Psychosocial considerations in the assessment of hand transplant candidates: A single-center experience and brief literature review.

Vascularized composite allograft, including hand transplantation (HT), has gained wider usage as a reconstructive treatment over the past 30 years. HT recipients face unique psychosocial challenges compared to their solid organ and/or bone marrow transplant counterparts. Accordingly, the psychosocial evaluation among HT candidates continues to evolve, leaving a lack of consensus as to the critical psychosocial domains and psychometric testing instruments to help evaluate individuals considering HT. The present manuscript describes the psychosocial evaluation process within the Duke HT program, which been contacted by 80 potential candidates since 2014. The Duke HT evaluation process incorporates a comprehensive psychosocial assessment within domains including personality, cognitive function, mood, behavioral adherence, social support, and substance use history, among others. Our experience underscores the potential utility of collecting thorough psychosocial evaluations, supplemented by psychometric test data, to comprehensively assess potential HT candidates.

Relation between prefracture characteristics and perioperative complications in the elderly adult patient with hip fracture.

BACKGROUND: The exact relation among patient prefracture characteristics such as age, American Society of Anesthesiologists (ASA) class, fracture type, and prefracture mobility status with perioperative complications in elderly adult patients with hip fracture is still unclear. The aim of the study was to assess the relations among patient prefracture characteristics and perioperative complications. METHODS: Patients 65 years old and older admitted to our institution between January 2006 and May 2010 with the diagnosis of a low-energy hip fracture were retrospectively reviewed. A total of 389 patients met the inclusion criteria and were analyzed in this investigation. Patient prefracture characteristics, comorbidities, and surgical and hospital courses were reviewed. RESULTS: Using logistic regression analysis, ASA class was found to be the only significant predictor of a patient having at least one or more perioperative complications (odds ratio [OR] 2.007). In addition to ASA class, prefracture mobility status was a significant predictor of delirium (OR 1.39) and pneumonia (OR 1.77), advanced age was a significant predictor of congestive heart failure (OR 1.73), and fracture type was a significant predictor of pneumonia (OR 1.6). None of the examined prefracture characteristics was found to be a significant predictor of pulmonary embolus, deep venous thrombosis, surgical wounds, transfusions, urinary tract infection, or death. CONCLUSIONS: At our institution, certain patient prefracture characteristics, particularly high ASA class, are related to certain perioperative complications. Recognition of patients who possess these risk factors can be used to alert the caregiving team about a potentially complicated hospital course.

Mordedura de perro: un accidente frecuente en la consulta diaria al servicio de vacunación del Hospital del Niño Jesús, Tucumán, Argentina / Dog bite. A frequent accident consulted daily at the vaccination service of the Niño Jesús Hospital, Tucumán, Argentina

En el presente trabajo se relacionan las consultas por mordedura de perro con determinados parámetros. El grupo etáreo más comprometido es el de 0 a 15 años (63.8 por ciento), teniendo la mayoría de los accidentes su origen en perros vivos conocidos (80.1 por ciento) y no vacunados (74.9 por ciento), ocurriendo el 52.1 por ciento de las mordeduras en un domicilio. Predominan las lesiones en miembros inferiores (49.6 por ciento). Prácticamente en la mitad de los casos (49.4 por ciento) no hubo motivo aparente para que el animal mordiese. El 62 por ciento de las veces fueron mordeduras únicas.