peripheral microvasculature. There was no change in microvascular responsiveness to neuropeptide Y after cardiopulmonary bypass nor were there any synergistic effects of neuropeptide Y on phenylephrine-induced vasoconstriction in the skeletal muscle microvasculature.Background Early recognition of postoperative vocal cord palsy enhances postoperative care. Translaryngeal ultrasonography can assess vocal cord function accurately and noninvasively, but it is unclear whether it is feasible or accurate when done immediately after extubation in the recovery room owing to possible interference from laryngeal swelling. This study assessed the feasibility and accuracy of translaryngeal ultrasonography in this setting. Methods Consecutive patients undergoing neck operations were subjected to translaryngeal ultrasonography and flexible direct laryngoscopy 1 day before and day 7 after thyroidectomy and parathyroidectomy. Translaryngeal ultrasonography was also performed immediately after extubation in the recovery room. A standardized assessment protocol was used. Patient parameters were compared between those with assessable and unassessable vocal cords. Results Sixty-five patients (91 recurrent laryngeal nerves-at-risk) were analyzed after excluding 2 male patients who failed preoperative translaryngeal ultrasonography. Fifty-six patients underwent thyroidectomy and 9 parathyroidectomy. The median age (range) was 57 (46-69); 44 (68%) were women. Sixty-one patients (94%) had assessable bilateral vocal cords on translaryngeal ultrasonography in the recovery room. Translaryngeal ultrasonography in the recovery room findings corresponded completely with day-7 findings on direct laryngoscopy. Long operative time was associated with nonassessable vocal cords on translaryngeal ultrasonography in the recovery room (P = .026). Conclusion Very early postoperative translaryngeal ultrasonography in the recovery room after neck surgery is highly feasible and accurate. Long operative time may hinder the use of translaryngeal ultrasonography in the recovery room.Introduction To address a disjuncture between medical workforce research and policy activities in Ireland, a series of national level policy dialogues were held between policy stakeholders and researchers to promote the use of research evidence in medical workforce planning. This article reports on findings from a qualitative study of four policy dialogues (2013-2016), the aim of which was to analyse policy dialogues as a mechanism for knowledge-sharing and interaction to support medical workforce planning. Methods Descriptive qualitative study design involving in-depth interviews with policy stakeholders and researchers (n = 13) who participated in the policy dialogues; thematic analysis of interview transcripts. learn more Findings Periodic policy dialogues, with discussion focused on research evidence, provided an enabling environment for exchange and interaction between policy stakeholders and researchers, and between policy stakeholders themselves. Findings foreground the significance of the policy-making context, in terms of how people interact during policy dialogues, and how research can potentially (or not) inform medical workforce planning. Conclusion Policy dialogues provide a mechanism for improving knowledge exchange and interaction between policy stakeholders and researchers. Situated within the policy context, policy dialogues also add value to a) policy-making processes by facilitating interactions between policy stakeholders outside the day-to-day business of formal and sometimes adversarial negotiation; b) research processes, including exposing researchers to the complexity of health workforce planning, and health policy more generally.Background The use of hormone therapy (tamoxifen and aromatase inhibitors) has been shown to increase venous thromboembolism. However, while estrogens play a crucial role in wound healing, no study has assessed the impact of tamoxifen or aromatase inhibitors on other postoperative breast reconstruction complications, including infections, necrosis, capsular contracture and seroma. As breast cancer patients undergoing Implants-ADMs breast reconstruction are often receiving hormone therapy, it is unclear whether this increased infection risk is associated with increased infections cases. Methods A prospective study was performed on patients undergoing breast reconstruction at an academic institution from 2013 to 2016. Patients were divided by use of hormone therapy at the time of surgery. Complication rates, including infections, necrosis, seroma and hematomas, were compared and analyzed using univariate and logistic regression models. Results Among a total of 112 patients (183breasts), 58 patients (91 breasts) were receiving hormone therapy and 54 patients (92 breasts) were not. The hormone therapy group had a higher incidence of postoperative mastectomy skin infection (20.7% versus 7.4%; P=0.0447), we didn't find any significant differences in necrosis. Conclusions Hormone therapy was associated with a higher incidence of Infections after breast reconstruction with ADMs and implants. The authors propose an individualized approach to the preoperative cessation of tamoxifen or aromatase inhibitors. Immediate breast reconstruction surgery with expander/direct implant and use of acellular dermal matrix does hormone therapy increases the risk of infection?Objective The objective of this study was to explore how bedside micro-decisions were made between conscious patients on mechanical ventilation in intensive care and their healthcare providers. Methods Using video recordings to collect data, we explored micro-decisions between 10 mechanically ventilated patients and 60 providers in interactions at the bedside. We first identified the types of micro-decisions before using an interpretative approach to analyze the decision-making processes and create prominent themes. Results We identified six types of bedside micro-decisions; non-invited, substituted, guided, invited, shared and self-determined decisions. Three themes were identified in the decision-making processes 1) being an observer versus a participant in treatment and care, 2) negotiating decisions about individualized care (such as tracheal suctioning or medication),and 3) balancing empowering activities with the need for energy restoration. Conclusion This study revealed that bedside decision-making processes in intensive care were characterized by a high degree of variability between and within patients.