ients with PPS. Whenever feasible, surgical resection, even in locally advanced disease, may yield long-term survival in these aggressive lung tumors, although the level of evidence is low.

Healthcare-associated infections are serious and significant complications present across healthcare services, including residential aged care facilities. Although ensuring high quality personal and clinical care delivered to older people residing in these facilities is a high national priority, there is a paucity of evidence published about outbreaks, governance and education programs held for healthcare workers within Australian residential aged care facilities. The aim of this study is to examine the scope of practice of Infection Prevention and Control professionals within Australian residential aged care facilities and the types of infection prevention and control education and training delivered.

A cross-sectional study was conducted inviting all Australian residential aged care facilities to participate in an online survey.

A total of 134 residential aged care facilities completed the survey. The majority (88.1%) reported having a designated Infection Prevention and Control professional responsib. Yet, more support and resources are needed to assist these efforts.The pandemic of the severe acute respiratory syndrome disease caused by the new coronavirus SARS-CoV-2 (COVID-19), had profound impact in many countries and their health care systems. Regarding Portugal, a suppression strategy with social distancing was adopted, attempting to break the transmission chains, bending the epidemy curve and reducing mortality. These measures seek to prevent an eventual National Health Service over-running, enforcing the suspension of all elective and non-urgent health care. Despite the success in so far, there is a consensus on the need to recover the previous level of health care provision and further enhance it. The Portuguese National Health Service, as a public, universal access, health care system funded by the State proved, in this context, its importance and relevance to the Portuguese population. However, long standing issues, such as the pre pandemic over long waiting lists for hospital ophthalmology attendance, whose determinants are fully identified but still unmet, emerge amplified from this pandemic. The lack of primary eye care in the National Health Service is a significant bottleneck, placing a huge stress on hospital-based care. An exclusive ophthalmologist’s center care was over-runned before pandemic and will be even more so. The optometrist’s exclusion from differentiated, multisectoral and multidisciplinary eye care teams remains the main hurdle to overcome and insure universal eye care in Portugal. National Health Service highlights the consequences of an overcome model. Universal eye care more than ever demands an evidence-based, integrated approach with primary eye care, in the community, on time and of proximity.

The purpose of this retrospective study was to report the results of reconstruction of segmental bone defects of the proximal phalanges using a reverse metacarpal vascularized bone flap harvested from the third metacarpal bone.

From August 2012 to May 2017, 17 patients with segmental osteomyelitis or necrotic bone of the proximal phalanges were treated. There were 15 male and 3 female patients, with a mean age of 36 years (range, 19-65 years). The mean size of bone defects was 26× 9× 9 mm (range, 16× 6× 7 mm to 35× 10× 7 mm); and the mean size of bone flaps was 27× 8× 7 mm (range, 15× 7× 4 mm to 40× 8× 7 mm).

The mean follow-up period was 26 months. The mean motion arc of the metacarpophalangeal joints was 56° (range, 22°-90°). The mean pinch strength of the injured fingers was 3.1 kg (range, 2-3.6 kg), and the mean pinch strength of the normal contralateral side was 6.9 kg (range, 4.2- 8.5 kg).

The reverse metacarpal bone flap may promote osseous healing in reconstructing segmental defects of the proximal phalanges.

Therapeutic IV.

Therapeutic IV.

This is a retrospective observational study that assessed the prevalence of positive diagnostic imaging and electrodiagnostic (EDX) findings in patients diagnosed with pronator syndrome (PS), who previously had a carpal tunnel syndrome (CTS) surgery. The other purpose of our study was to determine how often PS occurred and was missed in patients treated surgically for CTS.

The files of 180 patients who underwent CTS surgery were reviewed retrospectively. We assessed all patients for a diagnosis of PS. We accepted the clinical findings and patient history as the reference standard for the diagnosis of PS. Anteroposterior and lateral radiographs of the elbow, bilateral upper limb magnetic resonance imaging (MRI) studies, and bilateral dynamic forearm ultrasound (US) were performed on patients with clinical symptoms and physical examinations that indicated PS. Bilateral upper limb EDX was also performed for these patients. One patient refused additional tests.

A total of 174 extremities in 146 patients were included in the study. Pronator syndrome was diagnosed by 2 hand surgeons in 22 extremities (19 patients) through a clinical evaluation that included a history and physical examination. Diagnostic testing was positive for findings of PS in 24% of extremities (5 of 21) tested by EDX, in 57% of extremities (12 of 21) tested by US, and 5% of extremities (1 of 21) tested by MRI. There was no lower humeral spur that could cause median nerve compression on any plain radiographs.

With clinical evaluation as the reference standard, EDX, US, and MRI are not helpful in making a diagnosis of PS concurrent with CTS.

Diagnostic IV.

Diagnostic IV.

To investigate the residual articular incongruity on computed tomography image data and the early clinical outcome of 3-dimensional planned and navigated intra-articular osteotomies of the distal radius.

We conducted a retrospective analysis of intra-articular osteotomies executed between 2008 and 2016. We identified 37 patients (aged 26-73 years) and performed a combined intra-articular and extra-articular osteotomy on 20 patients. A preoperative 3-dimensional plan with the superimposed bone of the contralateral healthy side was performed in each case to analyze and execute the osteotomy by intraoperative navigation. The residual articular incongruity was assessed by quantification of the maximal stepoff in the coronal or sagittal computed tomography scans. Clinical outcome, including range of motion, grip strength, and return to work, was assessed after a minimum follow-up of 12 months and compared with preoperative measurements.

On average, the preoperative intra-articular stepoff was 2.5 mm (±0.6 mm; range, 1.4-4.2 mm) and was significantly reduced to 0.8 mm (±0.2 mm) after surgery. After surgery, 30 patients had a stepoff less than 1 mm; in 7, a stepoff of 1.1 to 1.4 mm was measured. After 1 year, 22 had no pain, 9 had slight pain during heavy work, and 5 had moderate pain with no improvement compared with their preoperative status, although wrist strength and range of motion improved in all 37 patients. One patient underwent a secondary radioscapholunate arthrodeses owing to persistent pain despite a congruent joint with a small residual intra-articular stepoff (0.6 mm).

Intra-articular osteotomies of the distal radius treated by 3-dimensional preoperative planning and patient-specific guides are an accurate technique to reduce articular incongruity to an average stepoff of 0.8 mm (range, 0.3-1.4 mm). The early clinical outcomes demonstrated overall reduction in pain and improvement of range of motion and grip strength in 36 of 37 patients.

Therapeutic IV.

Therapeutic IV.

The purpose of this study was to evaluate the effect of neoadjuvant chemotherapy (NACT) on squamous variant (SV) bladder cancer by investigating patients presenting with SV histology at the time of transurethral resection (TUR), stratified by their receipt of NACT.

The records of 71 patients with muscle-invasive bladder cancer and SV in the TUR specimen who underwent cystectomy between 2008 and 2018 were reviewed. Our primary outcome was pathologic response at time of cystectomy. Secondary outcomes included recurrence-free survival and overall survival stratified by receipt of NACT. A subgroup analysis was then conducted on the patients with defined SV% on TUR stratified by % involvement (< 50% SV vs.≥ 50% SV).

The median age of the NACT and no-NACT groups was 60.2 and 70 years, respectively (P= .003). The complete response rate at cystectomy was 60% versus 13.7% for the NACT and no-NACT groups, respectively (P< .001). The non-organ-confined disease rate at time of radical cystectomy was 35% for the NACT group and 68.6% for the no-NACT group (P= .01). The NACT group had fewer recurrences than the no-NACT group (10% vs 47.1%; P= .003). In the subgroup analysis, the lower rate of non-organ-confined disease persisted for the patients who underwent NACT at the lower SV percentage but failed to remain significant at greater percentage involvement. This was also true for overall survival.

The effect of NACT in variant histology bladder cancer is variable. In patients with SV, these results favor the recommendation in favor of NACT administration, particularly when the primary tumor has< 50% involvement by the variant histology.

The effect of NACT in variant histology bladder cancer is variable. In patients with SV, these results favor the recommendation in favor of NACT administration, particularly when the primary tumor has less then 50% involvement by the variant histology.

Hump nose in Asians should be managed differently in consideration of the lateral profile and the balance between the dorsal height and nasal tip projection. We suggest an alternative approach comprising mild rasping and nasal tip projection using a septal extension graft.

In this retrospective study, patients who underwent hump nose correction with rhinoplasty between March 2012 and July 2015 were recruited. Instead of applying conventional dorsal augmentation after humpectomy, our approach involved only smooth dorsal contouring in limited cases. 15 patients were evaluated, with surgical outcomes demonstrated using three-dimensional photogrammetry.

Over the postoperative period, hump height decreased (pre 2.77±2.07, post 0.31±0.55, p=0.001). Regarding the efficacy of tip projection, both nasal tip protrusion (pre 17.64±4.82, post 20.46±4.05, p=0.001) and tip projection (pre 19.75±4.26, post 21.83±4.17, p=0.023) were increased. The hump nose reduction ratio was 84.94% after 6 months and 76.47% after 1 year, whereas increases in nasal tip projection and dorsal augmentation were minimal, with ratios of 14.75% and 12.76%, respectively, after 6 months).

Therefore, creating a balance between the nasal tip and nasal dorsum in hump nose correction is more important than dorsal augmentation after hump resection in Asians.

Therefore, creating a balance between the nasal tip and nasal dorsum in hump nose correction is more important than dorsal augmentation after hump resection in Asians.

High-rate, persistent criminal offending has substantial negative health consequences. This study examines how criminal offending trajectories during adolescence influence the risk of food insecurity in early adulthood.

The study uses four waves of the National Longitudinal Study of Adolescent to Adult Health to determine the association between criminal offending trajectory membership and food insecurity. The analysis controls for individual- and neighborhood-level risk factors and assesses the mediating effects of depression and household income.

Five distinct offending trajectories were established using a group-based trajectory model. Membership in various offending trajectories predicts an increased risk for food insecurity. Those in high-rate, chronic-offending trajectories have the highest risk of food insecurity in early adulthood (OR=2.062; P<.01). These effects are significantly attenuated by depressive symptoms.

This is the first study to test the association between criminal offending trajectory membership from adolescence through young adulthood and the risk of food insecurity in adulthood.