Evaluation and Management of Sleep Disorders in the Hand Surgery Patient.

Despite posing a significant public health threat, sleep disorders remain poorly understood and often underdiagnosed and mismanaged. Although sleep disorders are seemingly unrelated, hand surgeons should be mindful of these because numerous conditions of the upper extremity have known associations with sleep disturbances that can adversely affect patient function and satisfaction. In addition, patients with sleep disorders are at significantly higher risk for severe, even life-threatening medical comorbidities, further amplifying the role of hand surgeons in the recognition of this condition

Evaluación corporal en atletas jóvenes de baloncesto femenino

El objetivo del presente estudio consistió en caracterizar la composición corporal en atletas jóvenes de baloncesto femenino. Como objetivo secundario se procuró verificar de que modo se correlacionaban los valores obtenidos para el índice de masa corporal, porcentaje de grasa y pliegues subcutáneos. Fueron estudiadas 11 jugadoras de Baloncesto del sexo femenino (15 y 16 años). La composición corporal fue calculada a través de la formula propuesta por Sloan - Weir y Brozek, a través de la recogida de datos relativos a los pliegues subcutáneos, y el índice de masa corporal fue calculado a través del peso y altura. Los resultados permitirán concluir que: (i) existen correlaciones significativas entre IMC y porcentaje de grasa; (ii) existen correlaciones significativas entre IMC y pliega tricipital; (iii) no existen correlaciones significativas entre IMC y pliegue suprailiaco. Los resultados del presente estudio solo se ajustan a la presente muestra debido que el número de sujetos estudiados no llegan a 30, no siendo posible así generalizar los resultados

Predicting Revision Following In Situ Ulnar Nerve Decompression for Patients With Idiopathic Cubital Tunnel Syndrome.

PURPOSE: To determine the incidence of revision and potential risk factors for needing revision surgery following in situ ulnar nerve decompression for patients with idiopathic cubital tunnel syndrome (CTS). METHODS: We conducted a retrospective chart review of all patients treated at 1 specialty hand center with an open in situ ulnar nerve decompression for idiopathic CTS from January 2006 through December 2010. Revision incidence was determined by identifying patients who underwent additional surgeries for recurrent or persistent ulnar nerve symptoms. Bivariate analysis was performed to determine which variables had a significant influence on the need for revision surgery. RESULTS: Revision surgery was required in 3.2% (7 of 216) of all cases. Age younger than 50 years at the time of index decompression was the lone significant predictor of need for revision surgery. Other patient factors, including gender, diabetes, smoking history, and workers\u27 compensation status were not predictive of the need for revision surgery. Disease-specific variables including nerve conduction velocities, McGowan grading, and predominant symptom type were also not predictive of revision. CONCLUSIONS: For patients with idiopathic CTS, the risk of revision surgery following in situ ulnar nerve decompression is low. However, this risk was increased in patients who were younger than 50 years at the time of the index procedure. The findings of this study suggest that, in the absence of underlying elbow arthritis or prior elbow trauma, in situ ulnar nerve decompression is an effective, minimal-risk option for the initial surgical treatment of CTS. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic III

Geographic and Age-Based Variations in Medicare Reimbursement Among ASSH Members.

Background: The purpose of this study was to investigate how American Society for Surgery of the Hand (ASSH) members\u27 Medicare reimbursement depends on their geographical location and number of years in practice. Methods: Demographic data for surgeons who were active members of the ASSH in 2012 were obtained using information publicly available through the US Centers for Medicare and Medicaid Services (CMS). Hand-surgeons-per-capita and average reimbursement per surgeon were calculated for each state. Regression analysis was performed to determine a relationship between (1) each state\u27s average reimbursement versus the number of ASSH members in that state, (2) average reimbursement versus number of hand surgeons per capita, and (3) total reimbursement from Medicare versus number of years in practice. Analysis of variance (ANOVA) was used to detect a difference in reimbursement based on categorical range of years as an ASSH member. Results: A total of 1667 ASSH members satisfied inclusion in this study. Although there was significant variation among states\u27 average reimbursement, reimbursement was not significantly correlated with the state\u27s hand surgeons per capita or total number of hand surgeons in that given state. Correlation between years as an ASSH member and average reimbursement was significant but non-linear; the highest reimbursements were seen in surgeons who had been ASSH members from 8 to 20 years. Conclusions: Peak reimbursement from Medicare for ASSH members appears to be related to the time of surgeons\u27 peak operative volume, rather than any age-based bias for or against treating Medicare beneficiaries. In addition, though geographic variation in reimbursement does exist, this does not appear to correlate with density or availability of hand surgeons

Assessment of an hybrid multi-objective pattern search filter method

A hybrid multi-objective evolutionary algorithm (MOEA) for solving nonlinear multi-objective opti- mization problems that relies on a pattern search filter method is proposed. The aim is to reduce the computational time involved in solving expensive multi-objective problems by improving a subset of Pareto points. The proposed pattern search filter method relies on two components. Each entry in the filter aims to measure feasibility and optimality. The feasibility and optimality come directly from each single-objective nonlinear program problem that is associated to the multi-objective problem. Experi- ments carried out with a set of nonlinear multi-objective problems show that our pattern search filter approach is effective in reaching improved Pareto points. A comparison with other techniques known in the literature is presented.Fundação para a Ciência e a Tecnologia - Pluriannual Funding Program

Platelet-Rich Plasma Injection With Percutaneous Needling for Recalcitrant Lateral Epicondylitis: Comparison of Tenotomy and Fenestration Techniques.

Background: Recalcitrant lateral epicondylitis (LE) is a common debilitating condition, with numerous treatment options of varying success. An injection of platelet-rich plasma (PRP) has been shown to improve LE, although it is unclear whether the method of needling used in conjunction with a PRP injection is of clinical importance. Purpose: To determine whether percutaneous needle tenotomy is superior to percutaneous needle fenestration when each is combined with a PRP injection for the treatment of recalcitrant LE. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 93 patients with recalcitrant LE were treated with a PRP injection and percutaneous needle fenestration (n = 45) or percutaneous needle tenotomy (n = 48) over a 5-year study interval. Preoperative patient data, including visual analog scale for pain (VAS-P), Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH), and Patient-Rated Tennis Elbow Evaluation (PRTEE) scores and grip strength, were obtained from a chart review and compared with postoperative values obtained prospectively. Secondary outcomes included the incidence of complications, need for additional interventions, return to work, and patient satisfaction. Results: At a mean follow-up of 40 months, significant improvements in VAS-P (mean, -6.1; 95% CI, -6.8 to -5.5; P \u3c .0001), QuickDASH (mean, -46; 95% CI, -52 to -40; P \u3c .0001), and PRTEE (mean, -57; 95% CI, -64 to -50; P \u3c .0001) scores and grip strength (mean, +6.1 kg; 95% CI, 4.9 to 7.3; P \u3c .0001) were observed across the entire study cohort, with no significant differences noted between the fenestration and tenotomy groups. Nine of 45 patients (22%) underwent additional procedures to treat recurrent symptoms in the fenestration group compared with 5 of 48 patients (10%) in the tenotomy group (P = .05). No complications occurred in any patients, and no patients expressed dissatisfaction with their treatment course. Conclusion: A PRP injection with concomitant percutaneous needling is an effective treatment for recalcitrant LE, with sustained improvements in pain, strength, and function demonstrated at a mean follow-up of longer than 3 years. Although the method of concomitant needling does not appear to have a significant effect on treatment outcomes, more aggressive needle tenotomy is less likely to require conversion to open tenotomy than needle fenestration in the short term to midterm

The Contribution of Organic Livestock to Sustainable Rural Development in Sensitive Areas

Organic production may contribute positively to rural development. However, there is a gap of knowledge with regard to the livestock sector that the present work is aimed at filling by means of a multidisciplinary and participatory approach. The results suggest that ‘fully organic’ holdings (organic farms that sell products as organic) have the highest potential to contribute to the rural development in the area under study. Nevertheless, its implementation requires higher levels of education and implies higher costs. Due to these difficulties, public subsidies should support such production systems. Moreover, systems with low productivity but high environmental services should be also supported, such as those extensive (either conventional or organic)

Viabilidad de los distintos sistemas de producción en porcino Ibérico

publishedTomo I . Sección: Sistemas Ganaderos-Economía y Gestión. Sesión: Economía I. Ponencia nº 1