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PURPOSE OF THE STUDY: The purpose of this study was to assess the patient experience of trapeziectomy under WALANT for trapeziometacarpal joint (TMJ) osteoarthritis (OA) in a prospective study with 2-year follow-up. MATERIAL AND METHODS: The study included 23 patients with TMJ OA undergoing trapeziectomy with WALANT. All patients were seen by a hand therapist preoperatively and at 3, 12, and 24 months postoperatively. At each visit, VAS pain scores, thumb range of motion, grip strength, and Disabilities of the Arm, Shoulder and Hand (DASH) score were assessed. The Picker Patient Experience (PPE-15) questionnaire was administered within 2 weeks of surgery. RESULTS: All 23 patients completed the PPE-15 questionnaire. Their mean age was 64 years. The 21 patients who remained at the 24-month follow-up all said they would choose the same anaesthesia method again. At this follow-up, VAS pain scores, thumb range of motion, key pinch grip and DASH scores had improved significantly, while thumb opposition and hand grip strength remained largely unchanged. The majority of patients felt well informed before and during the procedure, and all patients rated pain relief as good or satisfactory. Nearly 40% of patients reported receiving inadequate information about the postoperative medications. DISCUSSION: Patients have a positive attitude to trapeziectomy with WALANT, and seem to prefer WALANT over other methods of anaesthesia. Trapeziectomy with WALANT for TMJ OA is a safe procedure and appears to give a functional outcome similar to trapeziectomy under general anaesthesia. CONCLUSIONS: Trapeziectomy with WALANT for TMJ OA is safe, preferred by patients and has similar clinical outcome as trapeziectomy in general anesthesia. KEY WORDS: trapeziectomy, osteoarthritis, WALANT.

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BACKGROUND: Adequate postoperative pain treatment is important for quality of life, patient satisfaction, rehabilitation, function, and total opioid consumption, and might lower both the risk of chronic postoperative pain and the costs for society. Prolonged opioid consumption is a well-known risk factor for addiction. Previous studies in upper extremity surgery have shown that total opioid consumption is a third of the amount prescribed, which can be explained by package size. The aim of this study was to examine whether implementation of prepacked takehome analgesia bags reduced the quantity of prescribed and dispensed opioids. MATERIAL AND METHODS: We introduced prepacked take-home analgesia bags for postoperative pain treatment in outpatient surgery. The bags came in two sizes, each containing paracetamol, etoricoxib, and oxycodone. The first 147 patients who received the prepacked analgesia bags were included in the study, and received a questionnaire one month after surgery covering self-assessed pain (visual analog scale of 0-10) and satisfaction (0-5), as well as opioid consumption. Prescription data after introducing the analgesia bags were compared with data before the bags were introduced. RESULTS: Of the 147 patients included in the study, 58 responded. Compared to standard prescription (small bag group: 14 oxycodone immediate release capsules (5 mg), large bag group: additional 28 oxycodone extended release tablets (5 mg), based on the smallest available package), the patients in the small analgesia bag group received 50% less oxycodone and 67% less for the large bag group. Patients with small bags consumed a median of 0.0 mg oxycodone and those with large bags consumed a median of 25.0 mg oxycodone. The median satisfaction was 5.0 (range: 2-5) and the median pain score was acceptable at the first postoperative day. Prescription data showed a significant reduction of 60.0% in the total amount of prescribed opioids after the introduction of prepacked analgesia bags. CONCLUSIONS: The introduction of prepacked analgesia bags dramatically reduced the quantity of opioids prescribed after outpatient hand surgery. Patient satisfaction was high and the postoperative pain level was acceptable. KEY WORDS: analgesia, hand surgery, opioids, outpatint surgery, wrist surgery.

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A wide range of observations in studies of surfaces exposed to ion beams can be explained and analyzed successfully by continuum models of the Kuramoto-Sivashinsky type. Despite certain progress in the theoretical understanding of the model parameters on the basis of atomistic models, much of the applications are based on phenomenological determination of several unknown quantities. In this work a numerical tool is discussed and investigated, which allows us to determine model coefficients and complex model structures from experimental findings. The method resembles known approaches in machine learning and data-driven reconstruction techniques. To keep the discussion on a fundamental level, numerical simulations are conducted by employing a scaled test model. The reconstruction technique is demonstrated for this model system and shows a high accuracy in recovering input parameters for situations without beam noise. As an application to an unknown system to be explored, the algorithm is then applied to a system with lognormal distributed ion bombardment. The impact of the beam fluctuations in the proposed model are discussed. Perspectives of the numerical algorithm for an analysis of experimental data are addressed.

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RBC-transfusion dependence is common in persons with myeloproliferative neoplasm (MPN)-associated myelofibrosis. The objective of this study was to determine the rates of RBC-transfusion independence after therapy with pomalidomide vs placebo in persons with MPN-associated myelofibrosis and RBC-transfusion dependence. Two hundred and fifty-two subjects (intent-to-treat (ITT) population) including 229 subjects confirmed by central review (modified ITT population) were randomly assigned (2:1) to pomalidomide or placebo. Trialists and subjects were blinded to treatment allocation. Primary end point was proportion of subjects achieving RBC-transfusion independence within 6 months. One hundred and fifty-two subjects received pomalidomide and 77 placebo. Response rates were 16% (95% confidence interval (CI), 11, 23%) vs 16% (8, 26%; P=0.87). Response in the pomalidomide cohort was associated with ⩽4 U RBC/28 days (odds ratio (OR)=3.1; 0.9, 11.1), age ⩽65 (OR=2.3; 0.9, 5.5) and type of MPN-associated myelofibrosis (OR=2.6; 0.7, 9.5). Responses in the placebo cohort were associated with ⩽4 U RBC/28 days (OR=8.6; 0.9, 82.3), white blood cell at randomization >25 × 109/l (OR=4.9; 0.8, 28.9) and interval from diagnosis to randomization >2 years (OR=4.9; 1.1, 21.9). Pomalidomide was associated with increased rates of oedema and neutropenia but these adverse effects were manageable. Pomalidomide and placebo had similar RBC-transfusion-independence response rates in persons with MPN-associated RBC-transfusion dependence.

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Systematic measurements on the edge turbulence and turbulent transport have been made by Langmuir probe arrays on TEXTOR under various static Dynamic Ergodic Divertor (DED) configurations. Common features are observed. With the DED, in the ergodic zone the local turbulent flux reverses sign from radially outwards to inwards. The turbulence properties are profoundly modified by energy redistribution in frequency spectra and suppression of large scale eddies. The fluctuation poloidal phase velocity changes direction from electron to ion diamagnetic drift, consistent with the observed reversal of the Er x B flow. In the laminar region, the turbulence is found to react to an observed reduced flow shear.

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The magnetic field penetration process into a magnetized plasma is of basic interest both for plasma physics and astrophysics. In this context special measurements on the field penetration and field amplification are performed by a Hall probe on the dynamic ergodic divertor (DED) on the TEXTOR tokamak and the data are interpreted by a two-fluid plasma model. It is observed that the growth of the forced magnetic reconnection by the rotating DED field is accompanied by a change of the plasma fluid rotation. The differential rotation frequency between the DED field and the plasma plays an important role in the process of the excitation of tearing modes. The momentum input from the rotating DED field to the plasma is interpreted by both a ponderomotive force at the rational surface and a radial electric field modified by an edge ergodization.

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OBJECTIVE: A field trial was conducted to evaluate the effectiveness of on-farm antemortem inspection performed by Australian pig producers in terms of proficiency in detecting unhealthy animals (suspects), the impact on food safety and animal welfare outcomes. ANIMALS: A total of 64 trial groups of market pigs (n = 10,703) were dispatched from 20 herds to three abattoirs in three states. PROCEDURE: All producers and abattoir antemortem inspectors were trained in antemortem inspection prior to the trial, using a standardised set of antemortem criteria. Study 1 consisted of three comparisons: on-farm versus abattoir antemortem inspections on the same pigs, transport effects in suspect and normal pigs, and meat rejection and carcase disposition in suspect and normal pigs. Study 2 compared Salmonella spp. status of suspect and normal pigs. Studies 3 and 4 were conducted to assist the interpretation of the results of on-farm versus abattoir inspection. Antemortem inspection results of three producers and one abattoir antemortem inspector were compared with those of a reference inspector (Gold Standard). RESULTS: Of the pigs examined, 2.12% (95% CI: [1.84%, 2.42%]) were classified as suspect at on-farm antemortem inspection compared to only 0.14% at abattoir antemortem inspection. Forty one percent of pigs classified as suspect on-farm had locomotor problems (arthritis, lameness and foot abscess). Compared to normal pigs, suspect pigs had a relative risk of 67.7 (P < 0.0001) of suffering transport injuries. Meat rejection amounted to the equivalent of 9.68% of suspect carcases, compared to the equivalent of 0.35% of normal carcases. The isolation of Salmonella species from caecal content from 20.9% of 67 suspect pigs and 18.8% of 133 control pigs (two matched healthy pigs from the same batch for each suspect pig) were not significantly different. When compared with the reference inspector on-farm, three producers classified abnormalities in 2495 pigs with high specificity (0.98), acceptable sensitivity (0.82) and kappa (0.57). CONCLUSIONS: With training, producer sensitivity in antemortem inspection may be high and more proficient than abattoir antemortem inspection. Use of producer inspections may have benefits for animal welfare and chain efficiency, but not food safety.

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OBJECTIVE: A field trial was conducted to evaluate the effectiveness of on-farm antemortem inspection performed by Australian pig producers in terms of proficiency in detecting unhealthy animals (suspects), the impact on food safety and animal welfare outcomes. ANIMALS: A total of 64 trial groups of market pigs (n= 10,703) were dispatched from 20 herds to three abattoirs in three states. PROCEDURE: All producers and abattoir antemortem inspectors were trained in antemortem inspection prior to the trial using a standardised set of antemortem criteria. Study 1 consisted of three comparisons: on-farm versus abattoir antemortem inspections on the same pigs, transport effects in suspect and normal pigs, and meat rejection and carcase disposition in suspect and normal pigs. Study 2 compared Salmonella spp status of suspect and normal pigs. Studies 3 and 4 were conducted to assist the interpretation of the results of on-farm versus abattoir inspection. Antemortem inspection results of three producers and one abattoir antemortem inspector were compared with those of a reference inspector (Gold Standard). RESULTS: Of the pigs examined, 2.12% (95% CI: 1.84%, 2.42%) were classified as suspect at on-farm antemortem inspection compared to only 0.14% at abattoir antemortem inspection. Forty one percent of pigs classified as suspect on-farm had locomotor problems (arthritis, lameness and foot abscess). Compared to normal pigs, suspect pigs had a relative risk of 67.7 (P < 0.0001) of suffering transport injuries. Meat rejection amounted to the equivalent of 9.68% of suspect carcases, compared to the equivalent of 0.35% of normal carcases. The isolation of Salmonella species from caecal content from 20.9% of 67 suspect pigs and 18.8% of 133 control pigs (two matched healthy pigs from the same batch for each suspect pig) were not significantly different. When compared with the reference inspector on-farm, three producers classified abnormalities in 2,495 pigs with high specificity (0.98), acceptable sensitivity (0.82) and kappa (0.57). CONCLUSIONS: With training, producer sensitivity in antemortem inspection may be high and more proficient than abattoir antemortem inspection. Use of producer inspections may have benefits for animal welfare and chain efficiency, but not food safety.

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We report our results using three different threaded acetabular components (Mecring A, Mecring B and Weill) in 715 hips with a follow-up of between one and ten years (median: 99.1, 56.5, 38.3 months, respectively). All cups were implanted with one type of cementless stem. The clinical results were good or acceptable in about 70% of the hips, but signs of loosening with radiolucency and/or migration were found in 10.1%. Radiological evidence of loosening did not correlate significantly with the clinical outcome. Pain was not a reliable indicator of loosening and its absence sometimes allowed severe osteolysis to develop. Twenty-five hips were revised (3.5%) for aseptic loosening of the acetabular component. Kaplan-Meier estimates of the cumulative rate of failure showed a rapid increase five years after the initial operation, but no significant correlation with gender, age or weight. The high rate of failure indicates that further use of these acetabular components cannot be recommended. Annual radiographs are required to assess osteolysis even if the patients are free from pain.

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The authors identify six ways in which the borderline diagnosis is commonly abused to express countertransference hate, mask imprecise thinking, excuse treatment failures, justify the therapist's acting out, defend against sexual clinical material, and avoid pharmacologic and medical treatment interventions. The paper focuses on diagnostic abuses that trainees present to clinical supervisors and educators. It attempts to show educators how to discern these abuses and turn them into teaching opportunities. These abuses are seen not only in trainees; they also occur in the professional community as a whole. Clinicians should expect the same diagnostic rigor of themselves that they expect of their students.

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The authors present the case of a patient with an institutional transference and point out the existence of institutional countertransference, which confounded his therapy and obscured his potential for change. Confronted with the patient's tradition in the institution, the new therapist had to overcome feelings of unimportance and therapeutic impotence to focus on the patient as a person in his own right. The authors discuss the signs of institutional countertransference and describe how it can seriously hinder clinical assessment of patients with institutional transferences.

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It has recently been suggested that patients with mania are often misdiagnosed as having schizophrenia. The authors report a favorable clinical response to lithium carbonate in a father and son with an apparent schizo-affective syndromes may respond favorably to lithium but caution that a favorable response in such cases does not absolutely confirm a diagnosis of mania.

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