Differences In Need Research Articles

Ventricular assist devices as bridge to heart transplantation: minimally invasive approach with axial pumps vs sternotomy approach with centrifugal pumps: short term results

Abstract Introduction Microaxial flow ventricular assist devices (VADs) with hybrid approach could provide an advantage over centrifugal flow VADs with surgical implantation via median sternotomy as bridge to heart transplantation. Purpose We aimed to compare short-term results in intensive cardiac care unit between both groups. Methods Single-center retrospective registry comparing patients supported with microaxial flow VADs with hybrid approach (Impella 5.0 or 5.5) and surgical centrifugal flow VADs (biventricular or left univentricular CentriMag) as bridge to heart transplantation. Results Including 12 patients (January 2020-March 2022), 7 patients in hybrid approach group (2 patients with Impella 5.0-16,7% and 5 patients with Impella 5.5-41,7%) and 5 pacientes in sternotomy approach group (33.3% biventricular support and 8.3% left ventricular support). In first 48 hours after VAD implantation, worsening of renal function was greater in sternotomy approach group (Cr 2.23±0.88, 1.07±0.58;p=0.021) and there was a trend toward lower hemoglobin values (7.72±0.19, 8.9±1.35;p =0.059), with no differences in other analyzed variables (Table). A trend toward earlier respiratory weaning was observed in hybrid approach group (median 12 vs 48 hours,p=0.067). Sternotomy approach group required more frequent use of continuous renal replacement therapy (60% vs 0%,p=0.045). There were statistically non-significant differences in need for blood products or surgical reinterventions, although percentage of red blood cells transfused in first 48 hours after VAD implantation were lower in hybrid approach group than sternotomy approach group (median 4 (1.5-8) versus 8(2.5-13.5) in sternotomy approach group, p=0.309). The most common complication in sternotomy approach group was tamponade (80%- 4 patients versus 0 patients in hybrid approach) and in hybrid approach group access-related infections (28.57%, 2 patients). Ten patients received a transplant, one died for non-cardiovascular cause, and another underwent the implantation of long term VAD as bridge to transplantation. There were no differences in time from assistance implantation to heart transplantation. The most common complication after heart transplantation was primary graft failure in both groups (40%,2 patients) with no differences in mortality. Conclusions Microxial flow VADs with hybrid approach provide adequate support, with less need for continuous renal replacement therapy and shorter duration of mechanical ventilation after VAD implantation to admission in intensive cardiac care unit, a trend towards lower rates of reintervention due to bleeding was observed. The advantages of minimally invasive approach could increase its use as bridge to heart transplantation compared to VADs with sternotomy approach although small sample size may negatively influence the failure to reach statistical significance, and more studies are necessary to validate our preliminary experience.Variables analyzed 48 hours of admission

Comparing the efficacy and safety of monotherapy and combination therapy with tadalafil, tamsulosin, and silodosin for distal ureteral stones: A systematic review and meta-analysis

ObjectiveMedical expulsive therapy (MET) is a suitable option for facilitating stone expulsion in patients with distal ureteral stones. This meta-analysis was conducted to compare the efficacy of tamsulosin, silodosin, tadalafil monotherapy, and combinations on stone expulsion rate (SER) and stone expulsion time (SET), as well as their comparative safety, number of colic pain episodes, and need for analgesics. MethodsRandomized controlled trials were retrieved by searching PubMed, Scopus, and Web of Science up to November 27, 2023. Papers in-English that compared the safety and efficacy of at least two of the above agents in adults with distal ureteral stones ≤10 mm were included. ResultsIn total, 27 studies were identified. More than half of them (n=15, 55.6%) were conducted in India. SER significantly improved with silodosin compared with tamsulosin (odds ratio [OR] 2.24, p<0.001), whereas the difference in SET was non-significant. Tadalafil achieved a significantly higher SER compared with tamsulosin (OR 1.42, p=0.040) without any difference in SET. Subgroup analysis of 5- and 10-mg doses of tadalafil showed no significant difference in SER and SET. We found no significant difference in need for analgesic (mean difference [MD −53.73, p=0.200) or the mean number of colic episodes (MD −0.42, p=0.06) between tadalafil and tamsulosin. SER and SET were not significantly different between silodosin and tadalafil. Tadalafil plus tamsulosin led to a significantly higher SER (OR 1.87, p<0.001) and SET (MD −2.99, p=0.002) compared with tamsulosin, without any significant difference in the adverse effects. ConclusionCompared with tamsulosin, SER significantly improved with silodosin, tadalafil, and the combination of tadalafil plus tamsulosin. Meanwhile, the difference in SET was only significant between tadalafil plus tamsulosin versus tamsulosin. It appears that tadalafil and silodosin have similar efficacy in SET and SER. All METs had comparable safety.

Examining the causal effects of social exclusion on shame and dissociative detachment

Background and objectivesDissociative detachment experiences (e.g., derealization, absorption) underpin much psychopathology and are often researched in relation to co-occurring affective states such as shame, the latter being known to occur in situations involving actual or perceived negative social evaluation. The association between shame and dissociative detachment may also be moderated by individual differences in people's need to belong. The goal of the present study was to experimentally investigate the effects of social exclusion on shame and dissociative detachment depending on perceivers' need to belong. MethodsAfter measuring individual differences in need to belong and shame proneness, the Cyberball paradigm was utilized to communicate either social inclusion or exclusion. Following Cyberball, a sample of 281 participants completed measures of state shame and state dissociation. ResultsSocial exclusion increased dissociative detachment, and these effects were mediated by increases in state shame. These effects were particularly evident among people with a high need to belong. LimitationsOther individual differences such as rejection sensitivity may also moderate the relationship between exclusion and shame. While Cyberball can be used to investigate shame, it can only induce shame via social exclusion, whereas shame can also be elicited in other ways such as performance failure. ConclusionsSocial exclusion can elicit shame, which is most acutely felt by those with a strong need to belong, and this aversive experience appears to be managed by dissociative detachment.

Differences in need for and access to eye health services between older people with and without disability: A cross-sectional survey in four districts of northern Uganda.

Eye health and disability are both common among older people, and it is important to understand how disability relates to visual health status and access to services. While people with disabilities face barriers to accessing health services, few studies have measured participants' functional status in domains other than vision and little evidence exists on how disability impacts eye health services access. This paper describes how visual impairment and access to eye health services differ between people aged 50 years and above with and without disability in Karamoja, Uganda, and explores the factors driving that difference. This was a cross-sectional survey among individuals aged 50 years and above. A standardised eye health survey was conducted, with additional questions on personal and health characteristics. Ophthalmologists conducted a vision examination, and recorded participants' self-reported functional difficulties using the Washington Group Short Set Enhanced. Descriptive analyses were conducted using Stata, and multivariate models constructed to explore relationships. 21.7% of respondents self-reported some sort of functional difficulty. Twenty-five percent of individuals with a non-visual functional difficulty are also blind, and a further 29% experience a lower level of VI. In a multivariate model, blindness was associated with self-reported difficulties seeing, but not any other type of difficulty. Blindness was also associated with age, not being married, and living in a smaller household. Access to cataract surgery was associated with non-visual functional difficulties, male gender, and having a regular household income. This study confirms that in the study area, disability and visual impairment are common among people aged 50 years and above, access to eye health services is low, and self-reported functional difficulties are not associated with lower access to services.

Ureteroscopy for stone disease in pediatric patients with neurogenic bladder: A single institution case-control study

Ureteroscopy (URS) for urolithiasis in pediatric patients may be particularly challenging for patients with co-morbidities that increase the risk for stone formation and recurrence. Patients with neurogenic bladders (NGB) and/or patients that are non-ambulatory are reported to have higher rates of additional comorbidities and a particularly increased risk of developing urolithiasis, and higher rates of infections and post-operative complications. To report outcomes of URS for stone disease in pediatric patients with NGB and/or non-ambulatory status and compare these outcomes to patients without these co-morbidities. An IRB-approved prospective single institutional registry was used to retrospectively identify all patients under 18 years of age who underwent URS for stone disease between July 2012 and July 2021, excluding bladder stones. Patients were categorized in two groups: patient with NGB with or without non-ambulatory status versus all other patients (control). Baseline demographics, pre-operative radiologic imaging, intra-operative details, and post-operative outcomes including 30-day complications were aggregated and compared between the two groups. 275 URS in 198 patients were performed during the study period, and 49 (18%) of these were performed on patients with NGB. Pre-operative imaging showed significantly higher number of stones (3 vs 2, p=0.003) and larger total stone burden in patients with NGB than those without NGB (15mm vs 9mm, p=0.009). Patients with NGB had a significantly longer length of procedure (86 vs 60min, p=0.002), increased need for staged procedures, increased length of stay (1 vs 0 days, p<0.001), and increased use of an extended duration of antibiotics prior to the procedure (<0.001). There was no difference in need for passive dilation, stent placement, or other intra-operative parameters. There was no statistical difference in the incidence of 30-day complications between the two groups post-operatively. However, there was a higher incidence of febrile UTIs (8.2% vs 1.3%, p=0.021) in patients with NGB and a lower incidence of pain related complications (0 % vs 9.3%, p=0.032). Patients with NGB had a higher incidence of requiring ipsilateral URS for recurrent stone disease within a year of surgery (34.6% vs 18.9%, p=0.01). The results show that URS for urolithiasis can be done safely and effectively in pediatric patients with neurogenic bladders. The increased risk of infectious complications within 30 days of surgery warrants careful pre- and post-operative antibiotic care plan for this patient population.

Retrospective analysis based on a clinical grading system for patients with hepatic hemangioma: A single center experience.

The optimal approach for managing hepatic hemangioma is controversial. To evaluate a clinical grading system for management of hepatic hemangioma based on our 17-year of single institution experience. A clinical grading system was retrospectively applied to 1171 patients with hepatic hemangioma from January 2002 to December 2018. Patients were classified into four groups based on the clinical grading system and treatment: (1) Observation group with score < 4 (Obs score < 4); (2) Surgical group with score < 4 (Sur score < 4); (3) Observation group with score ≥ 4 (Obs score ≥ 4); and (4) Surgical group with score ≥ 4 (Sur score ≥ 4). The clinico-pathological index and outcomes were evaluated. There were significantly fewer symptomatic patients in surgical groups (Sur score ≥ 4 vs Obs score ≥ 4, P < 0.001; Sur score < 4 vs Obs score < 4, χ² = 8.60, P = 0.004; Sur score ≥ 4 vs Obs score < 4, P < 0.001). The patients in Sur score ≥ 4 had a lower rate of in need for intervention and total patients with adverse event than in Obs score ≥ 4 (P < 0.001; P < 0.001). Nevertheless, there was no significant difference in need for intervention and total patients with adverse event between the Sur score < 4 and Obs score < 4 (P > 0.05; χ² = 1.68, P > 0.05). This clinical grading system appeared as a practical tool for hepatic hemangioma. Surgery can be suggested for patients with a score ≥ 4. For those with < 4, follow-up should be proposed.

Medical abortion in Ghana: A non-randomized, non-inferiority study of access through pharmacies compared with clinics

ObjectivesTo compare self-reported clinical outcomes following medical abortion with mifepristone and misoprostol sourced from either a pharmacy or health clinic. Study designWe conducted a prospective, non-randomized, non-inferiority cohort study across four regions in Ghana, from high-volume pharmacies and health clinics. Participants seeking medical abortion (less than nine weeks’ gestation) who met usual medical abortion eligibility criteria were recruited. Data collection included baseline surveys, follow-up phone interviews, and self-reported assessments of medical abortion outcomes. The study aimed to enroll 2000 medical abortion users (1000 from each source). ResultsComplete outcome data was available and analyzed from 1958 participants (of 2208 enrolled), with the adjusted risk difference of need for additional treatment to complete the abortion indicating non-inferiority of the pharmacy group compared to the clinic group [−2.3% (95% CI −5.3% to 0.7%)]. Both groups reported low rates of additional treatment (4.9%) and adhered similarly to the abortion regimen. Secondary outcomes showed no significant differences, with moderate acceptability in both groups (65.4% pharmacy, 52.3% facility). Adverse outcomes were rare: one ectopic pregnancy, one blood transfusion and no deaths or other major complications were reported. ConclusionsAccessing medical abortion pills directly from pharmacies without prior consultation from a provider demonstrated non-inferior self-reported clinical outcomes compared to seeking care from health clinics. The findings align with the growing global evidence supporting the safety and effectiveness of medical abortion self-care. ImplicationsThis study contributes data which support future registration of over-the-counter use of medical abortion drugs up to nine weeks’ gestation. Such measures could expand options for safe abortion care, especially in regions where unsafe abortion poses a substantial maternal health risk. Trial registrationClinicalTrials.gov (NCT03727308).

Increasing Use of Rapid Magnetic Resonance Imaging for Children with Blunt Head Injury

To increase the percentage of patients who undergo rapid magnetic resonance imaging (rMRI) rather than computed tomography (CT) for evaluation of mild traumatic brain injury (TBI) from 45% in 2020 to 80% by December 2021. This was a quality improvement initiative targeted to patients presenting to the pediatric emergency department (ED) presenting with mild traumatic brain injury (TBI), with baseline data collected from January 2020 to December 2020. From January 2021 to August 2021 we implemented a series of improvement interventions and tracked the percentage of patients undergoing neuroimaging who received rMRI as their initial study. Balancing measures included proportion of all patients with mild TBI who underwent neuroimaging of any kind, proportion of patients requiring sedation, emergency department (ED) length of stay (LOS), and percentage with clinically important TBI. The utilization of rMRI increased from a baseline of 45% to a mean of 92% in the intervention period. Overall neuroimaging rates did not change significantly after the intervention (19.8 vs 23.2%, p=0.24). There was no difference in need for anxiolysis (12 vs 7%, p=0.30) though ED LOS was marginally increased (1.4 vs 1.7 hours, p=<0.01). In this quality improvement initiative, transition to rMRI as the primary imaging modality for the evaluation of minor TBI was achieved at a level 1 pediatric trauma center with no significant increase in overall use of neuroimaging.

Prehospital Treatment of Atrial Fibrillation: Infusion Pump for Bolus and Infusion?

Objective The prehospital treatment for stable patients with atrial fibrillation with rapid ventricular response is rate-controlling agents such as calcium channel blockers, often diltiazem given as a bolus. At our agency we encourage the use of a bolus given via the infusion pump over two to four minutes immediately followed by a maintenance infusion, given concerns of recurrent tachycardia or hypotension secondary to rapid bolus administration. We examined if administering a bolus and infusion via an infusion pump shows better heart rate (HR) control at arrival to the emergency department (ED) compared with administration of a bolus only, while maintaining hemodynamic stability during transport. We also analyzed if a patient received a second bolus within 60 min of arrival to the ED. Methods We used a retrospective propensity-matched cohort of prehospital patients with atrial fibrillation for whom diltiazem was administered, from 1/1/2018 to 12/31/2021, in our system of 10 New Jersey paramedic units. We analyzed the age, gender, and initial HR and used it to match groups. We analyzed the mode and time of administration, dosage of the bolus, and presence of hypotension prehospitally. Results The matched groups contained 145 patients who received a prehospital diltiazem bolus only (BO) and 146 patients who received a diltiazem bolus and infusion (BI). There was no significant difference between the mean change in HR from initial paramedic arrival to ED arrival between the two groups (BO 38 vs. BI 34, p = 0.16). There was no significant difference in the need for a second bolus within the first 60 min of arrival to the ED (BO 9.7% vs. BI 11.6%, p = 0.30). Patients in the BO group were more likely to experience prehospital hypotension then in the BI group (BO 17.2% vs BI 8.2%, p = 0.01), despite receiving smaller initial bolus doses (BO 14.2 mg vs. BI 17.4 mg, p < 0.001). Conclusion Our results show no significant differences in HR control or need for repeat bolus at the ED with the use of a diltiazem infusion following a diltiazem bolus. However, even when administering larger boluses, the use of an infusion pump resulted in less hypotension.

Comparison of the Adjunctive Effect of Tranexamic Acid and Infusion Oxytocin on Blood Loss at Caesarean Section - A Randomised Study

Background: Postpartum haemorrhage is a major complication at caesarean section. Tranexamic acid and oxytocin infusion have been used for prophylaxis. Aim: To compare the effectiveness of prophylactic adjunctive use of Tranexamic acid and oxytocin infusion at caesarean section to reduce blood loss. Method: A randomised study at ABUTH, Zaria, in which 144 women, scheduled for elective or emergency caesarean section at term, were sequentially randomised into two groups of 72 each. The Tranexamic acid group received 1g intravenous and 500ml of Normal saline as placebo while the oxytocin group received placebo and 500ml of Normal saline containing 20IU of oxytocin after delivery of the neonate. Both adjunctive groups received 10IU Oxytocin as part of AMTSL. Trial registry: PACTR 202004568331645. Ethical approval: ABUTHZ/HREC/D37/2018. Result: There was no significant difference in parity, gestational age and indication for caesarean section in both groups p&lt;0.287, 0.270 and 0.095 respectively. There was no significant difference in primary outcome with mean blood loss 561.06 ± 209.23ml versus 567.78 ± 205.91ml in the Tranexamic acid and oxytocin group respectively, p&lt;0.847. Need for additional uterotonic agent and side effect profile were significantly reduced in the Tranexamic acid group. There was no significant difference in need for blood transfusion and haemodynamic status of parturient in both groups. There was no significant difference in mean blood loss at emergency versus elective caeserean section, 565.83± 205.51ml versus 567.97± 217.42ml respectively, p&lt;0.921.Blood loss in those with 1 previous CS was comparable in both groups 537.75± 209.69ml versus 522.05± 176.43ml respectively, p&lt;0.374, however, for those with 2 or more CS, while there was a clinical (reduction) difference of 80ml in the Tranexamic acid group, it was not statistically significant. 594.55± 0.91ml versus 674.06± 1.99ml respectively, p&lt;0.476. Conclusion: There is comparative adjunctive efficacy of Tranexamic acid and oxytocin infusion at caesarean section. Keywords: Caesarean delivery, Oxytocin infusion, Tranexamic acid, Postpartum haemorrhage

Paraesophageal hernia recurrence following repair: making the case for reoperative surgery in a propensity-matched cohort.

Paraesophageal hernia repairs (PEHRs) have high rates of radiographic recurrence, with some patients requiring repeat operation. This study characterizes patients who underwent PEHR to identify the factors associated with postoperative symptom improvement and radiographic recurrence. We furthermore use propensity score matching to compare patients undergoing initial and reoperative PEHR to identify the factors predictive of recurrence or need for reoperation. After IRB approval, patients who underwent PEHR at a tertiary care center between January 2018 and December 2022 were identified. Patient characteristics, preoperative imaging, operative findings, and postoperative outcomes were recorded. A computational generalization of inverse propensity score weight was then used to construct populations of initial and redo PEHR patients with similar covariate distributions. A total of 244 patients underwent PEHR (78.7% female, mean age 65.4 ± 12.3years). Most repairs were performed with crural closure (81.4%) and fundoplication (71.7%) with 14.2% utilizing mesh. Postoperatively, 76.5% of patients had subjective symptom improvement and of 157 patients with postoperative imaging, 52.9% had evidence of radiographic recurrence at a mean follow-up of 10.4 ± 13.6months. Only 4.9% of patients required a redo operation. Hernia type, crural closure, fundoplication, and mesh usage were not predictors of radiographic recurrence or symptom improvement (P > 0.05). Propensity weight score analysis of 50 redo PEHRs compared to a matched cohort of 194 initial operations revealed lower rates of postoperative symptom improvement (P < 0.05) but no differences in need for revision, complication rates, ED visits, or readmissions. Most PEHR patients have symptomatic improvement with minimal complications and reoperations despite frequent radiographic recurrence. Hernia type, crural closure, fundoplication, and mesh usage were not significantly associated with recurrence or symptom improvement. Compared to initial PEHR, reoperative PEHRs had lower rates of symptom improvement but similar rates of recurrence, complications, and need for reoperation.

‘Door-to-prophylaxis’ as a novel quality improvement metric in prevention of venous thromboembolism following traumatic injury

ObjectiveVenous thromboembolism (VTE) risk reduction strategies include early initiation of chemoprophylaxis, reducing missed doses, weight-based dosing and dose adjustment using anti-Xa levels. We hypothesized that time to initiation of chemoprophylaxis...

Intersectional disparities in outpatient alcohol treatment completion by gender and race and ethnicity.

Untreated alcohol use disorder (AUD) can have negative outcomes, including premature death. Completing specialty treatment for AUD can improve economic and educational outcomes. However, there are large racial and ethnic disparities in treatment completion, and how these disparities vary intersectionally (e.g., by gender and race and ethnicity) is unknown. Recent studies suggest that not using an intersectional approach can mask important disparities. We estimated disparities in AUD nonintensive outpatient treatment completion by gender alone, race and ethnicity alone, and intersectionally in a gender-by-race-and-ethnicity model. Accurately quantifying treatment completion disparities is critical not only for understanding healthcare disparities but reducing them to advance health equity. Data are from SAMHSA's 2017 to 2019 Treatment Episode Dataset-Discharges for adults aged 18+ who entered nonintensive outpatient treatment primarily for alcohol (n = 559,447 episodes; 30.3% women; 63.7% White, 18.0% Black, 14.4% Hispanic/Latinx, 2.1% American Indian/Alaska Native [AIAN], 1.0% Asian/Pacific Islander). Using the rank-and-replace method, treatment completion disparities were estimated by gender, race and ethnicity, and gender-by-race-and-ethnicity due to any reason other than differences in need for treatment, consistent with the Institute of Medicine's definition of a healthcare disparity. The intersectional gender-by-race-and-ethnicity model identified the widest range of disparities among all models tested. Using this model, the largest disparities were identified for minoritized women's treatment episodes. Compared to White men whose completion rate was 60.79% (95% confidence interval [CI]: 60.06, 60.98), Black, Hispanic/Latina, AIAN, and Asian-American/Pacific Islander women had treatment episode completion rates that were 12.35 (CI: 12.33, 12.37), 9.08 (CI: 9.06, 9.11), 10.27 (CI: 10.22, 10.32), and 4.87 (CI: 4.78, 4.95) percentage points lower, respectively. In the United States, treatment completion rates for non-intensive outpatient alcohol treatment episodes are significantly lower for minoritized women than White men. The extent of the disparity is not apparent in univariate models, highlighting the importance of an intersectional approach to understanding disparities in the completion of non-intensive outpatient treatment for AUD.

Familial retinoblastoma: variations in clinical presentation and management based on paternal versus maternal inheritance

BackgroundSeveral studies have demonstrated the effect of parent-of-origin on retinoblastoma penetrance. The purpose of the current study was to assess differences in clinical presentation of paternally versus maternally inherited retinoblastoma. MethodsThe clinical records of all children with familial retinoblastoma treated on a tertiary Ocular Oncology Service between December 1975 and May 2020 were reviewed retrospectively. ResultsA total of 179 patients with familial retinoblastoma were included. Paternal inheritance (PI) was identified in 109 (61%) patients and maternal inheritance (MI) in 70 patients (39%). A comparison (PI vs MI) revealed PI patients were older at presentation (57.2 vs 24.4 months [P = 0.002]) with no difference in patient sex (53% females vs 57% males [P = 0.606]) or number of family members affected (3.2 vs 3.0 family members [P = 0.255]). PI patients had more advanced classification according to the International Classification of Retinoblastoma (ICRB) (group E: 31% vs 8% [P = 0.012)] and greater largest tumor in basal diameter (9.0 vs 6.2 mm [P = 0.040]) and thickness (5.6 vs 4.0 mm [P = 0.038]); they were also less likely to be located in the macula (40% vs 60% [P = 0.004]). There was no difference in tumor laterality (69% vs 64% bilaterality [P = 0.530]). PI patients required enucleation more frequently (34% vs 14% [P = 0.007]). There was no difference in need for plaque radiotherapy (P = 0.86) or chemotherapy (P = 0.85). One PI patient developed metastatic retinoblastoma, and there were no retinoblastoma-related deaths. ConclusionsPatients with paternally inherited retinoblastoma presented at an older age, with larger, more peripheral tumors and more advanced ICRB group, and were more likely to require enucleation compared to those with maternally inherited retinoblastoma.

Implications of Single-Vessel Runoff on Long-Term Outcomes of Free Tissue Transfer for Lower Extremity Reconstruction.

Patients with complex lower extremity (LE) wounds and single-vessel LE runoff (1-VRO) are often considered for amputation. While more challenging, free tissue transfer (FTT) is a means for limb salvage. This study aims to demonstrate the feasibility of limb salvage with FTT in patients with 1-VRO. Patients undergoing FTT by a single surgeon between 2011 and 2021 were retrospectively reviewed. Data collected included demographics, wound characteristics, vascular status, and operative details. Patients were divided into cohorts based on 1- versus 3-VRO of tibial vessel inflow. Outcomes of interest included postoperative complications such as flap necrosis, flap success, limb salvage, and ambulatory status. A total of 188 patients underwent FTT to LE, with 25 patients (13.3%) having 1-VRO. Patients with 1-VRO had a comparable prevalence of diabetes (56.0% vs. 50.0%, p = 0.569) and end-stage renal disease (8.0% vs. 3.7%, p = 0.319). Osteomyelitis was more common in the 1-VRO group (80.0% vs. 60.1%, p = 0.056). FTT donor sites and flap composition were similar between cohorts. At mean follow-up of 21.2 months (interquartile range 24.5:5.6, 30.1 months), limb salvage rates were similar between cohorts (84.0% vs. 91.4%, p = 0.241), with no significant differences in ambulatory status or mortality. Higher complication rates occurred in the 1-VRO cohort (48.0% vs. 21.5%, p = 0.004), of which partial flap necrosis was more prevalent in the 1-VRO group (8.0% vs. 1.2%, p = 0.029). There was no difference in flap success rates between groups (p = 0.805). More postflap angiograms were performed in the 1-VRO group (32.0% vs. 9.2%, p = 0.001), but there was no difference in need for repeat percutaneous endovascular intervention between groups. This study demonstrates that FTT reconstruction to the LE remains a reliable reconstruction option for limb salvage in patients with single-vessel supply to the LE. Reliance on advanced perioperative management and patient optimization is effective at reducing negative outcomes.

No Difference in Range of Motion, Components, or Complications Following Conversion of Robotic-Assisted Total Knee Arthroplasty Compared to Manual TKA After Undergoing Manual or Robotic-Assisted Unicompartmental Knee Arthroplasty

BackgroundConversion surgery from unicondylar knee arthroplasty (UKA) to total knee arthroplasty (TKA) remains a challenge due to scarring, implant/cement removal, and loss of bony landmarks. Robotic-assisted (RA) TKA may assist in challenges seen in manual conversion TKA. The aim of this study is to identify if there are differences in components and functional outcomes dependent on manual/RA primary UKA and conversion TKA. MethodsA retrospective chart review was performed on patients undergoing conversion from UKA to TKA over a 10-year period at a single institution. Data extracted included surgical technique, reason for UKA failure, range of motion at 1 year, need for augments, and utilization of revision components. ResultsForty-nine patients (50 knees) with a UKA converted to a TKA were divided into 4 groups based on primary and conversion surgery: manual-to-manual (n = 11), manual-to-robot (n = 11), robot-to-manual (n = 11), and robot-to-robot (n = 17). There was no difference in need for augments (P = .376), size of poly (P = .23), postoperative flexion (P = .52), or extension (P = .76) at 1 year between the 4 groups. However, patients with primary manual UKA did require significantly more augments during revision (P = .032). ConclusionsOur study did not show any statistically significant differences of primary RA or manual UKA to RA or manual TKA in terms of range of motion at 1 year, complications, or differences in components. RA conversion from UKA to TKA is a new but equivalent technique to manual conversion. Primary surgery may impact the requirement for augments during conversion surgery.

CSR-company fit in the sin industry: addressing negative contributions, NFC, and perceived motives

ABSTRACT Guided by the persuasion knowledge model, this study investigated how the fit between corporate social responsibility (CSR) and a sin company that makes negative societal contributions influences consumers’ responses. Specifically, using a sample of 234 Koreans, it examined whether individual differences in need for cognition (NFC) moderate CSR-company fit and how such NFC-moderated fit affects consumers’ responses through two distinct perceived motives (i.e. public-serving motive, self-serving motive). The analysis showed that NFC moderated the fit’s influence on perceived public-serving motives, perceived self-serving motives, and attitudes toward CSR. It also indicated that the NFC-moderated fit indirectly impacted attitudes toward CSR and positive word-of-mouth intentions via perceived public-serving motives.

Does framing climate change policies to fit with epistemic needs for predictability reduce conservatives’ opposition?

AbstractA short‐term obstacle to united political action to fight climate change in various countries is opposition to pro‐environmental policies among conservatives. Three preregistered studies test the hypothesis that because conservatives have a higher need for closure than liberals (Hypothesis 1), framing pro‐environmental policies in a way that appeals to the need for closure, reduces conservatives’ opposition to these policies (Hypothesis 2). Study 1 confirms Hypothesis 1. Next, two studies test Hypothesis 2 and find that conservatives are less opposed to pro‐environmental policies proposed by a politician (Study 2) or an NGO (Study 3) if these policies are framed in a way that appeals to the need for closure, while the opposite is the case for liberals. Across these two studies, we also test the underlying process but find no evidence for the idea that differences in need for closure mediate the effect (Hypothesis 3a). Instead, the effect is primarily driven by inferences about group membership and ingroup bias (Hypothesis 3b, non‐preregistered). That is, these data suggest that framing policies to appeal to closure needs reduces conservatives’ opposition because they infer that the policy is proposed by a fellow conservative.

Prophylactic anticoagulants for non-hospitalised people with COVID-19.

Prophylactic anticoagulants for non-hospitalised people with COVID-19.

Effects of Different Anticoagulation Doses on Moderate-to-Severe COVID-19 Pneumonia With Hypoxemia.

Background COVID-19is a prothrombotic disease that can cause thromboembolism and microthrombi, which could lead to multiorgan failure and death. Since COVID-19 is a relatively new disease, there are guidelines for anticoagulation dosing for COVID-19 patients without consensus on the dosing. We studied the effects of different doses of anticoagulation in hospitalized patients with COVID-19 pneumonia and hypoxemia on any differences in need for high-flow oxygen, mechanical ventilation, and mortality. We also analyzed the patient population who benefited most from anticoagulation. Methodology We performed a retrospective chart review of all patients who were admitted with the diagnosis of COVID-19 infection with positive polymerase chain reaction, pneumonia (confirmed either by chest X-ray or CT chest), and hypoxemia (oxygen saturation of <94%, while on room air). These patients were studied for outcomes (the need for high-flow oxygen, the requirement for mechanical ventilation, and overall mortality) for different doses of anticoagulation (prophylactic, escalated, and therapeutic). Results The sample consists of 132 subjects, predominantly males (116, 87%), with a mean age of 59 years and a standard deviation of 15. About one-third of the participants had diabetes, and more than 50% had hypertension. Additionally, 27 (20.3%) had a history of heart disease, and 70 (53%) of the subjects were admitted to the intensive care unit (ICU) at some point during the study. Among those admitted to the ICU, about 11 (8%) subjects required mechanical ventilation and 16 (12%) passed away during the study. Those who died had higher use of high-flow oxygen, noninvasive mechanical ventilation, and invasive mechanical ventilationand had a longer stay on mechanical ventilation. There was no significant difference in mortality or need for mechanical ventilation for any strategy of anticoagulation. Conclusions Different doses of anticoagulation did not show any statistically significant relationship between the need for mechanical ventilation and mortality. More patients on high-flow oxygen had received escalated doses of anticoagulation as compared to those who were not on high-flow oxygen. Anticoagulation levels did not have any statistically significant effect on overall survival of patients.