Failure after proximal humeral fracture osteosynthesis: a one year analysis of hospital-related healthcare cost.

PURPOSE: The issue of rising healthcare costs and limited resources is a topic of worldwide discussion over the last several decades. We hypothesized that failure of proximal humeral fracture osteosynthesis is presumed to be an important determinant in healthcare resources and related costs. The aim of this study was to calculate the total hospital-related healthcare cost of proximal humeral fracture osteosynthesis over one  year focusing on failure. METHODS: A total of 121 patients with a proximal humeral fracture treated by angular stable osteosynthesis were included in this retrospective study. All hospital-related healthcare costs were investigated. Five main hospital-related cost categories were defined: hospitalization cost, honoraria, day care admission, materials, and pharmaceuticals. RESULTS: A total healthcare cost of € 1,139,448 was calculated for the whole patient group. Twelve patients needed revision surgery due to complications or fixation-related failure. This failure rate alone costed € 190,809 of the healthcare resources. In other words, failure after proximal humeral fracture osteosynthesis costed 17% of the total healthcare expenditure inone year. CONCLUSION: This study demonstrates that a high amount of hospital-related healthcare resources is spent because of failure after proximal humeral fracture osteosynthesis. Further research is necessary and should investigate on how to prevent failure. This is not only in the patient's interest, but it is also of great importance for maintaining a healthy healthcare system.

Clay hydroxyl isotopes show an enhanced hydrologic cycle during the Paleocene-Eocene Thermal Maximum.

The Paleocene-Eocene Thermal Maximum (PETM) was an abrupt global warming event associated with a large injection of carbon into the ocean-atmosphere system, as evidenced by a diagnostic carbon isotope excursion (CIE). Evidence also suggests substantial hydrologic perturbations, but details have been hampered by a lack of appropriate proxies. To address this shortcoming, here we isolate and measure the isotopic composition of hydroxyl groups (OH-) in clay minerals from a highly expanded PETM section in the North Sea Basin, together with their bulk oxygen isotope composition. At this location, we show that hydroxyl O- and H-isotopes are less influenced than bulk values by clay compositional changes due to mixing and/or inherited signals and thus better track hydrologic variability. We find that clay OH- hydrogen-isotope values (δ2HOH) decrease slowly prior to the PETM and then abruptly by ∼8‰ at the CIE onset. Coincident with an increase in relative kaolinite content, this indicates increased rainfall and weathering and implies an enhanced hydrologic cycle response to global warming, particularly during the early stages of the PETM. Subsequently, δ2HOH returns to pre-PETM values well before the end of the CIE, suggesting hydrologic changes in the North Sea were short-lived relative to carbon-cycle perturbations.

Osteosynthesis of proximal humeral fractures: a 1-year analysis of failure in a Belgian level-1 trauma centre.

PURPOSE: Proximal humeral fractures are the third most common fractures affecting the elderly. Angular stable osteosynthesis has become indispensable in the operative treatment. However, surgical fixation remains challenging. The aim of this retrospective study was to analyse the failure rate after osteosynthesis of proximal humeral fractures over a year in a level-1 trauma centre. Furthermore, parameters that are presumed to be related to osteosynthesis failure will be investigated and discussed. METHODS: After meeting the exclusion criteria, 134 patients were operatively treated with angular stable osteosynthesis between January 2017 and January 2018 at the University Hospitals of Leuven. RESULTS: Circa 16% of the proximal humeral osteosyntheses failed. Our study showed that the most significant parameter for osteosynthesis failure was smoking. The odds of failure were significantly lower if treated by a shoulder surgeon compared to another trauma surgeon in the plate and nail group combined. CONCLUSION: The management of proximal humeral fracture osteosynthesis remains a controversial subject. In this retrospective analysis, a failure rate of 15.7% was calculated. Smoking is a statistically significant parameter related to osteosynthesis failure. The subspecialty of the treating trauma surgeon affected the failure rate significantly. A lower failure rate was noted after osteosynthesis by a shoulder surgeon compared to another trauma surgeon.

Ethics and lactation consultants: developing knowledge, skills, and tools.

This article studies the role of ethics in the context of the work of International Board Certified Lactation Consultants. It provides an overview of some of the main ethical approaches with the goal of contributing to the knowledge, skills, and tools required by lactation consultants. Five main sections structure the article: background, current literature, ethical theory and principles, implications for lactation consultants, and decision-making frameworks. Background about the International Board of Lactation Consultant Examiners and International Board Certified Lactation Consultants and the significance of applied ethics in their work are described. Current literature regarding ethics and lactation consultants is reviewed. Because a computer-based literature search yielded a lack of articles, ethics in nursing literature is also presented. Three main ethical theories and 5 key ethical principles are explored with a view to their implications for lactation consultants. Finally, decision-making frameworks are considered as systematic tools for making ethical decisions.