Using time-limited trials to improve surgical care for frail older adults.

An 85-year-old male nursing home resident who is frail but enjoys his current quality of life is admitted with an acute high-grade small bowel obstruction potentially due to adhesions from prior abdominal surgery. The patient has significant tenderness on abdominal exam with involuntary guarding and signs of pneumatosis on the CT scan that are concerning for bowel ischemia. After discussing potential options for management, including surgical intervention and palliative care, the patient and his family express a desire to proceed with surgery because there is a small chance that he could return to his preoperative quality of life.

Nanostructured manganese oxides as highly active water oxidation catalysts: a boost from manganese precursor chemistry.

We present a facile synthesis of bioinspired manganese oxides for chemical and photocatalytic water oxidation, starting from a reliable and versatile manganese(II) oxalate single-source precursor (SSP) accessible through an inverse micellar molecular approach. Strikingly, thermal decomposition of the latter precursor in various environments (air, nitrogen, and vacuum) led to the three different mineral phases of bixbyite (Mn2 O3 ), hausmannite (Mn3 O4 ), and manganosite (MnO). Initial chemical water oxidation experiments using ceric ammonium nitrate (CAN) gave the maximum catalytic activity for Mn2 O3 and MnO whereas Mn3 O4 had a limited activity.

Biomechanical effects of calcar screws and bone block augmentation on medial support in locked plating of proximal humeral fractures.

Background: The objective of this study was to investigate the biomechanical effects of medial fracture gap augmentation in locked plating of an unstable 2-part proximal humeral fracture with calcar screws and insertion of a corticocancellous bone block. Furthermore the mechanical behavior of dynamic locking screws in the non-parallel arrangement of a proximal humeral plate was of interest.

Methods: Thirty-two fresh frozen humeri were randomized in four equal groups.

The stability of the femoral component in the Oxford unicompartmental knee replacement: a comparison of single and twin peg designs.

Aseptic loosening of the femoral component is an important indication for revision surgery in unicompartmental knee replacement (UKR). A new design of femoral component with an additional peg was introduced for the cemented Oxford UKR to increase its stability. The purpose of this study was to compare the primary stability of the two designs of component.

Measurement of stable changes of self-management skills after rehabilitation: a latent state-trait analysis of the Health Education Impact Questionnaire (heiQ™).

Purpose: To assess stable effects of self-management programs, measurement instruments should primarily capture the attributes of interest, for example, the self-management skills of the measured persons. However, measurements of psychological constructs are always influenced by both aspects of the situation (states) and aspects of the person (traits). This study tests whether the Health Education Impact Questionnaire (heiQ™), an instrument assessing a wide range of proximal outcomes of self-management programs, is primarily influenced by person factors instead of situational factors.

Oleylethoxycarboxylate--an efficient surfactant for copper extraction and surfactant recycling via micellar enhanced ultrafiltration.

The nonaoxyethylene oleylether carboxylic acid Akypo RO90 VG, a surfactant with ionic character at high pH and non-ionic character at low pH, has been investigated with respect to copper removal from aqueous streams via micellar enhanced ultrafiltration (MEUF) with subsequent copper and RO90 separation using the method of cloud point extraction (CPE). Almost quantitative Cu2+ removal is obtained in MEUF and more than 90% Cu2+ is separated from RO90 in CPE. The investigation of Cu(2+)/RO90 complexes with small-angle neutron scattering (SANS) shows almost no structural change of RO90 micelles in the presence of Cu2+.

[Relevance of personal contextual factors of the ICF for use in practical social medicine and rehabilitation].

Personal contextual factors play an essential part in the model of the International Classification of Functioning, Disability and Health (ICF). The WHO has not yet classified personal factors for global use although they impact on the functioning of persons positively or negatively. In 2010, the ICF working group of the German Society of Social Medicine and Prevention (DGSMP) presented a proposal for the classification of personal factors into 72 categories previously arranged in 6 chapters.

Palliative surgery for malignant bowel obstruction from carcinomatosis: a systematic review.

Importance: Care of patients with malignant bowel obstruction caused by peritoneal metastases may present an ethical dilemma for surgeons when nonoperative management fails.

Objective: To characterize outcomes of palliative surgery for malignant bowel obstruction from peritoneal carcinomatosis to guide decision making about surgery and postoperative interventions for patients with terminal illness.

Evidence Review: We searched PubMed, EMBASE, Cochrane Library, Web of Knowledge, Cumulative Index to Nursing and Allied Health Literature Plus, and Google Scholar and performed manual searches of selected journals from inception to August 30, 2012, with no filters, limits, or language restrictions.

[Is the guideline for work-related medical rehabilitation successfully implemented?].

Background: The guideline for work-related medical rehabilitation (WMR) in responsibility of the German Pension Insurance describes standards of work-related measures in medical rehabilitation. We investigated if contents and recommended amount of treatment were successfully implemented and which improvements were associated with the implementation.

Methods: Implementation of the WMR guideline was evaluated at 7 inpatient orthopaedic rehabilitation centres.

A survey of preferences regarding surgical approach to thyroid surgery.

Background: Transaxillary thyroidectomy (TAT) has gained popularity in East Asian countries; however, to date there have been no attempts to evaluate the preferences regarding TAT in the US population. The aim of this study is to assess the preferences and considerations associated with TAT in an American cohort.

Methods: Self-administered surveys were distributed to 966 adults at various locations in a single state.

Influence of transfemoral amputation length on resulting loads at the osseointegrated prosthesis fixation during walking and falling.

Background: Transfemoral amputation is a surgical measure in which the surgeon typically conserves as much tissue and bone as possible. Osseointegrated fixation of prostheses is a promising alternative to conventional socket-based fixation. However, osseointegrated prostheses pose some risk of possible bone fracture under unexpected high-impact loading scenarios, such as a fall, and this should be protected against by a safety element.

It's big surgery: preoperative expressions of risk, responsibility, and commitment to treatment after high-risk operations.

Objective: To identify the processes, surgeons use to establish patient buy-in to postoperative treatments.

Background: Surgeons generally believe they confirm the patient's commitment to an operation and all ensuing postoperative care, before surgery. How surgeons get buy-in and whether patients participate in this agreement is unknown.

[Specific work-related problems: do they matter in access to work-related medical rehabilitation?].

Background: The study determined if need for rehabilitation in work-related medical rehabilitation (WMR) is more frequently characterised by specific work-related problems than in conventional medical rehabilitation (MR).

Methods: In 6 rehabilitation centres, persons with back pain (M50, M51, M53, M54) were surveyed about work-related restrictions of work ability at begin of their rehabilitation.

Results: Differences in work ability of WMR and MR patients confirmed need-related access.

Stiffness and ultimate load of osseointegrated prosthesis fixations in the upper and lower extremity.

Background: Techniques for the skeletal attachment of amputation-prostheses have been developed over recent decades. This type of attachment has only been performed on a small number of patients. It poses various potential advantages compared to conventional treatment with a socket, but is also associated with an increased risk of bone or implant-bone interface fracture in the case of a fall.

Multi-body simulation of various falling scenarios for determining resulting loads at the prosthesis interface of transfemoral amputees with osseointegrated fixation.

Conventionally, transfemoral amputees are treated with a shaft prosthesis fitted over the residual limb. To improve the quality of life of such patients, in particular those with complications relating to conventional attachment (e.g.

Loads on the prosthesis-socket interface of above-knee amputees during normal gait: validation of a multi-body simulation.

The treatment of above-knee amputees with a prosthesis based on a socket is currently considered the standard clinical treatment. Nevertheless there are few investigations on mechanical loading conditions on these devices under realistic circumstances. Further insight in this matter might improve the design of sockets for everyday application.

Quantification of photocatalytic hydrogen evolution.

A new photoreactor with defined irradiation geometry was developed and tested for the water reduction reaction using carbon nitride ("C(3)N(4)") as a photocatalyst. The hydrogen evolution rate was investigated with a sun simulator (I = 1000 W m(-2)) in two different operation modes: circulation and stirring of the catalyst dispersion. Only in the stirred mode, where shear stress is lower, a stable hydrogen evolution rate of about 0.

Surgeon-reported conflict with intensivists about postoperative goals of care.

Objective: To examine surgeons' experiences of conflict with intensivists and nurses about goals of care for their postoperative patients.

Design: Cross-sectional incentivized US mail-based survey.

Setting: Private and academic surgical practices.

Particle shape optimization by changing from an isotropic to an anisotropic nanostructure: preparation of highly active and stable supported Pt catalysts in microemulsions.

We recently introduced a new method to synthesize an active and stable Pt catalyst, namely thermo-destabilization of microemulsions (see R. Y. Parapat, V.