Surgical revascularization versus amputation for peripheral vascular disease in dialysis patients: a cohort study

BACKGROUND: Surgical treatment of peripheral vascular disease (PVD) in dialysis patients is controversial. METHODS: We examined the post-operative morbidity and mortality of surgical revascularization or amputation for PVD in a retrospective analysis of United States Renal Data System. Propensity scores for undergoing amputation were derived from a multivariable logistic regression model of amputation. RESULTS: Of the Medicare patients initiated on dialysis from Jan 1, 1995 to Dec 31, 1999, patients underwent surgical revascularization (n = 1,896) or amputation (n = 2,046) in the first 6 months following initiation of dialysis were studied. In the logistic regression model, compared to claudication, presence of gangrene had a strong association with amputation [odds ratio (OR) 19.0, 95% CI (confidence interval) 13.86–25.95]. The odds of dying within 30 days and within1 year were higher (30 day OR: 1.85, 95% CI: 1.45–2.36; 1 yr OR: 1.46, 95% CI: 1.25–1.71) in the amputation group in logistic regression model adjusted for propensity scores and other baseline factors. Amputation was associated with increased odds of death in patients with low likelihood of amputation (< 33(rd )percentile of propensity score) and moderate likelihood of amputation (33(rd )to 66(th )percentile) but not in high likelihood group (>66(th )percentile). The number of hospital days in the amputation and revascularization groups was not different. CONCLUSION: Amputation might be associated with higher mortality in dialysis patients. Where feasible, revascularization might be preferable over amputation in dialysis patients

Understanding Sustainability Innovations Through Positive Ethical Networks

In this paper, a positive organizational ethics (POE)-based framework is informed by the microfinance and socially responsible investing movements to capture the process of sustainable financial innovations. Both of these movements are uniquely characterized by the formation of positive ethical networks (PENs) to develop sustainability innovations in response to external crises. The crisis–PEN–innovation framework proposed makes four contributions to the POE literature: (1) positions corporate sustainability through a POE lens; (2) formalizes the PEN construction through POE theory; (3) proposes PENs are mobilized to respond to external crises; and (4) demonstrates how PENs facilitate sustainability innovations. The theoretical framework is tested using theory-guided process tracing in the sustainable banking sector to understand how sustainability innovations were realized. The findings are consistent with the crisis–PEN–innovation framework proposed