High Average Gradient in a Laser-Gated Multistage Plasma Wakefield Accelerator.

Plasma wakefield accelerators driven by particle beams are capable of providing accelerating gradient several orders of magnitude higher than currently used radio-frequency technology, which could reduce the length of particle accelerators, with drastic influence on the development of future colliders at TeV energies and the minimization of x-ray free-electron lasers. Since interplasma components and distances are among the biggest contributors to the total accelerator length, the design of staged plasma accelerators is one of the most important outstanding questions in order to render this technology instrumental. Here, we present a novel concept to optimize interplasma distances in a staged beam-driven plasma accelerator by drive-beam coupling in the temporal domain and gating the accelerator via a femtosecond ionization laser.

Minimally invasive hardware removal after minimally invasive distal radius plate osteosynthesis (MIPO): Feasibility study in a 388 case series.

HYPOTHESIS: The aim of the present study was to assess the technical feasibility of minimally invasive volar plate removal following distal radius fracture. MATERIAL AND METHODS: Three hundred and eighty-eight plates removed from 387 patients (357 females: mean age, 50 years) were assessed retrospectively. The incision used the primary minimally invasive approach and was closed after plate removal by intradermal continuous suture, without drainage or immobilization. RESULTS: Mean scar size was 22.2mm preoperatively, and the incision was 19.8mm at start and 21.4mm at end of procedure, these differences being non-significant. The scar was enlarged by accidental skin tear in 13 cases and intentionally by lancet in 11 cases. There were 29 screw-related complications, 1 bone crack without clinical impact, and 1 plate fracture. There were no postoperative complications. DISCUSSION: The present results demonstrate the feasibility of removing a volar plate on the distal radius via a 20-mm approach. These findings should be confirmed on a future study comparing minimally invasive plate ablation and conventional approaches.

Treatment of unstable distal phalanx fractures by extra-articular DIP pinning: A series of 12 cases.

Unstable distal phalanx fractures are typically treated by pinning of the distal phalanx or the distal interphalangeal joint (DIP). Complications include unstable fixation, K-wire migration, septic arthritis and osteoarthritis. To limit these complications, we wanted to explore the benefits of using locked extra-articular DIP pinning. The cohort consisted of 12 patients (mean age 36.3 years) who had an extra-articular (6 cases) or intra-articular distal phalanx fracture (6 cases). All patients were treated surgically with a construct consisting of two connected K-wires: one was placed inside the shaft of the distal phalanx and the other was placed perpendicular to the middle phalanx. The K-wires were removed after 1 month. After an average follow-up of 19.9 weeks, pain was 0.4/10 and the QuickDASH score was 7.41/100 on average. The range of motion was, on average, 30.0° less than the contralateral uninjured side for active flexion, 8.8° less for active extension, 32.0° less for passive flexion and 4.1° less for passive extension. The overall hand strength averaged 85.2% of the contralateral one. One secondary displacement occurred but there were no infections. In all, these findings suggest that locked extra-articular DIP pinning is a simple and reproducible surgical treatment for distal phalanx fractures. LEVEL OF EVIDENCE: IV.

Comparison of distal interphalangeal fusion with and without joint preparation in cases of stage IV chondropathy.

UNLABELLED: The main complications in distal interphalangeal (DIP) fusion are non-union and hardware-related symptoms. The primary aim of this study was to show that joint preparation for DIP fusion is not necessary in cases of stage IV chondropathy. The secondary aim was to show that use of buried compression screws decreases the complication rate. This continuous retrospective study included two groups of DIP percutaneous arthrodesis procedures carried out with 1.8mm break-away compression screws: group 1 underwent joint preparation through a dorsal approach and group 2 underwent a percutaneous procedure without joint preparation. Group 1 included 15 patients (18 fingers) with a mean age of 65.3 years, representing nine cases of osteoarthritis, four cases of open trauma, one of gout, and one of rheumatoid arthritis. Group 2 included 18 patients (21 fingers) with a mean age of 58.9 years, representing 16 cases of osteoarthritis, one of rheumatoid arthritis and one of swan-neck deformity. Tourniquet time was longer in group 1 (61min) than in group 2 (24min). The amount of emitted ionizing radiation was not different between groups. Pain and QuickDASH scores were not improved in group 1 but they were in group 2. There was no difference in the fusion time. One non-union was observed in group 1. Our results show that joint preparation for DIP arthrodesis is unnecessary in stage IV chondropathy. No hardware-related complications were observed. LEVEL OF EVIDENCE: III.

Hand injuries due to firework devices: a series of 58 cases.

Fireworks or firecrackers can cause serious accidents. They are classified from K1 to K4 according to the amount of powder they contain. In Alsace (France), a type-K1 firecracker is available on the free market and the K2 and K3 ones are prohibited. The aim of this study was to reveal the effects of measures taken in order to prevent repercussions related to hand injuries caused by fireworks. Patients who fell victim to firework incidents have been recorded since 2006, starting date of the prevention campaign. Records have been taken on the circumstances, the group of firecracker, the level of injury and the severity of the injury in four stages. Our series included 62 hands from 58 patients (average age: 25 years), including two women. Most of them sustained their injury during the night of New Year's Eve. The study dealt with 21 K1, and 35 K2 or K3. We registered 29 cases of grade I, 2 grades II, 21 grades III and 9 grades IV. One patient died. The numbers of consultations, K2/K3 injuries and number of surgeries increased from 2006 to 2012. Our results show that firework-related injuries to the hand are serious, pluridigital, multistage and/or bilateral. Prevention was ineffective but should be improved and strengthened, as a total ban on fireworks is a counterproductive measure.

Can ring finger injuries be prevented by pre-weakened rings? Three clinical cases.

Prevention of finger trauma can be directly related to the manufacture of pre-weakened rings. We report on three clinical cases of finger injuries caused by pre-weakened rings. Lesions were less severe than conventional ring finger injuries, such as those caused by iron fences. Surgery was required in all three cases and chronic cold sensitivity was noted in one case. This small series advocates the imposition of a ring manufacturing standard at the European level. Given this lack of consensus, the idea is to prevent injuries by developing rings with intentional weak points that open automatically in case of trauma. These pre-weakened rings have never been subject to clinical study to demonstrate their potential safety.

[Should we keep using the heating lamp in microsurgery?]. / Faut-il encore utiliser la lampe chauffante en microchirurgie ?

The "heating lamp" is one of the complementary measures used to improve the survival rate of replantations and flaps. No publication demonstrated its efficiency, but burn injuries have been reported. The purpose of this study was to estimate the efficiency of the "heating lamp". A questionnaire was sent to the members of the French society for surgery of the Hand, 16 % of who answered. The heat emitted by three electric bulbs (energy saving, strand, halogen) was measured at room temperature at 10, 15, 20 and 25cm distance from the bulb over 4h. The pressure of capillary drip PFC of the pulp of the index was measured in 10 healthy subjects by a laser Doppler. The PFC was measured without source of heat, then at 38, 40 and 42°C, during 30min. Among the answers to the questionnaire, 67 % never use the heating lamp. Among the 33 % who use it, the protocol was variable; 18 control the temperature without precision, 18 use it continuously, and 23 use it more than 24hours. Nine reported complications, including eight burns (five flaps, three replantations). Subjectively, the majority of the users believe in its efficacy. Objectively, the heat emitted by the "heating lamp" was unimportant; whatever the distance from the source. The PFC did not vary with the temperature. The "heating lamp" is used empirically in microsurgery. The physical and physiological measures at the lower threshold for burns (43°C) show that it is ineffective. Burns have been reported. In conclusion, the "heating lamp" should no longer be a part of the therapeutic arsenal of the hand surgeon.

A risk management approach to the security of hospital information systems.

Risk management in today's technologically advanced health care system demands proactive rather than reactive strategies. Risk management is defined as a planned program for liability control and involves the identification, analysis and evaluation of legal risks followed by strategies to reduce or eliminate these risks. The concept of risk management is most often associated with quality assurance and direct patient care activities. For current purposes, the risk management concept is borrowed from arena of patient care and applied to the security measures surrounding hospital information systems. In this context, risk management/liability control is viewed as proactive activities designed to protect both the hospital information system and the confidentiality of patient information.

Mapping the future of hospital information systems: priorities for nursing applications.

The purpose of this study was to determine the value of computerized applications to nurse users in a large acute-care university-affiliated hospital. A hospital information system has been in place since 1983. A convenience sample of 77 staff nurses and 33 nurse managers from various clinical areas rated the benefits for decision making and patient care of approximately 19 existing automated applications, and prioritized for future acquisition, approximately 40 applications not currently available. Results of the study revealed that of the applications currently automated, respondents ranked the applications of results reporting, order entry, nursing station census, and message switching as most useful for decision making and patient care. Applications identified as high priorities for future acquisition were on-line charting, automated medication record, and enhanced results reporting.

The case for using computers in the operating room.

The largest cost center and revenue generator in most hospitals, the operating room is subject to demands for increased cost accountability and quality assurance. Information technology tools can be incorporated into the operating room and have the potential to positively affect practices there through addressing nursing, administrative/financial and medical needs. Microcomputer-based operating room systems now on the market can provide functions from scheduling and case costing to medical records and market analysis. Of 21 functions identified, 10 can be characterized as mandatory and the remaining as optional. Individual systems offer varied configurations, providing from 0 to 21 functions. These enhanced capabilities for data collection, monitoring and analysis enable health care professionals to provide both better and more cost-effective care for surgical patients.