Wolters Kluwer (Netherlands)

An independent observation.

Although Vancouver B2 periprosthetic fractures (PPFs) have been historically managed with revision total hip arthroplasty (rTHA), open reduction and internal fixation (ORIF) has been proposed as an alternative option for reasons including lower cost and surgical time. The purpose of this study was to, therefore, create a Markov model to assess the cost effectiveness of ORIF versus rTHA for Vancouver B2 periprosthetic femur fractures and evaluate various inflection points for varying costs and outcome measures. A Markov model was built using discrete and mutually exclusive health states of the hypothetical patient with Vancouver B2 PPF. A decision tree was created on possible outcomes for each health state, using probabilities defined in the recent PPF literature. Direct costs and quality-adjusted life-years for each surgery and complication state were also collected. One-way and two-way deterministic sensitivity analyses were conducted to better understand the effect of 1 to 2 variables on the incremental cost-effectiveness ratio. The hypothetical patient with a Vancouver B2 PPF that was treated with rTHA incurred a cost of $52,559.64 with an effectiveness of 0.71. When treated with ORIF, the cost was $47,371.97 with an effectiveness of 0.38. The incremental cost and effectiveness of rTHA over ORIF were found to be $5,187.67 and 0.33, respectively. The cost of rTHA, the cost of ORIF, and the effectiveness of ORIF were the most influential variables in the model. On two-way sensitivity analysis, rTHA was more cost effective than ORIF within realistic healthcare parameters. From the payer perspective, we estimate that rTHA is more cost effective than ORIF for the treatment of Vancouver B2 PPFs within certain cost and quality-of-life parameters.

Last week, I attended the International Council of Nurses NP/APN 13th Network Conference in Aberdeen, Scotland. There were 811 delegates from 45 countries, giving me an even greater appreciation and respect for the hard work advanced practice nurses (APNs) do around the globe, often under less-than-ideal conditions. Even though the concept and actualization of advanced practice vary across countries, the unity of APNs was evident at the meeting—language and culture were not barriers. Everyone was eager to learn from each other. A highlight for me was meeting World Health Organization (WHO) Chief Nursing Officer Dr. Amelia Latu Afuhaamango Tuipulotu from the Kingdom of Tonga. Her presentation about her career journey, challenges around the world for quality and equitable healthcare, and her unwavering dedication to positioning nursing and midwifery as a viable solution to achieve universal healthcare and improve the lives of all sent a powerful message of hope, action, and determination. After her appointment to the WHO, she stated, “I feel it's very important that someone from the Pacific, from small island developing states, is engaged at the global stage and to be able to contribute to global health and support nursing and midwifery.”1 I felt in the presence of nursing and public royalty, so, of course, I took a selfie of us to preserve the moment. The conference provided opportunities to meet many of the world's past and present leading advocates for advanced practice. CELEBRATING NPs IN THE US NPs in the US now number approximately 385,000, and the 2024 National NP Week celebration, November 10-16, is themed “NPs at the Heart of Health Care.” Core, soul, center, and seat are synonyms for heart, from which other components leaf and function. While going about your daily activities, do you ever ask yourself why you work so hard, why you seem to be the “go-to” person on the team, why you keep returning, why you enjoy what you do, and why the people you care for care for you in return? The following quote from Maya Angelou provides one explanation: “The true mark of a nurse is not just their knowledge, but their heart. It is their kindness and empathy that leave a lasting impression on those in their care.” Beyond your colleagues and patients, make legislators and elected officials aware of the power of and need for NPs. Particularly during this election year, know the candidates and their positions on all aspects of healthcare before voting. Until NPs across the US have full practice authority, our work is not done. And when this does happen, the work will continue here and abroad. INTERNATIONAL ADVOCACY NPs establish connections and collaborations with nurses, midwives, and APNs in other countries through healthcare organizations, mission work, universities, government and nongovernmental organizations, and other interests. Another speaker at the ICN conference, Vicky Treacy-Wong, part of the nursing leadership group with Médecins Sans Frontières (MSF; Doctors Without Borders), gave attendees an inside look at the critical role APNs, internal and external to a country, play in alleviating suffering experienced by populations during humanitarian crises. I was not aware of how much of the boots-on-the-ground work is actually done by RNs/APNs and not physicians. As a strong advocate for the continued development of nursing leadership and representation within the MSF, the message is clear. Involvement in the ICN NP/APN Network can facilitate your personal efforts. Numbers and actions matter, and membership in NP organizations brings power to the profession. Jamesetta A. Newland, PhD, FNP-BC, FAANP, DPNAP, FAAN Editor-in-Chief [email protected]

Robotics in unicompartmental knee arthroplasty (UKA) continues to increase with the ever-growing demand to use technology in the surgical setting. However, no studies have used minimal clinically important difference (MCID) to compare patient-reported outcome measures (PROMs) between robotic UKA (rUKA) and manual UKA (mUKA). This study aimed to compare the rate of achieving MCID for improvement (MCID-I) and worsening (MCID-W) and the time to achieving MCID. We conducted a retrospective analysis of robotic and manual UKAs performed between 2016 and 2022. Preoperative and postoperative Patient-Reported Outcomes Measurement Information System (PROMIS) Global Physical, PROMIS Physical Function Short-Form 10a (PF-10a), and Knee Injury and Osteoarthritis Outcome Score-Physical Function Short-Form (KOOS-PS) scores were collected. Patients were stratified on reaching MCID-I, MCID-W, or "no notable change" (score between MCID-W and MCID-I). Survival curves with and without interval censoring were used to assess the time to achieving the MCID. Log-rank and weighted log-rank tests were used to compare groups. A total of 256 UKAs (64 robotic and 192 manual) were analyzed. No differences were observed in the proportion of patients achieving MCID-I or MCID-W across all three PROMs. Similarly, median time to achieving MCID showed no significant differences between rUKA and mUKA for PROMIS Global Physical (3.3 versus 4.9 months, P = 0.44), PROMIS PF-10a (7.7 versus 8.3 months, P = 0.93), and KOOS-PS (3.0 versus 6.0 months, P = 0.055) scores, both with and without interval censoring. This study indicates that rUKA and mUKA exhibit comparable rates of achieving MCID-I and MCID-W, along with similar median time to reach MCID. These findings offer valuable patient-centric insights into the effectiveness of rUKA. Additional studies evaluating the long-term outcomes of rUKA are needed to determine its long-term advantages. Level III, retrospective comparative study.

Abstract Reactive distillation (RD) is a process intensification technique that offers major advantages over conventional technologies by enabling the integration of reaction and separation into a single apparatus. This integration introduces and exploits complex interaction between mass transfer, chemical reaction and hydrodynamics within an RD column; however, these complexities can hinder the adoption of RD by industry. Many approaches have been developed by the scientific community to advance understanding and to expedite the initialization of RD design at the conceptual level. This paper critically discusses recent developments in conceptual methods for synthesizing RD processes. This review paper is the first to consider the range of available approaches for assessing the technical feasibility, controllability, economic viability, and sustainability of RD units by taking into account various configurations in which RD is treated as a new unit operation, and as part of process synthesis in a different way of designing processes based on functions. The review also addresses complex configurations, such as advanced RD technologies. Special attention is paid to process modeling and simulation as well as to education. Knowledge gaps to be filled by further research are indicated. © 2024 The Authors. Journal of Chemical Technology and Biotechnology published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry (SCI).

Elections have consequences for a variety of health care issues.

Ms. Hoffmeister is a freelance medical writer in Camp Hill, Pennsylvania. To earn CME credit, you must read the CME articles and complete the quiz and evaluation assessment survey on the enclosed form, answering at least 70% of the quiz questions correctly. This continuing medical enduring material activity expires at 5 pm EST on September 30, 2025. All authors, faculty, and staff have no relevant financial relationships with any ineligible organizations regarding this educational activity. Learning objective:After completing this activity, physicians should be better able to assess the potential risks of common treatments toward the development of interstitial lung disease in patients with rheumatoid arthritis. Lippincott Continuing Medical Education Institute, Inc., is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. Lippincott Continuing Medical Education Institute, Inc., designates this enduring material for a maximum of 1.5 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Lippincott's Bone and Joint Newsletter is an independent publication solely owned and published by Wolters Kluwer and has no affiliation with the Journal of Bone & Joint Surgery.

Celem opracowania jest analiza zabójstw w Polsce, ich uwarunkowań, zróżnicowania geograficznego i zmian w czasie. Wykorzystano informacje dotyczące liczby zgonów i liczby zabójstw pozyskane z roczników statystycznych. Dla poszczególnych województw oraz dla całego kraju obliczono współczynnik morderstw, a następnie wykreślono krzywe zmienności jego wartości w czasie. Stworzono kartogramy dla wartości współczynnika morderstw dla Polski według województw dla następujących wybranych lat: 2000, 2005, 2010 i 2014. Wykazano, że w Polsce umieralność utrzymuje się na względnie stałym poziomie około 3,5 mln zgonów rocznie. Zgony dominują w ośrodkach miejskich, przewyższając dane dla ośrodków wiejskich około trzykrotnie. W całym badanym okresie województwa: mazowieckie, śląskie i dolnośląskie wykazują najwyższe wartości współczynnika zabójstw, natomiast najniższe wartości są notowane dla województw: opolskiego i świętokrzyskiego. Województwa: zachodniopomorskie i pomorskie wykazują stały wysoki poziom analizowanego współczynnika, pozostałe zaś cechują stosunkowo niskie jego wartości.

Ms. Hoffmeister is a freelance medical writer in Camp Hill, Pennsylvania. To earn CME credit, you must read the CME articles and complete the quiz and evaluation assessment survey on the enclosed form, answering at least 70% of the quiz questions correctly. This continuing medical enduring material activity expires May 31, 2025. All authors, faculty, and staff have no relevant financial relationships with any ineligible organizations regarding this educational activity. Lippincott Continuing Medical Education Institute, Inc., is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. Lippincott Continuing Medical Education Institute, Inc., designates this enduring material for a maximum of 1.5 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Lippincott's Bone and Joint Newsletter is an independent publication solely owned and published by Wolters Kluwer and has no affiliation with the Journal of Bone & Joint Surgery.