The mediating and moderating role of recovery experience between occupational stress and turnover intention in nurses caring for patients with COVID-19.

AIM: This study aimed to investigate the relationships among occupational stress, recovery experience and turnover intention among nurses caring for patients with coronavirus disease 2019 (COVID-19). BACKGROUND: The high turnover intention among nurses affect patient safety quality of patient care. DESIGN: The cross-sectional study design was used. This study was guided by STROBE. METHODS: Convenience sampling identified 202 registered nurses working in the COVID-19 wards of three tertiary general hospitals in two cities in South Korea. The collected data were analysed using SPSS version 26.0, and the PROCESS macro in SPSS was employed to estimate path coefficients and assess the adequacy of the model. The moderating effects of recovery experience on the pathway in which occupational stress of the participants affects turnover intention were verified using model 1 of the SPSS PROCESS macro proposed by Hayes. RESULTS: The recovery experience did not significantly mediate the relationship between occupational stress and turnover intention. However, it had significant moderating effect on the relationship between occupational stress and turnover intention (ß = .005, 95% CI [.001, .010]). The effect of occupational stress on turnover intention was dependent on recovery experience. CONCLUSION: The results revealed that occupational stress among nurses caring for patients with COVID-19 affect the turnover intention and the level of recovery experience moderates this relationship. Thus, not only during the COVID-19 pandemic but also during challenging times of various infectious disease outbreaks, hospitals can enhance the health and well-being of nurses and promote the retention of nursing staff. IMPLICATIONS FOR THE PROFESSION: During the COVID-19 pandemic, nurses have been exposed to understaffing and overwhelming workloads. However, policies for nurses' welfare and benefits are still insufficient, even as the pandemic comes to an end. The results of this study indicate that sufficient rest and appropriate nursing personnel are of utmost importance to nurses. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Comparison of the Characteristics of Three Acellular Dermal Matrices Subjected to Distinct Processing Methods Using Five Types of Histochemical Staining.

BACKGROUND: Acellular dermal matrix (ADM) is treated using various devitalization and aseptic processing methods. The processing effects on ADM were evaluated by histochemical tests. METHODS: From January 2014 to December 2016, 18 patients [average age, 43.0 (range, 30-54) years] who underwent breast reconstruction with an ADM and tissue expander were prospectively enrolled. During the permanent implant replacement, a biopsy of the ADM was performed. We used three different human-derived products, namely, Alloderm®, Allomend®, and Megaderm®. Hematoxylin and eosin, CD68, CD3, CD31, and smooth muscle actin were used to evaluate the collagen structure, inflammation, angiogenesis, and myofibroblast infiltration. Each ADM was semi-quantitatively analyzed. RESULTS: Significant differences in collagen degradation, acute inflammation, and myofibroblast infiltration were observed among the ADMs. Collagen degeneration (p<0.001) and myofibroblast infiltration (smooth muscle actin-positive, p=0.018; CD31-negative, p=0.765) were the most severe in Megaderm®. Acute inflammation, represented by CD68, was most severe in Alloderm® (p=0.024). Both radiation and freeze-drying treatment physically damaged the collagen structure. Collagen degeneration was most severe in Megaderm®, followed by Allomend® and Alloderm®. Since Alloderm® is treated using chemicals, an assessment of the chemical irritation is warranted. CONCLUSIONS: The biopsy results were inconclusive. Therefore, to better interpret processing, more large-scale, serial, histochemical studies of each ADM are needed. LEVEL OF EVIDENCE IV: This journal requires that authors 38 assign a level of evidence to each article. For a full 39 description of these Evidence-Based Medicine ratings, 40 please refer to the Table of Contents or the online 41 Instructions to Authors www.springer.com/00266 .

Modified Keystone Perforator Island Flap Techniques for Small- to Moderate-Sized Scalp and Forehead Defect Coverage: A Retrospective Observational Study.

We aimed to demonstrate the effective application of keystone perforator island flap (KPIF) in scalp and forehead reconstruction by demonstrating the authors' experience with modified KPIF reconstruction for small- to moderate-sized scalp and forehead defects. Twelve patients who underwent modified KPIF reconstruction of the scalp and forehead from September 2020 to July 2022 were enrolled in this study. In addition, we retrospectively reviewed and evaluated the patient's medical records and clinical photographs. All defects (size range, 2 cm × 2 cm to 3 cm × 7 cm) were successfully covered using four modified KPIF techniques (hemi-KPIF, Sydney Melanoma Unit Modification KPIF, omega variation closure KPIF, and modified type II KPIF) with ancillary procedures (additional skin grafts and local flaps). All flaps (size range, 3.5 cm × 4 cm to 7 cm × 16 cm) fully survived, and only one patient developed marginal maceration that healed with conservative management. Furthermore, through the final scar evaluation with the patient satisfaction survey and Harris 4-stage scale, all patients were satisfied with their favorable outcomes at the average final follow-up period of 7.66 ± 2.14 months. The study showed that the KPIF technique with appropriate modifications is an excellent reconstructive modality for covering scalp and forehead defects.

Modified Keystone Perforator Island Flap for Tension-Reducing Coverage of Axillary Defects Secondary to Radical Excision of Chronic Inflammatory Skin Lesions: A Retrospective Case Series.

Axillary defect coverage is often challenging after radical excision of chronic inflammatory skin lesions, such as complicated epidermoid cysts and hidradenitis suppurativa. This retrospective case series aims to demonstrate our experience with axillary reconstruction using the modified keystone perforator island flap (KPIF) technique, emphasizing its tension-reducing effects. All patients who presented for axillary reconstruction after radical excision of chronic inflammatory skin lesions between May 2019 and December 2020 were identified using the medical record database. Eleven patients ranging in age from 17 to 71 years underwent modified KPIF axillary reconstruction. Four types of modifications (modified type II KPIF, omega variation closure, Sydney melanoma unit modification, and hemi-KPIF) were used. All defects (size range, 2.5 × 3 cm2 to 8 × 13 cm2) were successfully covered using these modified KPIF techniques. All flaps (size range, 3.5 × 3.5 cm2 to 11 × 30 cm2) fully survived without complications. All patients exhibited favorable functional outcomes, and no cases of recurrence or limitations in joint range of motion were observed during the follow-up period (range, 4-5 months). Modified KPIF techniques may represent a reliable, effective alternative reconstructive modality for managing axillary defects.

Average 22-Year Results of Total Hip Arthroplasty Using Harris-Galante Prosthesis in Patients under 50 Years.

Background: The Harris-Galante (HG) prosthesis is a first-generation, cementless total hip arthroplasty (THA) prosthesis. Considering the recent increase in the demand for THA in young patients and their life expectancy, a study with a follow-up duration of longer than 20 years in a young population is needed. Therefore, we evaluated the long-term clinical and radiographic results after cementless THA using the HG prosthesis in patients younger than 50 years. Methods: A total of 61 THAs performed using the HG with a minimum follow-up of 10 years were included. There were 38 men and 11 women with an average age of 46 years and the mean follow-up duration was 22 years. Clinical evaluation included modified Harris Hip Score (HHS) and radiographic analysis consisted of cup inclination, anteversion angle, component stability, osteolysis, liner wear rate, wear-through, liner dissociation, and heterotopic ossification. Complications included recurrent dislocation, periprosthetic femoral fracture, and periprosthetic joint infection. Survivorship analysis included cup and stem revision for aseptic loosening, as well as any revision. Results: The HHS improved from 46.5 preoperatively to 81.8 postoperatively (p < 0.001). The average linear wear rate was 0.36 mm/yr. A total of 34 hips (56%) were revised: stem revision in 10 (16.4%), cup revision in 9 (14.8%), exchange limited to bearing surface in 8 (13.1%), and revision of all components in 7 (11.5%). Estimated survivorship at 34 years postoperatively was 90.9% for cup revision for aseptic loosening, 80.5% for stem revision for aseptic loosening, and 22.1% for any revision. Conclusions: THA using the HG prosthesis showed satisfactory estimated survivorship of the acetabular and femoral components at 34 years postoperatively with good clinical outcomes. Bearing-related problems, such as osteolysis and liner dissociation, accounted for 56% of revision operations and were concerns in patients younger than 50 years.

Modified Mini-Keystone Flaps for Coverage of Tiny Volar Pulp Defects of the Fingertips in Cases with Missing Amputation Skin Stumps: A Retrospective Study.

This study aimed to demonstrate the expanding versatility of keystone flap reconstruction in fingertips. Fifteen patients who underwent the modified mini-keystone flap reconstruction for tiny volar pulp defects of the fingertip between September 2020 and February 2021 were included in this study (average age: 43.4 ± 13.52 years, range: 19-61 years). Patient data were retrospectively collected from their medical records. The two-point discrimination test was used to evaluate the degree of sensory recovery. All defects were successfully covered with the modified mini-keystone flap. The defect sizes ranged from 0.5 cm × 1 cm to 1.2 cm × 2.0 cm, and the flap sizes ranged from 0.7 cm × 1.5 cm to 1.5 cm × 3.0 cm. Although one patient showed a small distal margin maceration, all flaps survived fully. The overall outcomes were favorable at the mean follow-up period of 5.73 ± 0.79 months. We suggest that the modified mini-keystone flap technique is a promising alternative modality for covering tiny volar pulp defects of the fingertip, with few complications and favorable outcomes.

Peri-implant atypical femoral fracture after nail or plate osteosynthesis.

BACKGROUND: A lack of scientific information regarding the risk factors and diagnosis of peri-implant atypical femoral fracture (PI-AFF) exists. We report a case series of developed PI-AFF with a nail or plate construct wherein prior femoral fractures were already healed after osteosynthesis. This study aimed to identify the cause and risk factors of PI-AFF and to devise a preventive method based on this. METHODS: We identified 11 PI-AFFs displaying features of AFFs. All patients were ambulant females (mean age, 74.9 years). The mean T-score of the femur measured by DEXA (Dual Energy X-ray Absorptiometry) scan was 3.5. Osteosynthesis was performed with a plate and an intramedullary nail in six and five patients, respectively. Possible risk factors were investigated, including the used implant, the medication of bisphosphonate, the characteristics of previous fracture (AFF or non-AFF), and the co-existence of AFF on the contralateral side. RESULTS: The PI-AFFs developed at an average of 6.6 years from the time of prior fracture. All fractures were located at the screw through the plate or nail. Regarding anatomic locations, seven and four fractures were at the subtrochanteric area and diaphysis, respectively. Diaphyseal PI-AFFs occurred in plating cases, all of which were associated with excessive femoral bowing. Subtrochanteric PI-AFFs included all five patients with nail fixation, which occurred near a proximal interlocking screw. Six of the 11 patients were on bisphosphonate treatment before or at the time of fracture. The duration of bisphosphonate treatment was 6 years on average. Concerning the previous femoral fractures, seven and four patients were AFF and non-AFF, respectively. Considering the pathology on the contralateral leg, eight had suffered diaphyseal AFF. Four patients were treated nonoperatively. Seven patients needed an operation; 6 of them healed after reconstruction nailing, and one needed hip arthroplasty because of the associated displaced femoral neck fracture. CONCLUSIONS: PI-AFFs may develop through the screw hole at the subtrochanteric or diaphyseal area due to femoral fragility and stress riser effect of the implant. An improved osteosynthesis strategy may be necessary to avoid PI-AFFs when fixing osteoporotic femoral fractures.

Early postoperative treatment of mastectomy scars using a fractional carbon dioxide laser: a randomized, controlled, split-scar, blinded study.

BACKGROUND: Mastectomy leaves unsightly scarring, which can be distressing to patients. Laser therapy for scar prevention has been consistently emphasized in recent studies showing that several types of lasers, including fractional ablation lasers, are effective for reducing scar formation. Nonetheless, there are few studies evaluating the therapeutic efficacy of ablative CO2 fractional lasers (ACFLs). METHODS: This study had a randomized, comparative, prospective, split-scar design with blinded evaluation of mastectomy scars. Fifteen patients with mastectomy scars were treated using an ACFL. Half of each scar was randomized to "A," while the other side was allocated to group "B." Laser treatment was conducted randomly. Scars were assessed using digital photographs of the scar and Vancouver scar scale (VSS) scores. Histological assessments were also done. RESULTS: The mean VSS scores were 2.20±1.28 for the treatment side and 2.96±1.40 for the control side. There was a significant difference in the VSS score between the treatment side and the control side (P=0.002). The mean visual analog scale (VAS) scores were 4.13±1.36 for the treatment side and 4.67±1.53 for the control side. There was a significant difference in VAS score between the treatment side and the control side (P=0.02). CONCLUSIONS: This study demonstrated that early scar treatment using an ACFL significantly improved the clinical results of the treatment compared to the untreated scar, and this difference was associated with patient satisfaction.

A comparative study for tension-reducing effect of Type I and Type II keystone perforator island flap in the human back.

The keystone perforator island flap (KPIF) is popular in reconstructive surgery. However, despite its versatility, its biomechanical effectiveness is unclear. We present our experience of KPIF reconstruction in the human back and evaluate the tension-reducing effect of the KPIF. Between September 2019 and August 2020, 17 patients (51.82 ± 14.72 years) underwent KPIF reconstruction for back defects. In all cases, we measured wound tension at the defect and donor sites before and after KPIF reconstruction using a tensiometer. All defects occurred after complete excision of complicated epidermoid cysts and debridement of surrounding tissues. The defects were successfully covered with Type IIA KPIFs. All flaps survived, and there were no significant postoperative complications. The mean "tension change at the defect after Type I KPIF" and "tension change at the defect after Type II KPIF" were - 2.97 ± 0.22 N and - 5.59 ± 0.41 N, respectively, (P < 0.001). The mean "rate of tension change at the defect after Type I KPIF" and "rate of tension change at the defect after Type II KPIF" were - 36.54 ± 1.89% and - 67.98 ± 1.63%, respectively, (P < 0.001). Our findings confirm the stepwise tension-reducing effect of KPIF and clarify the biomechanics of this flap.

Keystone Flaps for Coverage of Defects in the Posterior Neck and Lower Occipital Scalp: A Retrospective Clinical Study.

ABSTRACT: The coverage of the posterior neck and lower occipital scalp defects should be approached carefully. Thick, stiff, and inelastic skin properties of these areas tend to make coverage of even small defects difficult. Herein, the authors present a retrospective review of our experience with posterior neck and lower occipital scalp reconstruction using the keystone flap (KF) and describe the expanding versatility of KF reconstruction. The medical records of 17 patients who underwent KF reconstruction to cover the posterior neck and lower occipital defect from April 2017 to May 2020 were reviewed. Clinical and operative data were collected. All defects were successfully covered with the KFs. The defect sizes ranged from 2.5 × 3.5 cm to 6 × 11 cm, and the flap sizes ranged from 3 × 5.5 cm to 9 × 18 cm. All flaps fully survived, although marginal maceration developed in one case; however, it healed with conservative management. The final results were favorable, and all patients were satisfied with their final outcomes. Consequently, the KF can be considered as a good reconstruction modality with few complications and provides an alternative to other reconstructive options for coverage of the posterior neck and lower occipital defects.