Over a 6-month period, 23 members of the International Microvascular Research Group participated in a prospective survey of their microvascular free-flap practice. Data were recorded with each case for 60 variables covering patient characteristics, surgical technique, pharmacologic treatment, and postoperative outcome. A total of 493 free flaps were reported with a representative demographic distribution for age, sex, indications for surgery, risk factors, flap type, surgical technique, and pharmacologic intervention. Mixed effects logistic regression modeling was used to determine predictors of flap failure and associated complications. The overall incidence of flap failure was 4.1 percent (20 of 493). Reconstruction of an irradiated recipient site and the use of a skin-grafted muscle flap were the only statistically significant predictors of flap failure, with increased odds of failure of 4.2 (p = 0.01) and 11.1 (p = 0.03), respectively. A postoperative thrombosis requiring re-exploration surgery occurred in 9.9 percent of the flaps. The incidence of this complication was significantly higher when the flap was transferred to a chronic wound and when vein grafts were needed, with increased odds of failure of 2.9 (p = 0.02) and 2.5 (p = 0.02), respectively. There was a lower incidence of postoperative thrombosis when rectus/transverse rectus abdominis muscle (TRAM) flaps were used, where odds of failure decreased by 0.36 (p = 0.04), and when subcutaneous heparin was administered in the postoperative period, where odds decreased by 0.27 (p = 0.04). There was an overall 69-percent salvage rate for flaps identified with a postoperative thrombosis. Intraoperative thrombosis occurred in 41 cases (8.3 percent) and was observed more frequently in myocutaneous flaps or when vein grafts were needed (5.5 and 5.0 greater odds, respectively; p < 0.001) but was not associated with higher flap failure (2 of 41 cases; 4.9-percent failure rate). The incidence of a hematoma and/or hemorrhage was increased in obese patients and when vein grafts were needed [2.7 (p = 0.02) and 2.6 (p = 0.03) greater odds, respectively], whereas this complication was significantly decreased in muscle flaps (myocutaneous or skin-grafted muscle), in tobacco users, when a heparinized solution was used for general wound irrigation, and when the attending surgeon performed the arterial anastomosis (in contrast to the resident or fellow on staff) (p < 0.05 for each factor). With the multivariable analysis, many factors were found not to have a significant effect on flap outcome, including the recipient site (e.g., head/neck, breast, lower limb, etc.); indications for surgery (trauma, cancer, etc.); flap transfer in extremes of age, smokers, or diabetics; arterial anastomosis with an end-to-end versus end-to-side technique; irrigation of the vessel without or with heparin added to the irrigation solution; and a wide spectrum of antithrombotic drug therapies. These results present a current baseline for free-flap surgery to which future advances and improve...

To date, using text messaging as a method to promote physical activity has only been studied by a small group of researchers. Current physical activity text messaging literature is characterized by small sample sizes, heterogeneous but positive effect sizes, and a lack of specificity as to the development of the text messages used in these studies. Further research in this area is imperative to facilitate the expansion of mobile technology to promote physical activity.

Findings suggest the potential impact of workshop group support on adherence in African-American women.

The purposes of this study were to identify strategies successful in the recruitment of African American (AA) women to a home-based walking program and to examine factors that contribute to attrition, eligibility, and ineligibility during the recruitment screening protocol. Of the 696 women who contacted the researchers, 281 (40.4%) women enrolled in the study, 227 (32.6%) were lost to attrition, and 188 (27%) were ineligible. Those not enrolled due to attrition during screening or ineligibility reported more family risk for cardiovascular disease (CVD) and lived in neighborhoods with higher poverty. Although our recruitment strategies may have been successful in attracting low-income AA women, we were not as successful in preventing their attrition during the screening protocol, particularly for those living in poorer neighborhoods.

Innovative, culturally tailored strategies are needed to extend diabetes education and support efforts in low-resourced primary care practices serving racial/ethnic minority groups. A randomized controlled trial examined the effect of a diabetes self-care coaching intervention delivered by medical assistants and the joint effect of intervention and ethnicity over time. The randomized repeated-measures design included 270 low-income African American and Hispanic/Latino patients with type 2 diabetes. The one-year clinic- and telephone-based medical assistant coaching intervention was culturally tailored and guided by theoretical frameworks. A1C was obtained, and a self-care measure was completed at baseline, 6 months, and 12 months. Data were analyzed using mixed-effects models with and without adjustment for covariates. There was significant overall improvement in mean self-care scores across time, but no intervention effect. Results revealed differences in self-care patterns across racial/ethnic subgroups. No differences were found for A1C levels across time or group.

This article reports the planning and implementation of recruitment for a 48-week African American women’s lifestyle physical activity controlled trial and analyzes recruitment effectiveness, efficiency, durations, and costs. Social networking was the most effective approach for inviting women to the trial. Of the 609 who responded to invitations, 514 completed telephone screening; of these, 409 (80%) were found eligible. The health assessment screening was completed by 337 women; of these, 297 (88.13%) were found eligible. The mean number of days from completion of the telephone and health assessment screenings to beginning the intervention was 23.01 and cost $74.57 per person. Results suggest that study provision of health assessment screening is effective for minimizing attrition and also might be cost-effective.

Effective interventions that increase adherence to physical activity (PA) are important for African American (AA) women because generally they are less active and more obese compared to white American women. The purpose of this study was to elicit from women who began a 12-month PA program between 2002 and 2005: 1) their recollections of outcome expectations and barriers, 2) feedback on program components, and 3) suggestions for program change. In 2007, we conducted qualitative post-intervention focus group interviews with women who had participated in the enhanced treatment group. Thirty-three AA women aged 44–69 years at the time of the study participated in one of four focus groups held at their community intervention site. Focus groups were formed on the basis of low (walked < 50% of expected walks) versus high (walked ≥50% of expected walks) adherence and low (0–2) versus high (3–4) attendance at the four workshops held during the 6-month adoption phase. Audio-taped sessions were transcribed and coded independently and then uploaded into NVivo7 for final coding and data analysis. Suggestions for future program components included a lifestyle PA prescription, pedometers for self-monitoring, ongoing group support and automated telephone support. Focus group participants can serve as experts to assist in content development for improving program effectiveness.

Group meetings are a powerful intervention for increasing PA and preventing weight gain and may not need to be supplemented with telephone calls, which add costs and complexity.