Smithohlsen0153

Guidelines for sterilization of reusable equipment (eg, arthroscopes, surgical equipment) have recently been established. These guidelines are supported by the U.S. Food and Drug Administration and affect costs for sterilization. The current analysis was undertaken to understand if reusable or disposable endoscopic carpal tunnel release (ECTR) equipment is a less-expensive option.

An activity-based cost analysis was undertaken to determine the costs of reusable versus disposable equipment for ECTR. this website Costs of disposable equipment were obtained from manufacturers. Costs of processing reusable equipment including labor, time, cost of operating room time, and sterilization supplies and equipment were obtained from the literature and from recent reports identifying these costs. Infection rates and costs of infection were also factored in. Decision analysis software was used to determine the expected costs of each option (disposable vs reusable). A sensitivity analysis was undertaken on those variables that were determined to have the greatest effect on the overall costs of the procedure and sterilization.

Costs for each option when totaled were $917 for disposable and $1,019 for reusable equipment, resulting in cost savings of $102 with disposable equipment. Reusable equipment was the least costly option when the following costs/events occurred cost of a disposable arthroscope, >$452; cost of disposable ECTR, >$647; costs of operating room time, <$28.63/min; set up time, <6.8 minutes for reusable equipment; and cost of disposable ECTR blade used with reusable equipment, <$160.

When considering the cost of operating room time, preparation, and processing of reusable equipment for ECTR, the disposable equipment for this procedure is less costly.

Economic Analysis II.

Economic Analysis II.

To investigate morphologic hand anomalies in children with severe but unclassifiable forms of thumb hypoplasia and radial-sided hand deficiency.

We identified 15 extremities in 13 patients with severe thumb hypoplasia and associated absent radial-sided digits through the Congenital Upper Limb Differences registry. link2 All patients had forearm involvement. Medical records, clinical photographs, and radiographs were evaluated. Radial longitudinal deficiency (RLD) and thumb hypoplasia were classified according to the Bayne and Klug classification and modified Blauth classification, respectively. Unusual or defining associated hand characteristics were identified and categorized.

The most common type of forearm abnormality was absence of the radius (Bayne and Klug type IV), which was present in 10 extremities in the cohort. All 15 extremities had absent thumbs with loss of additional digits. In 6 patients, RLD was part of a syndrome (46%).

Severe forms of thumb hypoplasia in RLD are uncommon. We propose a further modification of the Blauth classification of thumb hypoplasia, type VI, for improved communication regarding this severe type of radial deficiency involving the hand.

Diagnostic IV.

Diagnostic IV.

To evaluate the risk factors for, and clinical outcomes of, free lateral great toe flaps for the reconstruction of thumb pulp defects.

Between January 2009 and July 2017, 31 patients with thumb pulp defects were treated with free lateral great toe flaps. Seven patients were lost to follow-up. We included 9 female and 15 male patients, average age 35 years. We performed a retrospective review of risk factors, clinical outcomes, and complications. For patients in which the flap survived, we assessed postoperative range of motion, static 2-point discrimination, Semmes-Weinstein monofilament test, Michigan Hand Outcomes Questionnaire, time of return to work, and cold intolerance severity score.

Of 24 flaps, 20 survived completely. Smoking was found to be a potential risk factor for flap necrosis. Average follow-up of the 20 patients in whom the flap survived was 20 months (range, 12-24 months). At final follow-up, all patients were satisfied with recovery in terms of function and aesthetic appearance. No patient required additional aesthetic refinement procedures. Complications occurred in 6 patients and consisted of venous congestion, superficial infection, and deep infection.

Lateral great toe flap transfer in the reconstruction of thumb pulp defects has proven to be a good technique with overall satisfactory outcomes. Smoking increases the risk for flap necrosis.

Therapeutic IV.

Therapeutic IV.

To assess the validity and reliability of the posterior radioscaphoid angle (PRSA), an indicator of dorsal displacement of the scaphoid, in distinguishing wrists with and without chronic scapholunate instability (SLI).

We prospectively evaluated 40 patients (22 men and 18 women; mean age, 46 ± 13 years) with suspected SLI with radiographs and computed tomography arthrography. Based on these data, 3 groups were defined positive SLI (n= 16), negative SLI (n= 19), and questionable SLI (n= 5). An independent reader measured the PRSA on sagittal computed tomography images using the same procedure.

The PRSA median values were significantly lower in the negative SLI group (98°) compared with the positive SLI (110°) and questionable SLI (111°) groups. The difference between the positive SLI and questionable SLI groups was not significant. The best differentiation between patients with and without SLI was obtained with a PRSA threshold value of 103° (specificity of 86% and sensitivity of 79%).

In this preliminary study, PRSA analysis offers a quantitative tool for the evaluation of dorsal scaphoid displacement in cases of SLI, including for patients presenting with questionable initial radiography findings.

Diagnostic II.

Diagnostic II.

Pyrocarbon disc interposition arthroplasty has been designed for the surgical treatment of Eaton-Glickel grade II/III carpometacarpal thumb joint arthritis. This study presents the results of this technique with a minimum 5-year follow up.

We assessed 4 questionnaires for patient-reported outcome measurements in a cross-sectional study the Patient-Rated Wrist and Hand Evaluation, Disabilities of Arm, Shoulder, and Hand questionnaire, Michigan Hand Questionnaire, and questions about satisfaction at the 5-year follow up. We evaluated grip and pinch strength, range of motion, and the radiological position of the disc. Finally, a Kaplan-Meier survival analysis was performed.

A total of 164 thumbs (in 137 patients) were available for follow-up varying from 5 to 12 years. Median Patient-Rated Wrist and Hand Evaluation, Disabilities of Arm, Shoulder, and Hand, and Michigan Hand Questionnaire scores were 17, 18, and 76, respectively. The satisfaction score was 9 (Likert scale of 1-10). Grip and pinch strength reached nearly 100% compared with the contralateral hand. Range of motion resulted in a Kapandji score of 10. Thumb height showed a marginal loss and the Kaplan-Meier survival curve showed a survival rate of 91%.

Our study suggests that pyrocarbon disc interposition arthroplasty is a reliable and feasible treatment for carpometacarpal thumb joint arthritis at medium-term follow-up. It was associated with a high level of patient satisfaction; it maintained thumb height and the implant survived in 91% of patients. Strength and range of motion were comparable to the contralateral hand after a minimum follow-up of 5 years.

Therapeutic IV.

Therapeutic IV.

Numerous studies demonstrate that parental concern for infant pain contributes to vaccine hesitancy. The purpose of this project was to alleviate parental concern for pain and facilitate infant immunization.

Pediatric nurses at an urban ambulatory clinic implemented evidence-based nonpharmacological methods (breastfeeding or 24% sucrose solution) for managing vaccine pain in infants aged up to 6 months. A validated survey measured parental concern for vaccine-related pain before and after the implementation of pain relief interventions.

There was a statistically significant decrease in parental concern for vaccine pain from pre- to postintervention between both treatment groups (p = .035).

Nurses can effectively use nonpharmacological methods to alleviate the pain of infants undergoing routine vaccination while reducing the parental concern for vaccine-associated pain. Reducing infant pain and parental concern may increase vaccination rates.

Nurses can effectively use nonpharmacological methods to alleviate the pain of infants undergoing routine vaccination while reducing the parental concern for vaccine-associated pain. Reducing infant pain and parental concern may increase vaccination rates.Red mud is an alkaline by-product produced by alumina plants. The accumulation of red mud is becoming an increasingly serious problem with the growth of the aluminum industry. Various waste treatment methods utilizing red mud as an environmental remediation material have been developed. Red mud environmental remediation materials (RM-ERMs) are environmental remediation materials prepared by activating red mud, synergistically using red mud and other ingredients, or by extracting effective components from red mud. There are three general categories of use for RM-ERMs for waste water purification, waste gas purification and soil remediation. As well as providing an opportunity to improve the environment through purification technologies, the highly alkaline red mud is consumed in the production of RM-ERMs. The use of RM-ERMs has been shown to be a promising strategy for the simultaneous treatment of various wastes. In this paper, the developregeneration characteristics of various red mud granularent status of RM-ERMs is described, the physical and chemical properties of red mud are introduced, and the active mechanism of RM-ERMs on target pollutants in waste water, waste gas and soil is summarized. Moreover, a discussion on the current existing problems of RM-ERMs provides important tips and suggestions for future research on RM-ERMs.Fenpiclonil is an agricultural phenylpyrrole fungicide, which raise the concern about its ecotoxicological effects. In this paper, we investigate the indirect photochemical transformation mechanisms, environmental persistence and eco-toxicity of fenpiclonil initiated by various active oxidants (1O2, •OH and SO4•‾) in aquatic environments. link3 The results shown that 1O2 can react with pyrrole ring by cycloaddition pathways to form the endo-peroxides. In addition, •OH and SO4•‾ initial mechanisms are calculated, suggesting that •OH-initiated mechanisms play a dominant role in the degradation process of fenpiclonil at high rate constants (2.26 ×109 M-1 s-1, at 298 K). The kinetic calculation results indicate that high temperature is more favorable for the degradation of fenpiclonil. To better understand the adverse effects of the transformation products formed during the subsequent reaction of •OH-adduct IM10, the computational toxicology has been used for the toxicity estimation. The results show that aquatic toxicity of these products decrease with degradation process, especially the decomposition products (TP3 and TP4). However, TP1 and TP2 are still toxic and developmental toxicant. The study provides guidance for further experimental research and industrial application of fungicide degradation from the perspective of theoretical calculation.