Rewarding Procedure Research Articles

Discrete Choice Experiment on Financial Incentives for Engaging Young Adults in Vaping Cessation Programs

Introduction Contingency management involves rewarding individuals based on objective evidence of behavioral changes. This study explores preferences for financial incentives in vaping cessation programs. Methods A discrete choice experiment (DCE) was conducted among young adult current e-cigarette users aged 19-29. DCE attributes (and levels) included reward amount ($100, $300), reward schedule (consistent value, escalating value), reward procedure (gain-framed, loss-framed), vaping education modules (yes, no), text messaging support (yes, no), and cost ($30, $100). Participants were randomized into one of the four blocks, each containing four choice sets. Each choice set presented two hypothetical vaping cessation programs. Choice data (n × choice sets × alternative programs = 154 × 4 × 2 = 1,232 observations) were analyzed using generalized estimation equation models. Results Participants showed a preference for vaping cessation programs offering a higher reward amount (odds ratio [OR] = 11.5; 95% CI,7.0-19.2), gain-framed rewards for sustained abstinence (OR = 1.4; 95% CI,1.0-1.8), text messaging support (OR = 1.9; 95% CI,1.4-2.5), and a lower program cost (OR = 2.6; 95% CI,1.8-3.8). Interaction tests showed significant effects of the rewards procedure among daily e-cigarette users (adjusted OR [AOR] = 2.1; 95% CI,1.3-3.5), but not some-day users; and among those with no quit attempts in the past six months (AOR = 2.7; 95% CI,1.5-4.7), but not those with previous quit attempts. Female participants preferred text messaging support (AOR = 3.6; 95% CI,2.3-5.4), whereas male participants did not show this preference. Conclusion A multifaceted vaping cessation intervention augmented with financial incentives might improve participation and engagement among young adults. Future studies should investigate how these attributes can enhance program reach and vaping abstinence outcomes in real-world settings.

Factors Influencing Bone Resorption after Augmentation Mentoplasty with Implants: A Retrospective Study Using Three-Dimensional Imaging.

Augmentation mentoplasty with implants is an extremely rewarding procedure. Bone resorption is almost unavoidable. The high-risk factors for chin bone resorption have not been explored in the past. This study aimed to analyze and evaluate the factors influencing bone resorption after augmentation mentoplasty with implants using three-dimensional imaging. We retrospectively analyzed preoperative craniofacial Computed Tomography scan data from 105 patients who underwent mandibular implantation surgery and 108 patients who did not. We also examined the extent to which different factors influenced the occurrence of bone resorption in the chin area. Patients with silicone gel implants are more prone to bone resorption than those with Medpor implants. Patients who experienced bone resorption had thicker mentalis muscles than those who did not experience bone resorption (6.35 ± 1.mm vs. 5.73 ± 1.25mm, P < 0.05), and thinner cortical bone (3.25 ± 1.65mm vs. 5.22 ± 2.04 mm, P < 0.05). Additionally, implants placed above the mandibular bone were more likely to induce bone resorption than those placed below it. This study is the first to systematically reveal the impact of implant type, placement position, mentalis muscle thickness, and cortical bone thickness on bone resorption after chin augmentation surgery. For patients with thicker mentalis muscles and thinner cortical bones, greater attention should be paid to the occurrence of bone resorption. Choosing silicone implants or placing the implants higher on the mandible can help reduce the occurrence of bone resorption. This study can assist clinicians in selecting appropriate treatment methods, thereby reducing post-implantation bone resorption. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Data-driven stabilized finite element solution of advection-dominated flow problems

In this article, we address the solution of advection-dominated flow problems by stabilized methods, by means of data-driven least-squares computed stabilized coefficients. As main methodological tool, we introduce a data-driven off-line/on-line strategy to compute them with low computational cost.We compare the errors provided by the data-driven stabilized coefficients to those provided by several previously established stabilized coefficients within the solution of advection–diffusion and Navier–Stokes flows, on structured and un-structured grids, with Lagrange Finite Elements up to third degree of interpolation. We obtain substantial error improvements for high-order finite element interpolation.We conclude that the data-driven procedure is a rewarding procedure, worth to be applied to general stabilized solutions of general flow problems.

High survivorship and low complication rate in a single-centre series of 651 medial opening wedge high tibial osteotomy cases with a mean follow-up of 13 years.

This study aimed to report the early to midterm results of medial opening wedge high tibial osteotomy (MOWHTO) from the largest single-centre osteotomy database. The primary outcomes were reporting the radiological corrections and the functional outcomes represented by multiple patient-reported outcome measures (PROMs). The secondary outcomes were to report the complications, revisionsand survivorship up to 10 years postoperatively. A prospectively maintained single-centre database of 1138 knee osteotomies was retrospectively reviewed. Patients who underwent MOWHTO and met the inclusion criteria were included. Those inclusion criteria were moderate to severe knee pain that failed conservative management;varus knee malalignment; and isolated medial osteoarthritis of the knee. A total of 651 cases, with a mean age of 46.7 ± 9 years and a mean body mass indexof 29.6 ± 5.2 kg/m2 , were included. This comprised 71% males (n = 462) and 29% females (n = 189). The mean follow-up was 158.1 ± 45.4 months. Multiple PROMs were recorded preoperatively and serially postoperatively. This included the Knee injury andOsteoarthritisOutcome Scores, the Oxford Knee Score, the Oxford Knee Score-Activity and Participation Questionnaire, the Western Ontario and McMaster University Scores, the Visual Analogue Scale for health and pain, and the EQ-5D, which is a standardised measure of health-related quality of life. All lower limb alignment measurements were recorded pre- and postoperatively. The rates of osteotomy revision, conversion to arthroplasty, complications, and 5- and 10-year survivorship were recorded. A total of 651 cases were followed up to a mean of 158.1 ± 45.4 months. The mean planned correction angle was 7.6° ± 2.9°. The mean planned opening wedge distance was 8.1 ± 3.1 mm. The mean intraoperative anterior and posterior osteotomy gaps opening were 7.7 ± 3.4and 8.9 ± 3.8 mm, respectively. Postoperatively, the mean mechanical tibiofemoral angle improved from -5.7° ± 2.9° varus to 1.3° ± 2.5° valgus, the mean medial proximal tibial angle improved from preoperative 85.5° ± 2.3° to postoperative 91.6° ± 2.7°and the mean Mikulicz point improved from 21.7 ± 12.6% to 54.8 ± 11% (all p values < 0.001). All PROMs significantly improved at 24 months follow-up (all p values < 0.001). The rate of osteotomy revision was 1.1% at a mean of 2 ± 2.5 years postoperatively. The overall rate of arthroplasty conversion was 9.1%. This comprised 5.8% total knee arthroplasty conversion at a mean of 6.9 ± 3.5 years postoperatively and 3.2% unicompartmental knee arthroplasty conversion at a mean of 5.7 ± 2.5 years postoperatively. An overall 10.3% complication rate was recorded. The 5 and 10-year survivorship was 97.2%and 91.9%, respectively. MOWHTOis a radiologically and clinically rewarding procedure with a high survival rate at 5 and 10 years and a low complication rate in experienced hands. MOWHTO should be considered in patients presenting with medial unicompartmental knee pain with an evidence of overload and a varus mechanical coronal plane axis. Level IV, retrospective cohort study.

Real, potentially real, and hypothetical monetary rewards in probability discounting.

Although hypothetical rewards have been used almost exclusively in human discounting studies, investigations of their validity are limited. The present experiment compared the discounting of monetary reward value by probability across conditions in which the rewards were real, potentially real, and hypothetical. Twenty-four undergraduates choose between an uncertain large reward and a certain small reward 60 times (trials). In the real and hypothetical reward conditions, the participants made choices with real and hypothetical money, respectively, in every trial. In the potentially real condition, they did so with real money in randomly selected three of the 60 trials and with hypothetical money in the remainder. The log10 -transformed h values of a hyperbolic probability-discount function and the values of the area under the curve with an ordinal transformation of odds against were higher and lower, respectively, in the potentially real and in the hypothetical reward conditions than in the real reward condition, demonstrating that the probability discounting of hypothetical monetary rewards was larger than that of real rewards. These results suggest that future studies are required to identify why the hypothetical reward procedure overestimates the discounting rates of real rewards.

Flexible bronchoscopy in pediatric intensive care unit

Flexible bronchoscopy (FB) is a very rewarding procedure in the evaluation and management of appropriately selected children with respiratory issues in pediatric intensive care unit (PICU). An understanding of the alterations in respiratory physiology (airway resistance, compliance, and air exchange) during FB is absolutely essential for the safety of the child. To reduce discomfort and other side effects of FB it is necessary to optimize the condition of the child including sedation, analgesia, paralysis, ventilator settings, and cardiovascular status. With advancements in technology and instrumentation many interventional procedures can be performed safely and effectively using access to the airway through the endotracheal tube, tracheostomy tube, or Laryngeal Mask Airway (LMA). Close monitoring during and after FB minimizes complications.

A Single-Center Experience With Gynecomastia Treatment Using Liposuction, Complete Gland Removal, and Nipple Areola Complex Lifting Plaster Technique: A Review of 448 Patients.

Gynecomastia is defined as a benign enlargement of male breast glandular tissue. It is the most common breast condition in male, and the prevalence ranges from 32% to 72%. No standardized treatment exists for gynecomastia. The authors treat gynecomastia patient with liposuction and complete gland excision through periareolar incision without skin excision. In case of skin redundancy, the authors use their special technique called nipple areola complex (NAC) plaster lift technique. The authors conducted the retrospective analysis of patient who underwent gynecomastia surgery between January 2020 and December 2021 at Chennai Plastic Surgery. All patients were treated with liposuction, gland excision, and NAC lifting plaster when required. The follow-up period ranges from 6 to 14 months. A total of 448 patients (896 breasts) were included in our study with average age of 26.6 years. Grade II gynecomastia was most common in our study. The average BMI of the patients was 27.31 kg/m2. One hundred and sixteen patients (25.9%) experienced some form of complication. Seroma was most common complications in our study followed by superficial skin necrosis. Patient satisfaction rate was high in our study. Gynecomastia surgery is safe and highly rewarding procedure for surgeons. Various technologies and methods like liposuction, complete gland excision, and NAC lifting plaster technique should be adopted in gynecomastia treatment to give a better patient satisfaction. Complications are common in gynecomastia surgery but easily manageable.

EAR RECONSTRUCTION SURGERY: OUTCOME ANALYSIS OF 108 PATIENTS

Objective: To find out the outcome of the ear Reconstruction and its association with improvement in psychological wellbeing along with physical benefits.&#x0D; Study Design: A cross-sectional study.&#x0D; Place and Duration of Study: Department of Plastic Surgery and ENT, Combined Military Hospital Quetta and Multan in liaison with the department of Psychiatry, from Jan 2017 to Jan 2021.&#x0D; Methodology: A sample size of 108 was estimated while keeping level of significance 5%, confidence level 90%, estimated true proportion 63% based on the observation made in the study by Steffen, and 5% of absolute precision. Specific performas were filled by the patient pre and post operatively and data analysis was performed using SPSS-20.&#x0D; Results: The mean age was 20 ± 8.75 years with a range of 12-29 years. Thirteen (11.11%) were male and ninety-five (87.8%) were females, 14 (12.9%) were married, 94 (86%) were un-married and all (100%) had social support. Fifty-two (48.1%) had primary education. Ninety-four (94%) were un-employed. Fifty-five (50.9%) of participants had congenital ear defect. Ninetyeight (90.7%) of the participants showed confidence in surgical procedure and would go for the same procedure if required, 5 (4.6%) said no to the same procedure while 8 (7.4%) did not know whether to opt for same procedure.&#x0D; Conclusion: Ear Reconstruction is a very rewarding procedure for surgeon and patients. Apart from aesthetic and functional improvement it also enhances the self-esteem of the patients.

Shoulder Arthrodesis for Traumatic Brachial Plexus Injuries: Functional Outcomes and Complications.

The external rotation and abduction of shoulder are considered one of the priorities of reconstruction in brachial plexus injury. The aim of this study was to evaluate the functional results and complications of shoulder arthrodesis in patients with brachial plexus injury to better comprehend the benefits of this procedure. Between 2015 and 2019, 15 shoulder arthrodesis were performed in patients with long-standing brachial plexus injury. The main indication for arthrodesis was absent or poor recovery of shoulder abduction and external rotation. Patients presented different levels of injury. Shoulder measurements of active abduction and external rotation were made based on image records of the patients. A long 4.5-mm reconstruction plate was fit along the scapular spine, acromion, and lateral proximal third of the humerus. Structured bone graft was fit into the subacromial space. The mean preoperative abduction was 16°, and the mean postoperative abduction was 42°. The mean preoperative external rotation was -59°, and the mean postoperative external rotation was -13°. The mean increase in abduction and external rotation was 25° and 45°, respectively. Bone union was achieved in all cases at an average time of 5.23 months. We experienced humeral fractures in 26.66% of the cases, which were all successfully treated nonoperatively. Shoulder arthrodesis is a rewarding procedure for patients with brachial plexus injuries. A marked improvement in the upper limb positioning was observed in all patients. It should be considered as the main therapeutic option in cases where nerve reconstruction is no longer possible.

AMNION GRAFT VAGINOPLASTY IN VAGINAL AGENESIS

Vaginal agenesis seen in Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome is a condition with significant psychological and social consequences where there is embryonic underdevelopment of müllerian duct. It is estimated to occur one in 4000 to 5000 live births. Normalizing sexual life with vaginal reconstruction to adequate length is usually the treatment of choice. Among many non-surgical and surgical options available, McIndoe vaginoplasty is the commonest surgical management performed worldwide with various modifications, like the use of amnion as a graft. A 19-year-old girl with normal secondary sexual characters came with vaginal agenesis with hypoplastic uterus. MRI revealed streak like structure over the pelvis with imperforate hymen and atresia of the vagina. Surgical intervention included creation of vaginal canal from a potential space between urethra and bladder above and rectum below and a fresh amnion mounted mould was placed within the canal. The amnion graft was seen well taken with resultant 4 to 5 cm of vaginal canal when mould was removed 10 days later. She was counselled and taught to remove and insert the mould to prevent vaginal narrowing and maintain the length. Amnion graft vaginoplasty has with good success rate with minimal postoperative pain, infection and scarring and thus is a rewarding procedure especially in low resource countries.

(±)VK4‐40, a novel dopamine D3 receptor partial agonist, attenuates cocaine reward and relapse in rodents

Despite widespread abuse of cocaine, there are no approved treatments for cocaine use disorder. Chronic cocaine use is associated with up-regulated dopamine D3 receptor expression in the brain. Therefore, most D3 -based medication development has focused on D3 antagonists. However, D3 antagonists do not attenuate cocaine intake under "easy" self-administration conditions, when response requirements are low. We evaluated a novel, highly selective and metabolically stable D3 partial agonist, (±)VK4-40, for its efficacy in reducing cocaine intake and relapse to drug seeking. The impact of (±)VK4-40 on cocaine intake and relapse was evaluated using intravenous self-administration procedures under a fixed-ratio 2 reinforcement schedule and cocaine-primed reinstatement conditions in rats. Optogenetic brain-stimulation reward procedures were used to evaluate the interaction of (±)VK4-40 and cocaine in the mesolimbic dopamine system in mice. Sucrose self-administration in rats and a conditioned place preference paradigm in mice were used to evaluate the abuse potential of (±)VK4-40 alone and other unwanted effects. (±)VK4-40 dose-dependently reduced cocaine self-administration and cocaine-primed reinstatement of drug-seeking behaviour. (±)VK4-40 also inhibited cocaine-enhanced brain-stimulation reward caused by optogenetic stimulation of dopamine neurons in the ventral tegmental area. (±)VK4-40 alone decreased brain-stimulation reward but produced neither conditioned place preference nor place aversion. This new D3 partial agonist also failed to alter oral sucrose self-administration. The novel D3 partial agonist, (±)VK4-40 attenuates cocaine reward and relapse in rodents, without significant unwanted effects. These findings support further investigation of D3 partial agonists as putative treatments for cocaine use disorder.

Is high flexion total knee arthroplasty a rewarding procedure? An updated meta-analysis of prospective randomized controlled trials.

The aim of this study is to provide an updated meta-analysis comparing the benefits and clinical outcomes between high flexion (HF)-TKA and standard (S)-TKA. A detailed database analysis was carried out using Web of Science, PubMed, EMBASE, Cochrane Library, MEDLINE and Clinicaltrial.gov, to identify eligible studies. The meta-analysis and sensitivity analysis were performed using Review Manager 5.3 software and STATA 12.0. Twenty-two randomized control trials (RCTs), including 2841 patients and 4268 knees, were eligible for the meta-analysis. The pooled results of subgroup analysis reveal that there was significant difference between HF-TKA and S-TKA in each subgroup in terms of postoperative ROM, with a higher degree of knee flexion for HF-TKA than S-TKA. However, no statistical difference was identified between HF-TKA and S-TKA in other clinical outcomes including various functional scores and complications. On the basis of this meta-analysis, we can recommended HF-TKA as an alternative choice to S-TKA for patients requiring higher knee flexion in their daily activities.

Pediatric ossiculoplasty: optimizing outcomes.

Despite years of research, pediatric ossiculoplasty remains a challenging surgery with numerous variables factoring into successful outcomes. The aim of this review is to summarize recent publications on surgical technique, timing, and reconstruction materials. The cause behind ossicular discontinuity does not seem to play a role in hearing results after ossiculoplasty; however, revision surgery is associated with worsening outcomes. The status of the ossicles remains an active area of interest, but the data remain mixed in terms of them playing a role in predicting outcomes in adults and pediatric patients. There remains debate regarding the utility of staging the reconstruction and is often undertaken on a case-by-case basis. Other recent publications highlight positive outcomes associated with canal wall-up procedures, titanium prostheses, and partial ossicular reconstruction prostheses. Endoscopic middle ear surgery in ossiculoplasty has been shown to be successful in monitoring and removal of disease and helpful in reconstruction. Pediatric ossiculoplasty remains a challenging yet rewarding procedure. The bulk of publications are retrospective making much of the literature difficult to interpret. There remains a need for prospective and well controlled studies in both adult and pediatric populations.

The Effect of Behavior–based Safety Interventions on the Reduction of Unsafe Behavior

Background: Behavioral-based safety interventions such as the safety training system and reward and punishment procedures were used in most industries in order to reduce unsafe behaviors. Methods: In this applied study, unsafe behavior was evaluated by collecting data through observation, interviews, checklists and the Safety Behavior Sampling technique. After conducting safety training, as well as reward and punishment procedures for two consecutive months, unsafe behaviors were evaluated again. To determine the rate and diversity of the behaviors through a pilot study, a sample size of 1162 was determined to be observed. Moreover, to analyze the data and to specify the relationship between the variables, the ratio test, contingency tables, chi-square test and SPSS 22 statistical software package were used. Results: The results of the study showed that 22.8% of employees’ behaviors were unsafe before applying interventions, which got decreased to 17% after the intervention. There was also a significant relationship between the unsafe behaviors of the employees and their work experience (P-value was 0. 004), age (P-value was 0.023), work shift (P-value was 0.027), day of the week (P-value was 0. 007) and month of year (P-value was 0. 043). Conclusions: The paper indicated that continuous implementation of safety training courses and continuous implementation of the reward and punishment system are necessary in order to reduce unsafe behaviors.

Process reengineering and effectiveness analysis of scientific research achievements reward based on scientific research management system

Objective To make good use of the incentive function of the reward policy of scientific research achievements in hospitals, shorten the reward cycle of scientific and technological achievements, reduce the management cost, achieve the ultimate goal of details management of scientific and technological achievements. Methods Through retrospective analysis of the incentive process to identify possible barriers, reconstruct the rewarding procedures of scientific and technological achievements by bringing in informatization and publicity strategy, compare the bonus distribution cycle with the traditional model. Results The results show that the reward model based on the scientific research management system reduces the bonus arrival waiting period by about 62%, saves management costs and improves staff compliance. Conclusions According to the 4-year practice experiences, the new management model has further released the positive impact of the hospital award policy, solved the key problem of restricting the rewarding effect by technological means in the process of rewarding scientific research achievements. Key words: Scientific research achievements reward; Process reconstruction; Detail management; Scientific research management system; Effect analysis; Hospital

Cervical degenerative myelopathy: Surgical results and factors affecting outcome with special reference to age of patient and duration of symptoms

Currently the global population is experiencing a shift in age structure with proportion of population over 60 years increasing and also with change in lifestyle the number of degenerative myelopathy cases is ever increasing. Cervical degenerative myelopathy is a progressive disabling disorder compelling the patient to be bedridden. It generally requires surgical intervention owing to its progressive nature. The primary goal of surgery is to decompress the spinal cord. This study is an effort to evaluate functional outcome following surgical decompression and factors affecting it. Materials and Methods: 14 patients who presented with cervical degenerative myelopathy were included in the study that underwent decompressive surgery from June 2017 to December 2018. Each patient was graded according to Nurick grade. Pre and postoperative Nurick grade was compared along with age and duration of symptoms. Patients with associated orthopaedic comorbidities were excluded. The associated complications were recorded. Results: Out of 14 cases, 11 cases was subjected to posterior decompressive surgery, ant. Dissectomy and fusion was done in 2 cases and ant. Corpectomy and fusion was done in 1 case according to definite indications. Preoperatively patients had a mean Nurick grade of 3.43 which was reduced to 1.86 postoperatively at 6 months (p< 0.05). Neurological recovery was seen in 93% of cases but the grade of improvement was dependent on age of the patient and duration of symptoms. Conclusion: Surgical decompression is a rewarding procedure for compressive degenerative myelopathy with functional improvement in most patients. However the age and duration of the disease affects the functional outcome of the patient. We recommends that patients with compressive cervical myelopathy undergo surgical intervention as early as possible.

Patellofemoral Arthroplasty.

The first report of patellofemoral arthroplasty (PFA) was published in 19791. Reviews in 2005 and 20072,3 called for studies comparing PFA with total knee arthroplasty (TKA) for isolated patellofemoral osteoarthritis. A blinded randomized controlled trial (RCT) was initiated in 2007 for this purpose, and the first report with 2-year results was awarded the Mark Coventry Award of the Knee Society in 20174. It was found that (1) patients recover more quickly from PFA than from TKA; (2) during the first 2 years after surgery, PFA-treated patients have better average knee function than TKA-treated patients; and (3) PFA-treated patients regain their preoperative range of movement within the first postoperative year whereas TKA-treated patients do not regain it within the first 2 years4. There are general principles that are common to all brands of PFA implants. These include (1) an indication based on bone-on-bone contact in the patellofemoral joint with a preserved tibiofemoral joint; (2) replacing all surfaces of the patellofemoral joint, with metal on the femoral side and polyethylene on the patellar side; (3) ensuring a smooth transition from normal articular cartilage to the trochlear component; and (4) creating normal patellofemoral tracking. The primary treatment of any degenerative condition should be nonoperative, but when such measures are insufficient surgical treatment may be indicated. Many procedures have been suggested for relieving patellofemoral pain, but if there is bone-on-bone contact in the patellofemoral joint, the only current surgical option (except for experimental treatments) is joint replacement-i.e., either PFA or TKA. Our general principle for joint replacement of the knee is to replace only the affected compartment if unicompartmental changes are found. If ≥2 compartments are affected, we perform TKA. This principle is challenged both by proponents of performing TKA in all cases of knee osteoarthritis and by proponents of bicompartmental knee replacement for 2-compartment disease. The 2-year results of our blinded RCT comparing PFA and TKA4 support our current practice of PFA. In our practice, we have found PFA to be a rewarding procedure when the correct indications are used. PFA is likely to remain a fairly rare procedure, but any knee arthroplasty center should be able to offer it.

A study on functional outcome of cemented total hip arthroplasty by Moore’s approach

Background and Objectives: Pain in the hip joint is one of the most important causes in disabling human locomotion. Total hip arthroplasty represents the greatest single advance in modern orthopaedic surgery. Replacement of damaged cartilage surfaces with various artificial bearing materials has enabled surgeons to improve function and relieve pain in vast majority of patients. The present study was conducted to study functional outcome and the complications associated with cemented total hip replacement using modular prosthesis. All the cases are operated by Moore’s approach which is routinely used in our institution. Methods: In this study 30 patients with diseased hips, aged above 40 years, with pathological hip joints were treated with cemented total hip replacement using modular prosthesis by Moore’s approach in our institution and followed up for a period of 1-24 months. Results: Patients were evaluated both functionally and radiologically. Functional evaluation with Modified Harris hip score showed excellent results in 22 hips, good in 6 hips, fair in 2 hips. No poor results were noted. Radiological evaluation at the latest follow up of all cases showed no signs of aseptic loosening or implants failure. Conclusion: This study shows that cemented total hip replacement using modular prosthesis is a rewarding procedure with absolute prevention of limb length discrepancies as a common complication of the total hip arthroplasty. With proper patient selection, adequate planning, armamentarium and meticulous surgical technique, we have achieved results comparable to other authors. In a nutshell, in our institute, this procedure done with utmost technical precision has provided us with very good clinical results. Functional results are excellent and complications are minimal if done with utmost care and precision. Long term studies are necessary to study the late complications and to prove the efficacy of the implants and procedure.

An Assessment of the Role of Working Environment on Performance of Nurses in Devolved Health Services in Baringo County, Kenya

This study sought to assess the role of working environment on performance of nurses in devolved health services in Baringo County, Kenya. The study was motivated by the fact that majority of devolved units have faced a number of challenges in the health sector especially the nurses’ strikes. To achieve this objective, the study adopted descriptive survey design. The population of study comprised of all the nurses working in different health facilities in Baringo County. The health facilities were stratified on the basis of their size; level 1-community health unit, Level 2 - dispensaries, level 3- health centres, level 4- sub-county referral hospital and level5 – county referral hospital. Owing to the large number of nurses in the region, a sample equivalent to 30% was selected. A Pilot study was conducted in two hospitals in Elgeyo/ Marakwet County. Structured questionnaires were used to collect data from these nurses. The data collected were coded and entered into SPSS worksheet to facilitate analysis. Descriptively, data was presented using tables and figures. The regression model applied revealed a significant relationship between the independent variables and performance of nurses. The regression coefficients indicated that recognition, Career development, Management practices and Workload significantly affect performance of nurses. The results also show that lack of recognition will lead to poor performance of nurses under devolved health service. Further, it was evident that the nurses are not rewarded when they do well, but other health workers recognize the important role that nurses play in the hospital. The study findings therefore, imply that the hospital management in devolved health service in Baringo County should; devise reward procedure for employees who have performed well in their duties in order to motivate them to continue performing well. The management should also come up with a policy document spelling out promotion criteria and procedures for filling internal vacancies that ensure fairness for all employees. Further, hospital management should undertake team building programs regularly among their staff in order to enhance good working relationship among all the employees, put in place measures to reduce nurses’ workload by improving the working environment of the existing workforce to reduce seeking other better opportunities and recruiting more nurses regularly to reduce the deficit.

Firmin technique for microtia reconstruction

Microtia reconstruction is a challenging yet rewarding procedure. Many techniques exist for reconstruction of congenital auricular deformities. Although autologous costal cartilage reconstruction has been around for many years, modifications upon these techniques with the goal to provide high quality results while minimizing the number of surgeries and surgical morbidity continue to be published. The Firmin techniques represent modifications based on the Brent and Nagata techniques and will be discussed here. Microtia reconstruction is a challenging yet rewarding procedure. Many techniques exist for reconstruction of congenital auricular deformities. Although autologous costal cartilage reconstruction has been around for many years, modifications upon these techniques with the goal to provide high quality results while minimizing the number of surgeries and surgical morbidity continue to be published. The Firmin techniques represent modifications based on the Brent and Nagata techniques and will be discussed here.