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Background: Complex abdominal wall reconstruction technique remains controversial. The use of biologic mesh products is also debated in active infection, sepsis prophylaxis and high-risk patients. Differences in biologic mesh technology and cost remain significant. We aimed to compare the efficacy of 2 commonly used biologic meshes in regards to hernia recurrence at 1 year. Methods: This study was a parallel, dual-arm, double-blind randomized controlled trial involving adult patients undergoing complex abdominal wall reconstruction with a biologic mesh at a quaternary care institution (2017-2020). Patients were randomly assigned to receive Permacol (cross-linked) compared with Strattice (not crosslinked). The main outcome measure was hernia recurrence at 1 or more years following the index repair. Results: We included 94 patients randomized to undergo reconstruction with 1 of 2 commonly used biologic mesh products (mean age 59.4 yr, standard deviation [SD] 9.9; 51% female; body mass index 32.9, SD 6.8). We found no significant differences between the groups (patient comorbidities, hernia recurrence risk factors, hernia size or infection profiles). Hernia recurrence rates (15%) were similar between groups (median 783 days of follow up, interquartile range 119). We found there was significantly less of a need for a component separation technique in the Strattice group (69% v. 87%). All other secondary outcome measures were equivalent between study arms. Multivariate analysis identified hepatic transplantation (odds ratio [OR] 1.94, 95% confidence intervals [CI] 0.33-4.41), active abdominal wall infection (OR 2.01, 95% CI 0.50-7.01), and more than 1 previous hernia repair (OR 2.68, 95% CI 0.41-5.99) as risk factors for subsequent hernia recurrence; however, there was no difference in recurrence factors between patient study groups. Conclusion: Given similar clinical performance between the 2 most commonly used biologic mesh products, the most cost effective mesh should be used in cost-conscious health care systems. Contexte : Les techniques de reconstruction complexe de la paroi abdominale demeurent un sujet controverse. L'utilisation de treillis biologique ne fait pas non plus consensus dans les cas d'infection active et de prophylaxie du sepsis, ni chez les patients a risque eleve. Les differences dans la technologie employee et le cout des divers produits sur le marche demeurent considerables. Nous avons cherche a comparer l'efficacite de 2 treillis biologiques couramment utilises a prevenir la recidive de hernie apres 1 an. Methodes : Le modele d'etude choisi etait un essai clinique randomise a double insu en 2 bras paralleles auquel ont participe des patients qui subissaient une reconstruction complexe de la paroi abdominale a l'aide d'un treillis biologique dans un etablissement de soins quaternaires (de 2017 a 2020). Apres repartition aleatoire, les patients ont recu le treillis Permacol (reticule) ou le treillis Strattice (non reticule). L'indicateur de resultat principal etait la recurrence de hernie 1 an ou plus apres la reconstruction initiale. Resultats : Nous avons inclus 94 patients qui, apres repartition aleatoire, ont subi une reconstruction avec 1 des 2 treillis biologiques couramment utilises ici a l'etude (age moyen 59,4 ans, ecart-type [E.-T.] 9,9, proportion de femmes 51 %, indice de masse corporelle 32,9, E.-T 6,8). Nous n'avons observe aucune difference significative entre les groupes (comorbidite, facteurs de risque de recidive de la hernie, taille de la hernie ou profil infectieux). Les taux de recidive des hernies (15 %) etaient similaires dans les 2 groupes (mediane 783 j post-intervention; ecart interquartile 119). Nous avons observe un besoin moins frequent de la technique de separation des composants dans le groupe (69 % c. 87 %). Tous les autres indicateurs de resultats secondaires etaient comparables dans les 2 bras de l'etude. Selon l'analyse multivariee, la transplantation hepatique (rapport des cotes [RC] 1,94, intervalle de confiance [IC] de 95 % 0,33-4,41), l'infection active de la paroi abdominale (RC 2,01, IC de 95 % 0,50-7,01) et des antecedents de plus d'une chirurgie de la hernie (RC 2,68, IC de 95 % 0,41-5,99) seraient des facteurs de risque de recidive subsequente de la hernie; cependant, aucune difference dans les facteurs de recurrence n'a ete constatee entre les 2 groupes. Conclusion : Compte tenu des resultats cliniques similaires obtenus avec les 2 treillis biologiques les plus couramment utilises, les systemes de sante pour lesquels la rationalisation des couts est importante devraient choisir le produit le plus economique., Incisional hernias after abdominal operations are unfortunately common for patients (up to 23%) and costly to health care systems. (1-6) In patients who pursue surgical repair by way of abdominal [...]

Circular economy aims at decoupling human activities from resource use and creating wealth. However, many have questioned the link between increased circularity and sustainability, resulting in several methodological approaches being developed to answer that question. This article analyzes and discusses the insights gained from applying agent‐based modeling and simulation to study the techno‐economic and social conditions promoting circularity and sustainability. This article analyzes the benefits and limitations of this technology and discusses future methodology developments within the circular economy context. Moreover, six limits of the circular economy concept are used to interpret insights from the literature: thermodynamic limits, system boundary limits, limits posed by the physical scale of the economy, limits posed by path dependencies and lock‐in, limits of governance and management, and limits of social and cultural definitions. Promising research avenues are to use this methodology with machine learning, industrial ecology methods, and detailed geographic information. [ABSTRACT FROM AUTHOR]

The re-hospitalization rate of homecare patients within 60 days of hospital discharge is 30%. Enhanced care planning based on better information may reduce this rate. However, very little is known about the homecare admission and care planning processes. The research team collected data during observations of three nursing visits to admit homecare patients in Camden NJ, and conducted thematic content analysis on these data. Human factors methods helped to identify nurse decision-making related to selection of the plan of care problems, nonnursing resources, and the nursing visit pattern. They identified how the electronic health record (EHR) assisted the nurse in visit pattern frequency decisions. Major themes that emerged included reduced efficiency due to use of redundant intrateam communication methods to augment EHR documentation, redundant documentation, and workarounds and reorganization of clinical workflow. [ABSTRACT FROM AUTHOR]