Notes

Shunt conduit calcification as being a late side-effect regarding ventriculoperitoneal shunting.
INTRODUCTION Implant-based or expander-supported breast reconstruction is an established surgical method after mastectomies due to cancer or to prophylactic reasons. Patient reported outcome (PRO) and cosmetic outcome after breast reconstruction with a synthetic surgical mesh was investigated in a prospective, single-arm, multi-center study. MATERIAL AND METHODS Primary or secondary implant-based breast reconstruction with support of TiLOOP® Bra was performed in 269 patients during the PRO-BRA study. PRO 12 months after breast reconstruction was evaluated using Breast-Q questionnaire. Cosmetic outcome was evaluated by two independent experts by means of pictures taken preoperatively and at the follow-up visits. RESULTS Breast-Q and 12 months FU were completed by 210 women. Patients without adverse event had a significantly higher Breast-Q score for "sexual well-being" (p = 0.001); "psychosocial well-being" was negatively influenced by prior therapies (p less then 0.01), and older patients had significantly lower scores at 12 months FU compared to pre-OP for "satisfaction with breasts" (p less then 0.01) while the opposite was true for younger patients. Unilateral surgery resulted in reduced "satisfaction with breast" at 12 months FU (p less then 0.01). Radiotherapy negatively influenced "satisfaction with breast", "sexual well-being" and "physical well-being chest". The cosmetic evaluation showed a significant difference (p less then 0.001) in the evaluation by the patients and experts with the patients' assessment being worse compared to experts' assessment. CONCLUSION Our study showed that two years after implant-based breast reconstruction with support of TiLOOP® Bra PRO is influenced by different factors. This information can be used to improve the decision-making process for women who chose implant-based breast reconstruction. OBJECTIVE The aims of this study were firstly to assess the correlation between disease specific measures of quality of life (QOL) and physical performance and activity, and secondly to identify demographic, clinical, functional, and physical activity measures independently associated with QOL in people with intermittent claudication. METHODS This was a cross sectional observational study of 198 people with intermittent claudication caused by peripheral artery disease who were recruited prospectively. QOL was assessed with the intermittent claudication questionnaire (ICQ) and the eight-theme peripheral artery disease quality of life questionnaire. Physical performance was assessed with the six minute walk test (6MWT) and short physical performance battery (SPPB), and an accelerometer was used to measure seven day step count. The associations between QOL scores and 6MWT distance, SPPB scores and seven day step count were examined using Spearman Rho's (ρ) correlation and multivariable linear regression. RESULTS ICQ scores were significantly correlated with 6MWT distance (ρ = 0.472, p less then .001), all four SPPB scores (balance ρ = 0.207, p = .003; gait speed ρ = 0.303, p less then .001; chair stand ρ = 0.167, p = .018; total ρ = 0.265, p less then .001), and seven day step count (ρ = 0.254, p less then .001). PADQOL social relationships and interactions (ρ = 0.343, p less then .001) and symptoms and limitations in physical functioning (ρ = 0.355, p less then .001) themes were correlated with 6MWT distance. The 6MWT distance was independently positively associated with ICQ and both PADQOL theme scores (ICQ B 0.069, p less then .001; PADQOL social relationships and interactions B 0.077, p less then .001; PADQOL symptoms and limitations in physical functioning B 0.069, p less then .001). CONCLUSION Longer 6MWT distance independently predicted better physical and social aspects of QOL in people with intermittent claudication supporting its value as an outcome measure. Crown V. All rights reserved.OBJECTIVE To compare outcomes between long posterior flap (LPF) and skew flap (SF) amputation over a 13 year period. METHODS This was a retrospective observational cohort study. Consecutive patients undergoing a LPF or SF below knee amputation (BKA) over a 13 year period at one hospital were identified. Both techniques were performed regularly, depending on tissue loss and surgeon preference. The primary outcome was surgical revision of any kind. Secondary outcomes included revision to above knee amputation (AKA), length of hospital stay (LOS), and mortality. A smaller cohort of patients who were alive and unilateral below knee amputees were contacted to ascertain prosthetic use and functional status. RESULTS In total, 242 BKAs were performed in 212 patients (125 LPF and 117 SF; median follow up 25.8 months). Outcomes for the two groups were equivalent for surgical revision of any kind (27 LPF vs. 31 SF; p = .37), revision to an AKA (18 LPF vs. 14 SF; p = .58), LOS (29 days for LPF vs. 28 days for SF; p = .83), and median survival (23.9 months for LPF vs. 28.8 months for SF; p = .89). Multivariable analysis found amputation type had no effect on any outcome. Functional scores from a smaller cohort of 40 unilateral amputees who were contactable demonstrated improved outcomes with the LPF vs. the SF (p = .038). CONCLUSION Both techniques appear equivalent for rates of surgical residual limb failure. Functional outcomes may be better with the LPF. BACKGROUND Physicians are frequently asked to practice in hospitals different from their home institution, often under contracts called professional service agreements (PSAs). With highly variable onboarding processes, traveling physicians are often left to "figure out" the available resources, processes of care, crucial relationships, and culture of the new institution. MK-0991 This research aimed to understand the current practices of onboarding for the purpose of informing future improvements in practice. METHODS Two physicians conducted semistructured, in-depth interviews with physicians working at hospitals beyond their home institution. A thematic qualitative analysis was performed. RESULTS The sample included 20 physicians from six specialties. Key findings include (1) the basic logistics of providing care in a new environment are often not incorporated into physician onboarding and can limit physicians' ability to provide care efficiently and effectively; (2) the strength of interpersonal relationships greatly influences the ability of physicians to get help when working in new environments; and (3) managing clinical emergencies in unfamiliar settings can result in significant perceived risk to patient safety due to delays in providing care.
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