Hannaniebuhr8244

70; 95% CI 1.40-2.06). CONCLUSIONS Low compliance with the clinical guidelines for managing asthma is a common problem among primary care physicians. Compliance with these guidelines is associated with better asthma control. Actions need to be taken to improve primary care physician compliance with the asthma management guidelines. RATIONALE & OBJECTIVE Compared with conventional (rope-ladder cannulation [RLC]) methods, use of buttonhole cannulation (BHC) to access arteriovenous fistulas (AVFs) may be associated with increased risk for bloodstream infection and other vascular access-related infection. We used national surveillance data to evaluate the infection burden and risk among in-center hemodialysis patients with AVFs using BHC. STUDY DESIGN Descriptive analysis of infections and related events and retrospective observational cohort study using National Healthcare Safety Network (NHSN) surveillance data. SETTING & PARTICIPANTS US patients receiving hemodialysis treated in outpatient dialysis centers. PREDICTORS AVF cannulation methods, dialysis facility characteristics, and infection control practices. OUTCOMES Access-related bloodstream infection; local access-site infection; intravenous (IV) antimicrobial start. ANALYTIC APPROACH Description of frequency and rate of infections; adjusted relative risk (aRR) for infection with BHCection than RLC among in-center hemodialysis patients. Decisions regarding the use of BHC in dialysis centers should take into account the higher risk for infection. Studies are needed to evaluate infection control measures that may reduce infections related to BHC. BACKGROUND School-based trauma-informed care (TIC) represents a novel way of supporting children with trauma histories. However, minimal research has focused on how TIC impacts teacher wellbeing, which is concerning given the relationship between occupational stress and turnover from education. OBJECTIVE This study investigated teacher characteristics associated with perceived effectiveness of TIC and intent to leave education. PARTICIPANTS AND SETTING The study included 163 teachers in underserved elementary schools serving a high percentage of low-income, English-language learner Latinx students. METHODS Teachers completed a survey regarding an ongoing TIC program and quality of life for helping professionals. RESULTS Higher compassion satisfaction and secondary traumatic stress (STS), as well as lower burnout, were associated with perceived effectiveness of TIC. Older teachers, and those with lower compassion satisfaction and higher burnout, were more likely to report intentions to leave education. STS and perceived effectiveness of TIC were not associated with turnover intent. CONCLUSIONS Results suggest that teacher occupational wellbeing, particularly compassion satisfaction, plays a role in buy-in to TIC and retention among teachers. PURPOSE To evaluate the correlation between post-traumatic functional and psychological outcomes in patients with severe pelvic ring injuries. METHODS Forty-four patients who sustained a completely unstable pelvic ring injury (Tile C, AO/OTA 61C) treated in our institution from 2012 to 2017 were included. A telephone interview was performed in 16 of 44 patients to evaluate pelvic functionality, using the Majeed pelvic score, and psychological evaluation, using Hamilton anxiety and depression rating scales. RESULTS The mean Injury Severity Score (ISS) was 27 ± 12, and mean GCS at presentation was 13 ± 4. Average time from trauma to interview was 3 years (range, 1-5 years). Mean Majeed pelvic score was 67 ± 22. Majeed sub-scores were pain 19 ± 9, work 10 ± 7, sitting 8 ± 2, sexual intercourse 3 ± 2, walking aids 11 ± 2, gait unaided 9 ± 2, walking distance 8 ± 3. Mean depression and anxiety scores were 16 ± 12 and 17 ± 14, respectively. Significant correlations were observed between functional and psychological outcomes (P  less then  0.005). Majeed score was negatively correlated with depressive symptoms (r = -0.721, P = 0.002) and anxiety symptoms (r = -0.756, P = 0.001). Depression and anxiety scores were positively correlated (r = 0.945, P  less then  0.001). CONCLUSION Lower functional outcomes in patients with Tile C pelvic injuries were correlated with more severe symptoms of depression and anxiety. We recommend that providers consider and treat patients' mental health condition during posttraumatic recovery. INTRODUCTION Following proximal humeral plate osteosynthesis, mechanical complication rates ranging up to 40% have been reported. The study aims to determine the influence of surgeons' experience and the technique of drilling on the complication rate. MATERIALS AND METHODS The sample involved 45 cadaveric humeri. Six orthopaedic surgeons were divided into two groups with regard to their level of experience (novice versus expert group). On each humerus two different proximal humerus plates were applied. Drillings were performed either with a sharp or worn drill bit (to simulate either sharp or blunt drilling). The respective holes were drilled until the respective participant thought to have placed the drill bit subchondrally, followed by perforation of the cartilage of the humeral head. Both these values and cases of unintended penetration of the articular cavity were evaluated. RESULTS Fourteen holes (3.6%) were primary penetrated in the joint cavity in the worn-drill-bit-subgroup and 19 holes (5%) in the sharp-drill-bit-group. The latter had an average distance between the chosen subchondral position and the humeral articular surface of 8.3 mm and the worn-drill-bit-subgroup was at 10.6 mm. In the novice group 20 perforations (5.2%) of the joint space occurred and the mean interval between the chosen subchondral point and the humeral articular surface was 4.0 mm. The experienced surgeons showed a perforation rate of 3.4% and were at a mean of 14.9 mm. There were no significant differences regarding drilling manoeuvres and experience. CONCLUSION Although our results are satisfactory, they can be traced back to the relatively high interval between the respective chosen position of the drill bit and the humeral articular surface which may not guarantee screw stability during ORIF of all fracture patterns. Defects of the lower limb are generally difficult to correct, especially in patients with associated pathologies, and they represent a challenge for the reconstructive surgeon. The sural flap provides considerable versatility for lower limb reconstructions, successfully covering defects located between the knee and the ankle or the heel. Most frequently, this flap is used for defects located in the middle to distal third of the lower limb. The scope of reconstructing defects from the lower limb extremities must be concentrated both on covering the defect, and on functional recovery. When use of a local flap is insufficient, free flaps must be used, as they provide a wider coverage of defect. We report the successful surgical management of a case of a lower extremity injury consisting of a tibial pilon fracture, proximal fibula and lateral malleolus fractures, and a medium-to-large defect on both sides (internal and external) of the left ankle, on a 61 year-old patient, insulin dependent diabetic, heavy smoker, and with poor hygiene. BACKGROUND The Talon™ DistalFix™ Proximal Femoral Nail (Talon-PFN) is a new proximal femoral intramedullary nail designed for the treatment of intertrochanteric femoral fractures. This study aimed to report the clinical and radiological outcomes of patients treated using a proximal femoral intramedullary nail with a novel design. METHODS Patients with either stable or unstable (AO/OTA type 31-A1, 2, 3) intertrochanteric fractures who were treated with the Talon-PFN between October 2014 and January 2018 in our department participated in this retrospective study. Patients' demographics, clinical characteristics, and functional and radiographical outcomes were evaluated. RESULTS A total of 110 patients (65 females, 45 males) with a mean age of 80.6 ± 9.1 years participated in this study. The mean follow-up time was 24 ± 13.4 months. The overall mortality rate during follow-up was 50.48%. The most common perioperative complications were a malposition of the femoral neck screw and talon cutout, both of which occurred in 17 patients (15.5%). The most common complications observed during follow-up were a lesser trochanter nonunion/malunion in 34 patients (30.9%), valgus malunion in 18 patients 16.4%), lateral screw migration in four patients (3.6%), and varus malunion in 15 patients (13.7%). A late screw cutout through the femoral head was seen in four patients (3.6%). At least one complication was detected in 53 patients (48.2%). However, revision surgery was performed in only six of these cases (5.5%). CONCLUSION According to the results obtained in this study, the Talon-PFN, which has similar clinical and radiological outcomes compared to other proximal femoral intramedullary nail designs according to the reported studies, can be a suitable alternative in the treatment of intertrochanteric fractures. Extensive soft tissue loss or injury of the hand and upper extremity is a challenging reconstructive problem traditionally treated with abdominal-based pedicled flaps. Options for coverage included the groin flap based on the superficial circumflex iliac artery, the Scarpa's fascia flap based on the superficial inferior epigastric artery, and the paraumbilical perforator flap from the deep inferior epigastric artery perforators. Despite the ability to provide consistent and pliable soft tissue coverage with ease of elevation, these flaps have several disadvantages including restriction of mobility, requirement for multiple procedures, bulkiness and patient discomfort. With the advent of microsurgery, pedicled regional flaps, and off-the-shelf skin substitutes, the applications for these flaps have narrowed. However several indications still remain. These include patient and facility factors which deter microsurgery, the absence of recipient vessels after injury, prior surgical use of recipient vessels, the need to preserve major vessels for future reconstruction, and large multi-surface wounds requiring coverage. In this review we detail these indications and provide case examples for each. BACKGROUNDS The ASA (American Society of Anaesthesiologists) Score is the current standard for measuring comorbidity in the Australian Hip Fracture registry, however it has never been validated for this purpose. Subsequently, a more appropriate and useful measure should be investigated. This study aimed to compare the ASA and Charlson Comorbidity Index (CCI) scores in predicting 12-month mortality following acute hip fracture. METHODS A retrospective analysis was performed on an audit database of patients who were admitted to an orthogeriatric unit in a public metropolitan hospital from November 2010 to October 2011. 12-month mortality data was linked through a dual search of Queensland Health and mortality registry data. The Charlson comorbidity index was retrospectively applied. Demographics (age, gender, admission residence) and covariates including ASA, CCI, fracture type, fixation type, cognitive impairment on admission, BMI and time to surgery were analysed with logistic regression. ROC curve analysis was performed to assess varying thresholds for each comorbidity system.