tissue and osseous distances of the nasal region demonstrated 52% and 72% postoperative asymmetry, respectively. Soft tissue and osseous distances of the facial landmarks demonstrated 24% and 34% postoperative asymmetry, respectively. CONCLUSIONS Primary lip repair appears to effect gains in symmetry in soft tissue and provides sufficient molding forces to cause correlating symmetry changes in underlying osseous structures.
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Kane AA, DeLeon VB, Valeri C, Becker DB, Richtsmeier JT, Lo LJ. Preoperative osseous dysmorphology in unilateral complete cleft lip and palate: a quantitative analysis of computed tomography data. Plast Reconstr Surg 2007; 119:1295-1301. [PMID: 17496604 DOI: 10.1097/01.prs.0000258519.88178.c4] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The purpose of this study was to quantitate preoperative osseous dysmorphology in a homogeneous group of 3-month-old infants with unilateral complete cleft lip and palate. METHODS High-resolution computed tomography scans of 28 infants with unilateral complete cleft lip and palate were the basis for study. Coordinate data from 43 landmarks on the skull were collected using surface-rendered reconstructions of scan data. Euclidean distance matrix analysis was used to assess the degree of asymmetry between the cleft and noncleft sides of the craniofacial skeleton. RESULTS Linear distances involving primary and secondary landmarks (those that are located on or within the bony cleft and those that are near the cleft in the adjacent oronasal area, respectively) were highly asymmetric, with significantly greater distances on the cleft side. In addition, small (1 to 5 percent) but statistically significant asymmetries in linear distances were found involving tertiary landmarks (those that are not directly associated with the cleft or adjacent oronasal area). Most linear distances involving the nasion, zygomaxillare superius, and frontozygomatic junction were significantly greater on the cleft side, and certain linear distances in and around the middle cranial fossa were significantly smaller on the cleft side. CONCLUSIONS The extreme asymmetry of primary and secondary landmarks is explained by the cleft itself and the obvious displacement of the premaxilla toward the noncleft side. The subtler, statistically significant asymmetry of the tertiary landmarks supports the idea that the unilateral cleft affects development of the entire face and possibly the cranial base. Euclidean distance matrix analysis of computed tomography landmark data is a useful methodology for the quantitative morphometry of children with untreated unilateral cleft lip and palate.
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Affiliation(s)
- Alex A Kane
- St. Louis, Mo.; Baltimore, Md.; University Park, Pa.; and Taipei, Taiwan, R.O.C. From the Washington University School of Medicine; Johns Hopkins University School of Medicine; Pennsylvania State University; and Chang Gung Memorial Hospital
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Becker DB, Kane AA. Craniosynostosis: A review for the non-surgeon. Mo Med 2006; 103:260-4. [PMID: 16910434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Affiliation(s)
- Devra B Becker
- Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, USA
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Becker DB, Fundakowski CE, Govier DP, Deleon VB, Marsh JL, Kane AA. Long-Term Osseous Morphologic Outcome of Surgically Treated Unilateral Coronal Craniosynostosis. Plast Reconstr Surg 2006; 117:929-35. [PMID: 16525287 DOI: 10.1097/01.prs.0000200613.06035.51] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Unilateral coronal craniosynostosis has characteristic osseous dysmorphology that persists into adulthood if untreated. Knowledge of the long-term in vivo osseous morphologic outcome of surgically treated unilateral coronal craniosynostosis patients is limited. The purpose of this study was to define the osseous morphology of adolescent patients who underwent surgery for unilateral coronal craniosynostosis in infancy, compared with both their 1-year postoperative morphology and the morphology of other individuals with untreated unilateral coronal craniosynostosis. METHODS Three populations of unilateral coronal craniosynostosis were studied: group 1, patients with surgical treatment of unilateral coronal craniosynostosis in infancy who had reached dentoskeletal maturity, ranging in age from 13.5 to 32.7 years (n= 9); group 2, individuals with untreated unilateral coronal craniosynostosis, ranging in age from 1.1 to 21 years (n= 11); and group 3, a subset of group 1 patients 1 year after surgical correction of unilateral coronal craniosynostosis, ranging in age from 1.2 to 2.6 years (n= 6). Data from high-resolution, thin-slice computed tomographic scans of the head were analyzed. Thirty-five reproducible osseous landmarks were recorded as three-dimensional coordinates using ETDIPS imaging software. Nonmidline landmarks were designated as either ipsilateral or contralateral to the synostosis. One researcher performed all landmarking with high intrarater reliability (average error, <2 mm). Data from the three groups were analyzed for asymmetry using Euclidean distance matrix analysis techniques. RESULTS Euclidean distance matrix analysis asymmetry analysis demonstrated more statistically significant ipsilateral-contralateral asymmetric pairs in group 1 (68 of 135) than in group 3 (25 of 135), but fewer statistically significant ipsilateral-contralateral asymmetric pairs than in group 2 (93 of 135). CONCLUSIONS Surgical treatment of unilateral coronal craniosynostosis in infancy results in a less asymmetric craniofacial skeleton in adolescence than nontreatment. However, patients who have been followed to dentoskeletal maturity have a greater degree of asymmetry than those evaluated at 1 year postoperatively. These results support the conclusion that with time there is a partial reversion to the untreated phenotype.
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Affiliation(s)
- Devra B Becker
- Cleft Palate and Craniofacial Deformities Institute, St. Louis Children's Hospital, Washington University Medical Center, St. Louis, MO, USA
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Abstract
BACKGROUND The neuropsychological morbidity of nonsyndromic craniosynostosis is incompletely understood. The purpose of this study was to establish the prevalence of speech-language, cognitive, and behavioral abnormalities in this population and to stratify the findings on the basis of the affected suture and age of diagnosis with speech-language or psychological abnormalities. METHODS Charts of all patients with nonsyndromic craniosynostosis evaluated between 1978 and 2000 were reviewed, noting diagnoses of speech-language, cognitive, or behavioral abnormalities. Findings were statistically analyzed for variance with regard to affected suture and diagnosis of abnormalities. RESULTS Two hundred fourteen patients with nonsyndromic craniosynostosis had documented follow-up evaluations with an average age of 6 years 4 months at last visit. Speech, cognitive, and/or behavioral abnormalities were manifest in 49 percent of the patients with specific rates for each suture as follows: right unilateral coronal, 61 percent; bilateral coronal, 55 percent; multiple, 47 percent; metopic, 57 percent; left unilateral coronal, 52 percent; lambdoid, 44 percent; and sagittal, 39 percent. This prevalence of abnormalities was a statistically significant increase from the general population. Logistic regression demonstrated that as patient age increased, the percentage of abnormal diagnoses also increased. CONCLUSIONS Nonsyndromic craniosynostosis is often associated with cognitive, speech, and/or behavioral abnormalities. The etiopathology of this association is unknown. Furthermore, the proportion of children diagnosed with cognitive and behavioral dysfunction increases with age. Therefore, longitudinal cognitive, behavioral, and speech assessment and treatment are integral to the care of these patients.
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Affiliation(s)
- Devra B Becker
- The Cleft Palate and Craniofacial Deformities Institute, Department of Pediatric Psychology, St. Louis Children's Hospital, St. Louis, MO, USA
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Bönner FA, Weber S, Karg A, Schreiber WG, Munzel T, Horstick G, Becker DB. Delayed enhancement korreliert mit Narbenbildung in der Histologie 4 Wochen nach Myokardinfarkt (MI): Messung am infarzierten Rattenherz in vivo mit einem 1,5 Tesla-Ganzkörper-Tomographen. ROFO-FORTSCHR RONTG 2006. [DOI: 10.1055/s-2006-941079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Abstract
The etiopathology of the clinical entity normally referred to as unilateral coronal synostosis is commonly used to connote unilateral fusion of the frontoparietal suture. However, other sutures in the coronal ring may exhibit synostosis concomitant with or independent from frontoparietal synostosis and give rise to similar clinical phenotypes. This study retrospectively analyzes high-resolution computed tomographic data sets to determine patency of sutures within the coronal ring. Computed tomographic scan digital data from 33 infants who subsequently underwent surgical correction of unilateral coronal synostosis were assessed for sutural patency using Analyze imaging software. The frontosphenoidal suture was subdivided into intraorbital frontosphenoidal and extraorbital frontosphenoidal portions, and the patency of the frontoethmoidal suture was also assessed. Patients were sorted into two groups on the basis of the status of their frontosphenoidal sutures: group 1 had patent frontosphenoidal but synostotic frontoparietal sutures (n = 21) and group 2 had both frontosphenoidal and frontoparietal synostoses. Observer reproducibility was tested. The vertical and horizontal dimensions of the bony orbit and the endocranial base deflection angle were measured with the observer blinded with regard to sutural status group. Frontoethmoidal synostosis was not noted in any patients in either group. Two patients had no frontoparietal suture synostosis with isolated intraorbital frontosphenoidal and extraorbital frontosphenoidal suture closures. Suture diagnosis reproducibility was 99 percent. In group 1, the ipsilateral-to-contralateral vertical orbit dimension ratio averaged 1.11, whereas in group 2 it averaged 1.04 (p < 0.05). The ratio of horizontal orbit measurements was not significantly different between groups. In both groups, the endocranial base was deflected ipsilateral to the synostotic frontoparietal suture, with an average angle of 12 degrees in group 1 and 17 degrees in group 2 (p < 0.005). The extent of synostosis along the coronal sutural ring contributes to the dysmorphology of the orbit and the endocranial base deflection in patients whose clinical phenotypic diagnosis is unilateral coronal synostosis.
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Affiliation(s)
- Jason A Dundulis
- Washington University School of Medicine, St. Louis Children's Hospital, and Cleft Lip/Palate and Craniofacial Deformities Center, Mo. 63110, USA
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Becker DB, Pilgram T, Marty-Grames L, Govier DP, Marsh JL, Kane AA. Accuracy in identification of patients with 22q11.2 deletion by likely care providers using facial photographs. Plast Reconstr Surg 2005; 114:1367-72. [PMID: 15509921 DOI: 10.1097/01.prs.0000138591.20999.f1] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Numerous facial characteristics are associated with velocardiofacial syndrome. Care providers may use these facial characteristics to identify patients who may benefit from fluorescence in situ hybridization genetic testing to determine the presence of the 22q11.2 deletion. The purpose of this study was to test the hypothesis that experienced care providers were able to correctly diagnose the 22q11.2 deletion on the basis of studying frontal facial photographs. After approval was obtained from the human studies committee, patients who had undergone fluorescence in situ hybridization genetics testing for the presence of a 22q11.2 deletion were asked to submit two frontal photographs: one at infancy and one beyond the second birthday. These photographs were randomized, made anonymous, and then placed on a secure Web site. Specialists in the fields of plastic surgery, otolaryngology, genetics, and speech pathology were asked to evaluate their experience and confidence levels in diagnosing a 22q11.2 deletion and were then asked to rate the photographs by likelihood of deletion using a five-point Likert scale. Thirty-two specialists (10 surgeons, nine geneticists, and 13 speech pathologists) participated in the study. On the basis of clear responses, respondents predicted the presence (sensitivity) and absence (specificity) of the 22q11.2 deletion at chance levels. Of the remaining responses, 20 to 25 percent were unsure and 20 to 25 percent were clearly wrong. When an unsure response was treated as a weak positive, the results favored sensitivity slightly, with a sensitivity of 70 percent and a specificity of 50 percent. Sensitivity improved somewhat with experience, as measured by the number of patients seen per year. The prediction of the presence or absence of the 22q11.2 deletion at chance levels suggests that the ability to diagnose on the basis of appearance alone is not a sufficient diagnostic tool. Although the ability does increase with experience, it is of statistical but not clinical significance.
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Affiliation(s)
- Devra B Becker
- Kids Plastic Surgery and the Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, Mo 63110, USA
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Abstract
Divisions of the parietal bone are extraordinarily rare, and have been described previously only in skull specimens in the anatomical literature. We report a case of os parietale divisum (divided parietal bone) in an infant with plagiocephaly. A 36-weeks gestation male with multiple congenital anomalies presented to the deformational plagiocephaly clinic at 11 weeks of age. CT imaging demonstrated a suture dividing the left parietal bone into two segments. He had a plagiocephalic appearance, with the greater occipital and parietal protuberances ipsilateral to the abnormal left parietal suture, and a correspondingly flatter right occiput. Head circumference was in the normal range, and the anterior fontanelle was patent and of normal size. He had mild right-sided right frontal and malar protuberance. Mandibular asymmetry was noted with a chin-point to the right of midline. He had a left-sided head tilt. He was treated with cranial molding helmet therapy for his head shape and physical therapy for his head tilt. After 16 months of helmet therapy, he had little improvement of his head shape. This case is an in vivo presentation of a rare variant, os parietale divisum.
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Affiliation(s)
- Devra B Becker
- Cleft Palate and Craniofacial Deformities Institute, St. Louis Children's Hospital, Washington University Medical Center, St. Louis, MO 63110, USA
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Abstract
The timing of surgery for velopharyngeal dysfunction has been based on assumptions about the relation between age, speech development, and velopharyngeal dysfunction. Cleft palate teams often counsel parents to have an intervention for velopharyngeal dysfunction performed earlier rather than later, believing that earlier interventions result in more rapid or better normalization of speech. The objective of this retrospective chart review study is to determine whether the age at surgical intervention for velopharyngeal dysfunction has an effect on the subsequent length of speech therapy. Of 174 patients included in the study database, 36 had velopharyngeal dysfunction for which further velopharyngeal management was required. Of the 36 patients who received surgical velopharyngeal dysfunction management, 27 had verifiable speech therapy records. These 27 patients represent the study population. The outcome measure was the total length of subsequent speech therapy until speech normalization. The data suggest that there is no relation between the age at velopharyngeal dysfunction surgical management and the amount of speech therapy needed to achieve normalization of the speech impairments secondary to velopharyngeal dysfunction after that management. In conclusion, 1) the age at surgical velopharyngeal dysfunction management (pharyngeal flap or sphincter pharyngoplasty) does not have an effect on subsequent normalization of speech as measured by the duration of speech therapy necessary to achieve normalization of the speech impairments secondary to velopharyngeal dysfunction after that management, and 2) the age at surgical velopharyngeal dysfunction management does not affect the likelihood of subsequent surgical velopharyngeal dysfunction management procedures.
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Affiliation(s)
- Devra B Becker
- Cleft Palate and Craniofacial Deformities Institute, St. Louis Children's Hospital, Washington University Medical Center, St. Louis, Missouri 63141, USA.
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Affiliation(s)
- J Dayne Petersen
- Washington University School of Medicine, St. Louis Children's Hospital, MO 63110, USA
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Becker N, Becker DB. The golden rule of dentistry. J Mass Dent Soc 2001; 50:6. [PMID: 11494468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
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Becker N, Becker DB. Smoking cessation can begin in the dental office. J Mass Dent Soc 2001; 50:6. [PMID: 11326712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Affiliation(s)
- N Becker
- Boston University Goldman School of Dental Medicine, USA
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Glicksman M, Becker DB. Dental water line safety. What the dental practitioner should know. J Mass Dent Soc 2001; 49:12-4. [PMID: 11324037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
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Abstract
The neuroregenerative properties of FK506, an FKBP-12 ligand that inhibits calcineurin, and V-10,367, an FKBP-12 ligand that does not inhibit calcineurin, were evaluated in crush and transection models. Rats were randomly assigned to one of seven groups, including untreated controls and FK506- or V-10,367-treated experimental groups. Following crush or transection nerve injury, animals were assessed with walking tracks, and histomorphometry. FK506-treated animals demonstrated significant functional recovery 11 days following crush and 18 days following transection injury. In untreated and V-10,367 treated animals, nerves recovered 13 days following crush injury, but did not improve significantly prior to sacrifice at 28 days in animals sustaining a transection injury. No statistically significant differences in histomorphometric parameters were identified between any of the groups. The study confirms that FK506 accelerates recovery from tibial nerve injury.
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Affiliation(s)
- D B Becker
- Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, Missouri 63110, USA
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Becker DB. The dentist's role in treating child abuse. J Mass Dent Soc 1993; 42:33-34. [PMID: 8151214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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Abstract
Orofacial trauma was found in 49% of 260 documented cases of child abuse seen during of five-year period at the Children's Hospital Medical Center, Boston. An additional 16% of the cases involved head trauma; the total percentage of head and facial trauma was 65%. Head or facial trauma was the principal reason for admission to the hospital in 45% of the cases. A survey of 537 dentists in Massachusetts showed that the majority were unaware of their legal and social responsibilities to report suspected cases of child abuse. Eleven percent of all dentists surveyed saw orofacial trauma cases that were of a suspicious nature, by only 22 confirmed cases of child abuse were noted by the dentists. Of these, only four were reported to social agencies. In general, oral surgeons and pedodontists saw a higher percentage of these cases and were more aware of their responsibilities than were general practitioners.
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Becker N, Becker DB. Magic makes patients' anxieties disappear. Dent Stud 1978; 56:54-6. [PMID: 381051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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