Rizwan Siwani

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Mehmet Akif KILIC

Sağlık Bilimleri Üniversitesi

Eric Meyer

Lawrence Technological University

Bijan Khademi

Shiraz University Of Medical Sciences

José Ercolino

Universidad Central de Venezuela

Sampath Chandra Prasad Rao

Manipal Academy of Higher Education

Ales Stuchlik

Academy of Sciences of the Czech Republic

Gary Sibbald

University of Toronto

Michael Nichol

University of Southern California

Marios Loukas

St. George's University

Mario C Salinas-Carmona

Universidad Autónoma de Nuevo León

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Papers by Rizwan Siwani

An Observational Study of Clinical Application Downtimes in an Electronic Health Record

Health IT Usability Focus Section: Data Use and Navigation Patterns among Medical ICU Clinicians during Electronic Chart Review

Applied Clinical Informatics, 2017

Background A detailed understanding of electronic health record (EHR) workflow patterns and infor... more Background A detailed understanding of electronic health record (EHR) workflow patterns and information use is necessary to inform user-centered design of critical care information systems. While developing a longitudinal medical record visualization tool to facilitate electronic chart review (ECR) for medical intensive care unit (MICU) clinicians, we found inadequate research on clinician–EHR interactions. Objective We systematically studied EHR information use and workflow among MICU clinicians to determine the optimal selection and display of core data for a revised EHR interface. Methods We conducted a direct observational study of MICU clinicians performing ECR for unfamiliar patients during their routine daily practice at an academic medical center. Using a customized manual data collection instrument, we unobtrusively recorded the content and sequence of EHR data reviewed by clinicians. Results We performed 32 ECR observations among 24 clinicians. The median (interquartile ra...

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$Research paper thumbnail of Comparative analysis of fracture characteristics of the developing mandible: The Mayo Clinic experience$

Comparative analysis of fracture characteristics of the developing mandible: The Mayo Clinic experience

International Journal of Pediatric Otorhinolaryngology, 2014

Facial fractures occur relatively less commonly in pediatric patients compared with adults. Revie... more Facial fractures occur relatively less commonly in pediatric patients compared with adults. Review of national databases from 1997 through 2003 (the Kid's Inpatient Database and the Nationwide Inpatient Sample) for facial fracture discharges show that the pediatric population accounts for 14.7% of all facial fractures, with boyssustainingmore injuriesthan girls (ratio, 2.5:1) andhigher injury rates reported in older children [1]. Data drawn from regional patient populations show that fractures of the mandible account for 20-50% [2-5] of such injuries. Trends in prevalence, cause and patterns of injury, and treatment have been noted in age subgroups within the pediatric population. In the review of 912 pediatric patients from Porto, Portugal, with facial fractures published by Ferreira et al. [6], mandibular fracture was the most common type of fracture (48.8%) and was more prevalent in older children. In the United States, McGraw and Cole [7] reported prevalence for mandibular fractures of 21% and noted increasing fracture rates with age. Sherick et al. [8] reported a similar trend after studying their local population (Ann Arbor, Michigan). As an exception to this, data published by Thoré n et al. [9] showed a higher proportion of mandibular fractures, 73.9%, upon review of facial fractures in children in Finland over a 20-year period, with the proportion of mandibular fractures decreasing with increasing age. These patterns appear to be unique to the local population being studied, likely because of varying socioeconomic and cultural environments [10-13].

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Anatomic Evaluation of the Vertical Face-lift in Cadavers

JAMA Facial Plastic Surgery, 2013

arly face-lift surgery involved excision and redraping of lax skin. 1 Results were encouraging bu... more arly face-lift surgery involved excision and redraping of lax skin. 1 Results were encouraging but often short-lived and not ideal because of widening of scars and other shortfalls. Skin-only techniques were the standard surgery for the aging face until 1968, when Tord Skoog, 2 of Sweden, realized the importance of repositioning the deeper structures of the face by shifting the platysma in the neck and lower face and the fascia in the cheek. The concept of incorporating the superficial musculoaponeurotic system (SMAS) rather than simply working on the skin has become widely accepted and serves as the foundation for modern face-lift surgery. Over time, surgical approaches have evolved and been refined, leading to different face-lift techniques, all of which incorporate treatment of the SMAS, including the deep plane face-lift, the composite face-lift, the "SMAS-flap," the "SMASectomy," and the "SMAS-plication." 3,4 Regardless of plane of dissection or technique chosen, most of the face-lifts performed until a few years ago had focused primarily on a superolateral vector of pull. In recent years, however, and prompted by a number of newer techniques, such as the minimal access cranial suspension and others, discussions have emerged about incorporating a more vertical vector of pull on the face. 5 IMPORTANCE This study investigates how different orientations of tension vectors affect the amount of soft-tissue lift in specific cervicofacial regions. OBJECTIVES To compare differences in cosmetic neck and face changes generated by 3 different face-lift techniques, to quantify the amount of lift across different points on the face, and to quantify changes in platysmal dehiscence in each of 3 standard superficial musculoaponeurotic system plication face-lift techniques applied to fresh-frozen cadaver heads. DESIGN, SETTING, AND PARTICIPANTS Ten cadaver heads in an academic tertiary care center. INTERVENTION(S) Three different superficial musculoaponeurotic system plication rhytidectomy procedures were conducted in the following sequence: (1) vertical tension vector plication (vertical lift), (2) superolateral tension vector plication (superolateral lift), and (3) superolateral tension vector plication combined with midline platysmal plication (superolateral lift with platysmal plication). MAIN OUTCOMES AND MEASURES After completion of each technique, the amount of lift at 4 standard key points was measured and recorded, and differences in lift at the key points were analyzed. RESULTS Vertical lift was associated with greater total lift than superolateral lift alone or superolateral lift with platysmal plication (P < .001 for both). Platysmal dehiscence increased from baseline measurements after superolateral lift and decreased after vertical lift (P = .002 for both). CONCLUSIONS AND RELEVANCE Our findings establish how different orientations of tension vectors applied during face-lift surgery achieve different structural changes to various key points across the face. This study helps the face-lift surgeon and student understand the underlying structural anatomic changes associated with different face-lift techniques, which ultimately result in different cosmetic outcomes. LEVEL OF EVIDENCE NA.

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An Institutional Review of the MID Forehead Browlift Procedure

The Laryngoscope, 2009

Brow ptosis gives the face a sad, heavy look and often disturbs the visual field. In this retrosp... more Brow ptosis gives the face a sad, heavy look and often disturbs the visual field. In this retrospective case series we looked at patients who underwent a mid forehead browlift to assess the efficacy of this technique in correcting this functional and aesthetic disfigurement. We identified 16 patients with greater than six months of postoperative photographic documentation. Information was collected concerning patient demographics, etiology and severity of brow ptosis, and outcome of surgery. Four independent evaluators were recruited to compare pre operative with post operative photographs for the following aspects: brow symmetry, elevation, incision scar, and overall appearance. The mid forehead browlift was found to offer excellent aesthetic results in all patients.

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Alternate and incidental diagnoses on noncontrast-enhanced spiral computed tomography for acute flank pain

Urology journal, 2009

Our aim was to determine the incidence and spectrum of significant alternate or incidental diagno... more Our aim was to determine the incidence and spectrum of significant alternate or incidental diagnoses established or suggested on spiral computed tomography (CT) in a large series of patients with suspected renal colic. Records of all patients that had undergone spiral CT (5-mm to 7-mm slice thickness) for acute flank pain during a 5-year period were reviewed. The radiological diagnoses of urinary calculi and obstruction as well as clinical entities not suspected otherwise were analyzed. A total of 4000 CTs had been performed in the evaluation of acute flank pain. Urinary calculi had been identified in 3120 patients (78.0%). There were 398 patients (9.9%) who had an alternate cause of flank pain or an incidentally detected condition on CT. Of these patients, 102 (25.6%) had more than one additional finding. A total of 153 clinical conditions had been identified mimicking flank pain secondary to calculus and obstruction. In 47 patients (1.2%), incidental solid masses had been detected...

Perceptions of Pakistani medical students about drugs and alcohol: a questionnaire-based survey

by Rizwan Siwani, Ayesha Saleem, and Farah Salahuddin

Substance abuse treatment, prevention, and policy, 2006

Drug abuse is hazardous and known to be prevalent among young adults, warranting efforts to incre... more Drug abuse is hazardous and known to be prevalent among young adults, warranting efforts to increase awareness about harmful effects and to change attitudes. This study was conducted to assess the perceptions of a group of medical students from Pakistan, a predominantly Muslim country, regarding four drugs namely heroin, charas, benzodiazepines and alcohol. In total, 174 self-reported questionnaires were received (87% response rate). The most commonly cited reasons for why some students take these drugs were peer pressure (96%), academic stress (90%) and curiosity (88%). The most commonly cited justifiable reason was to go to sleep (34%). According to 77%, living in the college male hostel predisposed one to using these drugs. Sixty percent of students said that the drugs did not improve exam performance, while 54% said they alleviated stress. Seventy-eight percent said they did not intend to ever take drugs in the future. Females and day-scholars were more willing to discourage a f...

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Three-dimensional volumetric computed tomographic scoring as an objective outcome measure for chronic rhinosinusitis: clinical correlations and comparison to Lund-Mackay scoring

International forum of allergy & rhinology, 2013

We aimed to test the hypothesis that three-dimensional (3D) volume-based scoring of computed tomo... more We aimed to test the hypothesis that three-dimensional (3D) volume-based scoring of computed tomography (CT) images of the paranasal sinuses was superior to Lund-Mackay CT scoring of disease severity in chronic rhinosinusitis (CRS). We determined correlation between changes in CT scores (using each scoring system) with changes in other measures of disease severity (symptoms, endoscopic scoring, and quality of life) in patients with CRS treated with triamcinolone. The study group comprised 48 adult subjects with CRS. Baseline symptoms and quality of life were assessed. Endoscopy and CT scans were performed. Patients received a single systemic dose of intramuscular triamcinolone and were reevaluated 1 month later. Strengths of the correlations between changes in CT scores and changes in CRS signs and symptoms and quality of life were determined. We observed some variability in degree of improvement for the different symptom, endoscopic, and quality-of-life parameters after treatment. ...

Resection of Tumors of the Clivus by a Transnasal Trans-sphenoidal Approach

Skull Base, 2009

Sleep deprivation and its associated factors among general ward patients at a tertiary care hospital in Pakistan

by Rizwan Siwani, Ayesha Saleem, Farah Salahuddin, and Ali Tajik

JPMA. The Journal of the Pakistan Medical Association, 2006

To estimate the occurrence rate of sleep deprivation and to identify the environmental, staff-rel... more To estimate the occurrence rate of sleep deprivation and to identify the environmental, staff-related and patient-related factors associated with SD among general ward patients of a tertiary care hospital in Pakistan. In a cross-sectional study, a pre-tested questionnaire was administered to 108 patients admitted into the general medical and general surgical wards of Aga Khan University Hospital, Karachi. In all, 50 (46.3%) respondents felt deprived of adequate sleep in the hospital. Worry about illness disturbed the night-time sleep of 47 (43.5%) patients; most of these had SD (70%) (p < 0.001). Other patients' noise disturbed 31.5% of study subjects and a significant majority (68%) of these had SD (p = 0.003). Over 17% of study subjects reported cell phone's ringing as a disturbing factor; more by those with SD (68%) compared to those with no SD (32%); again the difference was significant (p = 0.003). Physical discomfort and presence of cannula were reported as disturbi...

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Predictors of Renal Outcome in HIV‐Associated Nephropathy

Clinical Infectious Diseases, 2008

Human immunodeficiency virus (HIV)-associated nephropathy (HIVAN) is an important cause of end-st... more Human immunodeficiency virus (HIV)-associated nephropathy (HIVAN) is an important cause of end-stage renal disease among African American patients. This study was performed to study the epidemiology of HIVAN in a predominantly black African population and the impact of highly active antiretroviral therapy and other factors on the development of end-stage renal disease. We retrospectively identified all patients with HIVAN, defined by biopsy or strict clinical criteria, in 8 clinics in the United Kingdom. Baseline renal function, HIV parameters, renal pathological index of chronic damage, and responses to highly active antiretroviral therapy were analyzed, and factors associated with adverse renal outcome were identified. From 1998 through 2004, we studied 16,834 patients, 61 of whom had HIVAN. HIVAN prevalence in black patients was 0.93%, and HIVAN incidence in those without renal disease at baseline was 0.61 per 1000 person-years. After a median of 4.2 years, 34 patients (56%) had developed end-stage renal disease. There were no significant differences in renal function and HIV parameters at baseline, time to initiation of highly active antiretroviral therapy, and rates of HIV RNA suppression between the 20 patients who developed end-stage renal disease &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;3 months after receiving the HIVAN diagnosis and the 23 patients who maintained stable renal function. However, the index of chronic damage score was significantly higher in those who developed end-stage renal disease (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .001), and an index of chronic damage score…

Students' Corner Sleep Deprivation and its associated factors among general ward patients at a Tertiary Care Hospital in Pakistan

JPMA, 2006

Objective: To estimate the occurrence rate of sleep deprivation and to identify the environmental... more Objective: To estimate the occurrence rate of sleep deprivation and to identify the environmental, staff-related and patient-related factors associated with SD among general ward patients of a tertiary care hospital in Pakistan. Methods: In a cross-sectional study, a pre-tested questionnaire was administered to 108 patients admitted into the general medical and general surgical wards of Aga Khan University Hospital, Karachi. Results: In all, 50 (46.3%) respondents felt deprived of adequate sleep in the hospital. Worry about illness disturbed the night-time sleep of 47 (43.5%) patients; most of these had SD (70%) (p<0.001). Other patients' noise disturbed 31.5% of study subjects and a significant majority (68%) of these had SD (p=0.003). Over 17% of study subjects reported cell phone's ringing as a disturbing factor; more by those with SD (68%) compared to those with no SD (32%); again the difference was significant (p=0.003). Physical discomfort and presence of cannula were reported as disturbing factors by 41.7% and 28.7% of the study subjects respectively but these were not significantly associated with SD. Conclusion: Our study revealed that sleep deprivation occurs commonly among general ward patients in tertiary care setting. Factors found to be associated with SD were amenable to modification to a greater extent (JPMA 56:614;2006).

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An Institutional Review of the MID Forehead Browlift Procedure

by Oren Friedman and Rizwan Siwani

The Laryngoscope, 2009

ABSTRACT

An Observational Study of Clinical Application Downtimes in an Electronic Health Record

Health IT Usability Focus Section: Data Use and Navigation Patterns among Medical ICU Clinicians during Electronic Chart Review

Applied Clinical Informatics, 2017

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$Research paper thumbnail of Comparative analysis of fracture characteristics of the developing mandible: The Mayo Clinic experience$

Comparative analysis of fracture characteristics of the developing mandible: The Mayo Clinic experience

International Journal of Pediatric Otorhinolaryngology, 2014

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Anatomic Evaluation of the Vertical Face-lift in Cadavers

JAMA Facial Plastic Surgery, 2013

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An Institutional Review of the MID Forehead Browlift Procedure

The Laryngoscope, 2009

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Alternate and incidental diagnoses on noncontrast-enhanced spiral computed tomography for acute flank pain

Urology journal, 2009

Perceptions of Pakistani medical students about drugs and alcohol: a questionnaire-based survey

by Rizwan Siwani, Ayesha Saleem, and Farah Salahuddin

Substance abuse treatment, prevention, and policy, 2006

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Three-dimensional volumetric computed tomographic scoring as an objective outcome measure for chronic rhinosinusitis: clinical correlations and comparison to Lund-Mackay scoring

International forum of allergy & rhinology, 2013