Incisional paresthesia following clavicle plate fixation: does it matter to patients?

BACKGROUND: Operative management of clavicle fractures is increasingly common. In the context of explaining the risks and benefits of surgery, understanding the impact of incisional numbness as it relates to the patient experience is key to shared decision making. This study aims to determine the prevalence, extent, and recovery of sensory changes associated with supraclavicular nerve injury after open reduction and plate internal fixation of middle or lateral clavicle shaft fractures. METHODS: Eighty-six patients were identified retrospectively and completed a patient experience survey assessing sensory symptoms, perceived post-operative function, and satisfaction. Correlations between demographic factors and outcomes, as well as subgroup analyses were completed to identify factors impacting patient satisfaction. RESULTS: Ninety percent of patients experienced sensory changes post-operatively. Numbness was the most common symptom (64%) and complete resolution occurred in 32% of patients over an average of 19 months. Patients who experienced burning were less satisfied overall with the outcome of their surgery whereas those who were informed of the risk of sensory changes pre-operatively were more satisfied overall. CONCLUSIONS: Post-operative sensory disturbance is common. While most patients improve, some symptoms persist in the majority of patients without significant negative effects on satisfaction. Patients should always be advised of the risk of persistent sensory alterations around the surgical site to increase the likelihood of their satisfaction post-operatively.

Catalysis through temporary intramolecularity: mechanistic investigations on aldehyde-catalyzed Cope-type hydroamination lead to the discovery of a more efficient tethering catalyst.

Mechanistic investigations on the aldehyde-catalyzed intermolecular hydroamination of allylic amines using N-alkylhydroxylamines are presented. Under the reaction conditions, the presence of a specific aldehyde catalyst allows formation of a mixed aminal intermediate, which permits intramolecular Cope-type hydroamination. The reaction was determined to be first-order in both the aldehyde catalyst (α-benzyloxyacetaldehyde) and the allylic amine. However, the reaction displays an inverse order behavior in benzylhydroxylamine, which reveals a significant off-cycle pathway and highlights the importance of an aldehyde catalyst that promotes a reversible aminal formation. Kinetic isotope effect experiments suggest that hydroamination is the rate-limiting step of this catalytic cycle. Overall, these results enabled the elaboration of a more accurate catalytic cycle and led to the development of a more efficient catalytic system for alkene hydroamination. The use of 5-10 mol % of paraformaldehyde proved more effective than the use of 20 mol % of α-benzyloxyacetaldehyde, leading to high yields of intermolecular hydroamination products within 24 h at 30 °C.

Virtual Photovoice With Older Adults: Methodological Reflections during the COVID-19 Pandemic.

Photovoice is a participatory action research method in which participants take and narrate photographs to share their experiences and perspectives. This method is gaining in popularity among health researchers. Few studies, however, have described virtual photovoice data collection despite the growing interest among qualitative health researchers for online data collection. As such, the aim of this article is to discuss the implementation of a virtual photovoice study and presents some of the challenges of this design and potential solutions. The study examined issues of social isolation and mental health among older adults during the COVID-19 pandemic in the Canadian province of Québec. Twenty-six older adults took photographs depicting their experience of the pandemic that were then shared in virtual discussion groups. In this article, we discuss three key challenges arising from our study and how we navigated them. First, we offer insights into managing some of the technical difficulties related to using online meeting technologies. Second, we describe the adjustments we made during our study to foster and maintain positive group dynamics. Third, we share our insights into the process of building and maintaining trust between both researchers and participants, and amongst participants. Through a discussion of these challenges, we offer suggestions to guide the work of health promotion researchers wishing to conduct virtual photovoice studies, including with older adults.

ß-Estradiol results in a proprotein convertase subtilisin/kexin type 9-dependent increase in low-density lipoprotein receptor levels in human hepatic HuH7 cells.

The lower risk of coronary artery disease in premenopausal women than in men and postmenopausal women implicates sex steroids in cardioprotective processes. ß-Estradiol upregulates liver low-density lipoprotein receptor (LDLR), which, in turn, decreases circulating levels of low-density lipoprotein, which is a risk factor for coronary artery disease. Conversely, LDLR protein is negatively regulated by proprotein convertase subtilisin/kexin type 9 (PCSK9). Herein, we investigated PCSK9 regulation by ß-estradiol and its impact on LDLR in human hepatocarcinoma HuH7 cells grown in the presence or absence of ß-estradiol. Immunoblot analysis showed upregulation of LDLR at 3 µm ß-estradiol (140%), and the upregulation reached 220% at 10 µm ß-estradiol; only at the latter dose was an increase in LDLR mRNA detected by qPCR, suggesting post-translational regulation of LDLR. No changes in PCSK9 mRNA or secreted protein levels were detected by qPCR or ELISA, respectively. ß-estradiol-conditioned medium devoid of PCSK9 failed to upregulate LDLR. Similarly, PCSK9 knockdown cells showed no upregulation of LDLR by ß-estradiol. Together, these results indicate a requirement for PCSK9 in the ß-estradiol-induced upregulation of LDLR. A radiolabeling assay showed a significant, dose-dependent decrease in the ratio of secreted phosphoPCSK9 to total secreted PCSK9 with increasing ß-estradiol levels, suggesting a change in the functional state of PCSK9 in the presence of ß-estradiol. Our results indicate that the protein upregulation of LDLR at subtranscriptionally effective doses of ß-estradiol, and its supratranscriptional upregulation at 10 µm ß-estradiol, occur through an extracellular PCSK9-dependent mechanism.

Hydrogen bonding directed intermolecular Cope-type hydroamination of alkenes.

Intermolecular hydroamination of unactivated alkenes represents a significant synthetic challenge. An efficient Cope-type hydroamination is achieved under mild conditions for reactions of N-alkylhydroxylamines with allylic amines, using hydrogen bonding to achieve increased reactivity and high regioselectivity. This approach provides a number of highly functionalized vicinal diamine motifs as Markovnikov addition products.

Primary Healthcare Organization and Quality-of-Life Outcomes for Persons with Chronic Disease.

PURPOSE: To explore the association between primary healthcare (PHC) organizational model and health-related quality of life (HRQoL) in persons with chronic disease. METHODS: We recruited 776 patients with a primary diagnosis of one of four chronic diseases from 33 PHC clinics. Patients were interviewed at baseline, 6, 12 and 18 months. We categorized PHC model by administrative type and by a taxonomy according to organizational attributes. HRQoL was measured by disease-specific questionnaires. RESULTS: Mean age was 67 years and 55.3% were female. PHC models differed with respect to case mix: community models served older patients with higher co-morbidity and lower health status. Multilevel logistic regression revealed that none of the PHC organizational models was associated with HRQoL. Having fewer co-morbidities, higher self-rated health and not using home care services were associated with higher HRQoL. CONCLUSION: Despite their having patients with more complex health problems, HRQoL in patients of community practices was equivalent to that of patients in other types of PHC organizations.

OBJET : Explorer les liens entre le modèle d'organisation des soins de santé primaires (SSP) et la qualité de vie liée à la santé (QVS) chez les personnes atteintes d'une maladie chronique. MÉTHODE : Nous avons interrogé 776 patients qui ont obtenu un diagnostic primaire pour une parmi quatre maladies chroniques dans 33 cliniques de SSP. Les patients ont été interrogés au début de l'étude, puis à 6, 12 et 18 mois. Nous avons classé les modèles de SSP selon le type d'établissement et selon une taxonomie des caractéristiques organisationnelles. Des questionnaires axés sur les maladies spécifiques ont servi à mesurer la QVS. RÉSULTATS : L'âge moyen des répondants était 67 ans et 55,3 % d'entre eux étaient des femmes. Les modèles de SSP différaient selon la composition des cas : les modèles communautaires offraient des services à une clientèle plus âgée présentant une plus grande comorbidité et un état de santé moindre. L'analyse de régression logistique multiniveau révèle qu'aucun des modèles d'organisation des SSP avait un lien avec la QVS. Une plus faible comorbidité, un plus haut taux d'autoévaluation en matière de santé et le non-usage des services de soins à domicile sont associés à une meilleure QVS. CONCLUSION : Malgré la présence de patients qui ont des problèmes de santé plus complexes, la QVS chez les patients des établissements communautaires est équivalente à celle des patients des autres types d'organisations de SSP.

Variations in patients' assessment of chronic illness care across organizational models of primary health care: a multilevel cohort analysis.

PURPOSE: To measure patients' assessment of chronic illness care and its variation across primary healthcare (PHC) models. METHODS: We recruited 776 patients with diabetes, heart failure, arthritis or chronic obstructive pulmonary disease from 33 PHC clinics. Face-to-face interviews, followed by a telephone interview at 12 months, were conducted using the Patient Assessment of Chronic Illness Care (PACIC). Multilevel regression was used in the analysis. RESULTS: The mean PACIC score was low at 2.5 on a scale of 1 to 5. PACIC scores were highest among patients affiliated with family medicine groups (mean, 2.78) and lowest for contact models (mean, 2.35). Patients with arthritis and older persons generally reported a lower assessment of chronic care. CONCLUSION: Family medicine groups represent an integrated model of PHC associated with higher levels of achievement in chronic care. Variations across PHC organizations suggest that some models are more appropriate for improving management of chronic illness.

Are primary healthcare organizational attributes associated with patient self-efficacy for managing chronic disease?

Our objective was to explore how individual and primary healthcare (PHC) organizational attributes influence patients' ability in chronic illness self-management. We conducted a cohort study, recruiting 776 adults with chronic disease from 33 PHC settings in the province of Quebec. Organizational data on the PHC clinics were obtained from a prior study. Participants were interviewed at baseline, 6 and 12 months, responding to questionnaires on self-efficacy, health status, socio-demographics, healthcare use and experience of care. Multilevel modelling showed that 52.5% of the variance in self-efficacy occurs at the level of the individual and 4.0% at the organizational level. Controlling for diagnosis, patient factors associated with self-efficacy were self-rated health (B coeff 0.76: CI 0.60; 0.92), concurrent depression (B coeff -1.41: CI 1.96; -0.86) and satisfaction with care (B coeff 0.27: CI 0.15; 0.39). None of the organizational attributes was significantly associated with self-efficacy after adjusting for lower-level variables. Patients generally reported receiving little self-management teaching across organizations.