Clinical Outcomes of Low-Cost, Anchorless Repair of the Triceps Tendon Using a Proximal Knot Technique.

PURPOSE: To use validated outcome measures to evaluate the clinical results of surgical repair of distal triceps tendon ruptures using transosseous tunnels and high-strength sutures with proximally based knots. METHODS: A consecutive series of traumatic distal triceps tendon ruptures at a single institution was studied. All cases were surgically repaired by 1 surgeon using high-strength suture with a bone tunnel-based repair technique. Repair knots were oriented proximally instead of in the traditional distal position. All patients were evaluated at long-term follow-up with a physical examination performed by the orthopaedic surgeon and the following validated outcome measures: Disabilities of the Arm, Shoulder and Hand score; Mayo Elbow Performance Score; and visual analog scale score. RESULTS: Seven male patients with a mean age of 38 years (range, 19-50 years) and mean follow-up period of 4.1 ± 1.2 years underwent distal triceps tendon repair with bone tunnels and high-strength sutures with proximally positioned knots. Of the repairs, 4 involved the dominant arm. At final follow-up, the mean Disabilities of the Arm, Shoulder and Hand score was 1.3 ± 3.1; the mean Mayo Elbow Performance Score was 99.3 ± 1.9; and the mean visual analog scale score was 0. One additional patient who declined participation in the study had wound dehiscence and infection with an associated partial rerupture. CONCLUSIONS: This case series of triceps tendon repairs using transosseous tunnels and proximally based knots showed favorable postoperative elbow function based on validated outcome measures. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

Ecological risk based assessment used to restore riparian physical functions to a fresh water Creek.

The purpose of this study was to determine if an interdisciplinary team using a qualitative proper functioning condition (PFC) assessment protocol could identify and reverse significant detrimental ecological alterations which occurred within Gertie's Creek watershed, Ontario, Canada. At potential, Gertie's Creek supported a woody debris glacial outwash fine gravel substrate fish spawning habitat. The anthropogenic activities on Georgina Island caused a denuded anadromous fish population since the early-to mid-1990's in the Gertie's Creek watershed. The PFC assessment indicated that anthropogenic activities on Georgina Island negatively impacted stream flows in Gertie's Creek. Reduced stream flow resulted in the natural stream (lotic) riparian habitat not advancing out of an early seral silver maple and eastern hemlock vegetated swamp (forested wetland) habitat. The Gertie's Creek interdisciplinary team PFC assessment indicated that the entire watershed is not in balance with the water and sediment being supplied along with a lack of diverse riparian vegetation. Sediment was not being transported to the wetland and lake coastal areas because of chronic reduced flows. Further qualitative assessments by the authors of other smaller lentic and lotic ecosystems on Georgina Island indicate that reduced hydrologic flow is an issue for the entire island. Ecosystem function management planning works with the ecosystem to continually respond as the ecology changes in ways that enhance remarkable natural recovery.

Sociodemographic and geographical inequalities in notifiable infectious diseases in Australia: a retrospective analysis of 21 years of national disease surveillance data.

BACKGROUND: Australia is a high-income country with a well established and largely publicly funded health-care system. However, some populations within Australia have shorter life expectancy and worse health outcomes than others. We explored geographical variations and sociodemographic inequities in infectious disease notifications in Australia. METHODS: In this retrospective study, we analysed National Notifiable Diseases Surveillance System (NNDSS) notifications from 1991-2011 (n=2·4 million). We assessed the effect of socioeconomic disadvantage and remoteness of residence on national notification incidence. We calculated Gini coefficients, adjusted relative risks (aRRs), population attributable fractions (PAFs), and attributable notifications. We reported aRRs for Indigenous status in three jurisdictions with more than 75% completeness of Indigenous status reporting from the Northern Territory, South Australia, and Western Australia. FINDINGS: Of the eight most commonly notified diseases from Jan 1, 1991, to Dec 31, 2011, gonococcal infection was the most geographically unequal and campylobacteriosis was the most evenly distributed across the country. Overall, notification incidence was higher in remote and very remote areas than in major cities (aRR 3·37), and higher in the most socioeconomically disadvantaged quintiles compared with less disadvantaged quintiles (aRR 1·15). The PAF for socioeconomic disadvantage was high for blood-borne viral hepatitis but decreased in other disease groups. In 2011, sexually transmitted infections had 11 093 notifications attributed to remoteness and 5597 notifications attributable to socioeconomic disadvantage. Notification incidence was higher in Indigenous than in non-Indigenous Australians (aRR 5·3). INTERPRETATION: All diseases had differing geographical concentration and sociodemographic risk. Overall, sociodemographic inequities in infectious disease notifications have decreased, but remain unacceptably high. National communicable disease control is complex, requiring both targeted and population-wide interventions. FUNDING: None.

Children, Families, and Disparities: Pediatric Provisions in the Affordable Care Act.

The Affordable Care Act has caused and continues to cause sweeping changes throughout the health system in the United States. Poorly explained, complex, controversial, confusing, and subject to continuous legal and regulatory definition, the law stands as a hallmark piece of legislation that will change the health sector in America forever. This article summarizes the Affordable Care Act with a focus on children, families, and disparities. Also provided is the context of the current system of health care coverage in the United States.

Utilizing Radiofrequency Identification Technology to Improve Safety and Management of Blood Bank Supply Chains.

INTRODUCTION: The importance of efficiency in the supply chain of perishable products, such as the blood products used in transfusion services, cannot be overstated. Many problems can occur, such as the outdating of products, inventory management issues, patient misidentification, and mistransfusion. The purpose of this article was to identify the benefits and barriers associated with radiofrequency identification (RFID) usage in improving the blood bank supply chain. MATERIALS AND METHODS: The methodology for this study was a qualitative literature review following a systematic approach. The review was limited to sources published from 2000 to 2014 in the English language. Sixty-five sources were found, and 56 were used in this research study. RESULTS: According to the finding of the present study, there are numerous benefits and barriers to RFID utilization in blood bank supply chains. RFID technology offers several benefits with regard to blood bank product management, including decreased transfusion errors, reduction of product loss, and more efficient inventory management. Barriers to RFID implementation include the cost associated with system implementation and patient privacy issues. CONCLUSIONS: Implementation of an RFID system can be a significant investment. However, when observing the positive impact that such systems may have on transfusion safety and inventory management, the cost associated with RFID systems can easily be justified. RFID in blood bank inventory management is vital to ensuring efficient product inventory management and positive patient outcomes.

Plant metabolomics is not ripe for environmental risk assessment.

Metabolomics separates and detects small molecules and helps determine the composition of plant materials. This makes it appear to be a possible contributor to environmental risk assessment (ERA) of transgenic plants. Here we argue that, despite important advances in the technology, limited annotation and our limited knowledge of the role of metabolites in plant-environment interactions means that metabolomics is not yet ripe for ERA.

Can utilizing a computerized provider order entry (CPOE) system prevent hospital medical errors and adverse drug events?

Computerized provider order entry (CPOE) systems allow physicians to prescribe patient services electronically. In hospitals, CPOE essentially eliminates the need for handwritten paper orders and achieves cost savings through increased efficiency. The purpose of this research study was to examine the benefits of and barriers to CPOE adoption in hospitals to determine the effects on medical errors and adverse drug events (ADEs) and examine cost and savings associated with the implementation of this newly mandated technology. This study followed a methodology using the basic principles of a systematic review and referenced 50 sources. CPOE systems in hospitals were found to be capable of reducing medical errors and ADEs, especially when CPOE systems are bundled with clinical decision support systems designed to alert physicians and other healthcare providers of pending lab or medical errors. However, CPOE systems face major barriers associated with adoption in a hospital system, mainly high implementation costs and physicians' resistance to change.

Evaluation of a breastfeeding assessment score in a diverse population.

A previous study performed in a predominately suburban population developed a breastfeeding assessment score (BAS) that was designed to predict, prior to hospital discharge, those mothers who would discontinue breastfeeding within the first 10 days of age. The purpose of the present study was to assess the BAS in a more diverse population. Patients were solicited from 3 urban hospitals serving patients primarily supported by public funding. Results of the present study with 1182 mother-infant pairs confirmed that 5 variables scored on a 0-2 scale (maternal age, previous breastfeeding experience, latching difficulty, breastfeeding interval, number bottles) remained highly significant for predicting discontinuation of breastfeeding. The data also demonstrate that the BAS is inversely related to the risk of cessation of breastfeeding at 7 to 10 days of age. Those at an early risk of cessation of breastfeeding, identified by the BAS, may benefit from early identification and a lactation consultation.

Enteric vaccines for pediatric use. Workshop summary.

Diarrheal diseases remain a major cause of death in children under 5 in less developed countries (LDCs). Vaccine development and implementation offers the best near-term approach to alleviating this problem. For this reason, a workshop to examine the possibilities for making enteric vaccines available to meet the specific needs of children in LDCs was convened in Virginia on April 24-26, 2004. Discussants considered research and development needs, regulatory and business issues, and previous experiences with enteric vaccine development and implementation. No insurmountable roadblocks to progress in this area were noted, and the possibility currently exists that properly supported efforts will enable the realization of enteric vaccines for pediatric use.

Q fever vaccine uptake in South Australian meat processors prior to the introduction of the National Q Fever Management Program.

Despite the availability of a vaccine, the incidence of Q fever disease among populations at risk continues to be high. Q fever is an important cause of morbidity for workers, particularly in the meat and agricultural industries. Following an increase in 1998 in the number of Q fever notifications among meat processors to the Communicable Disease Control Branch, South Australia, a survey was conducted in the same year to assess the uptake of Q fever immunisation programs in meat processors and to identify barriers to offering these programs. This survey was conducted prior to the introduction of the National Q Fever Management Program in 2001 that provided a targeted vaccination program to specific at-risk occupations. The results of the survey highlighted that very few meat processors in South Australia offered a Q fever immunisation program to their workers. More importantly, this article highlights that there was a wide variety of attitudes and beliefs about Q fever disease and its prevention. These attitudes and beliefs have the potential to impact on whether workers at risk are offered or seek Q fever vaccination. Previous attitudes may return and levels of protection in at-risk occupations will decrease without a concerted effort at a state level. A replication of this study should benchmark the prevailing attitudes about Q fever programs. In response to the 1998 survey a number of strategies and initiatives were developed to address the barriers to Q fever vaccination in South Australian meat processors. The National Q Fever Management Program (2001-2005) further enhanced the ability to address barriers such as vaccine cost.

A breast-feeding assessment score to evaluate the risk for cessation of breast-feeding by 7 to 10 days of age.

OBJECTIVES: To develop a succinct and comprehensive breast-feeding assessment score (BAS) to accurately identify infants at risk for early cessation of breast-feeding before initial hospital discharge. STUDY DESIGN: Mothers who intended to breast-feed their infants were solicited from 9 suburban hospitals. Two detailed data forms covering 107 items were completed before hospital discharge. A third form was completed at 7 to 10 days of age after telephone contact with the mother. RESULTS: Cessation of breast-feeding occurred in 113 of 1075 infants (10.5%). A multiple logistic regression analysis revealed 8 variables that were significant (P <.05) in predicting breast feeding cessation. A BAS was developed based on the odds ratios and relative risks of breast-feeding cessation for these 8 variables. CONCLUSIONS: The BAS was easily and quickly performed before hospital discharge for near term and term infants, which accurately predicted the risk of breast-feeding cessation within 7 to 10 days of age in the population studied.

Noninvasive assessment of the stenotic mitral valve orifice by two-dimensional echocardiography.

Two-dimensional echocardiographic imaging of the mitral valve orifice was attempted in 26 patients with isolated mitral stenosis. The intention was to examine further the clinical usefulness and limitations of this technique for estimating the severity of mitral stenosis. Technically adequate recordings of the mitral orifice were obtained in 20 patients (77%). Mitral valve area calculated from echocardiography compared favorably to the valve area derived from cardiac catheterization with the use of the Gorlin formula (r = 0.95). The average difference between the two methods was 0.109 cm(2). Two-dimensional echocardiography does provide clinically useful data for predicting the degree of mitral stenosis in the majority of patients provided that critical technical limitations are recognized.

Left ventricular function early after aortic valve replacement for aortic regurgitation: Assessment by gated radionuclide ventriculography.

This study characterizes left ventricular performance early after aortic valve replacement for severe isolated aortic regurgitation. Gated radionuclide ventriculography studies in 13 patients showed that left ventricular end-diastolic volume was reduced after surgery and that ejection fraction dropped significantly. Despite the fall in ejection fraction, the postoperative cardiac index was significantly greater than the preoperative value. Radionuclide ventriculography is a useful and reliable means of noninvasively assessing left ventricular function soon after aortic valve replacement for aortic regurgitation.

QUANTITATIVE ASSESSMENT OF LEFT VENTRICULAR ASYNERGY.

Myocardial performance in the intact human heart can be assessed from the analysis of ejection phase indices. Accordingly, among 20 consecutive patients who were studied by means of biplane left ventricular cineangio-cardiography, 18 were selected solely on the basis of high quality angiograms. The characteristics of left ventricular contraction were expressed quantitatively by the systolic ejection fraction, the mean velocity of circumferential fiber shortening at the left ventriculalr equator, and at several chords, the mean velocity of shortening of the hemichords and the mean normalized systolic ejection rate. All 18 patients had abnormalities of contraction based on the velocity of the hemichords. Both ejection fraction and mean normalized systolic ejection rate showed a low sensitivity in detecting depressed myocardial function in patients with segmental asynergy. Equatorial V(CF) provided additional information only when the affected areas were adjacent to the left ventricular minor axis. The sensitivity of this index was markedly increased by construction of several chords perpendicular to the left ventricular long axis (segmental V(CF)). However, when only one wall was affected, measurement of the velocity of shortening of the hemichords provided a better definition of the regional performance.