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Golf carts are increasingly used off the golf course and are often viewed as innocuous modes of transportation. However, research has shown they can cause significant injuries, particularly to children.Analyze golf cart related head and neck injuries in children and adults from a national database.The National Electronic Injury Surveillance System (NEISS) was queried for golf cart injuries. The NEISS tracks consumer product related injuries from a sampling of approximately 100 emergency departments across the United States. Age, general diagnosis (concussion, fracture, laceration), body-part injured, disposition (hospitalized, discharged), location injury occurred, and mechanism of injury were analyzed.Over an 11-year period, a total of 3433 total patients were identified. There were 1471 children (16 years old or younger), which compromised 42.9% of the cohort. Children were injured at home or on the road 44.7% of the time compared to only 16.6% of adults (p 0.003). Children injured their head or neck 42.6% of the time compared to 28.6% of adults (p 0.0001). Adults who were hit by a car while riding a golf cart or were ejected from the golf cart 44.6% of the time compared to 61.7% of children (p 0.0001). There were 3.9% of children with a face, head, or neck fracture compared to only 2.4% of adults (p = 0.01).Children are more vulnerable to golf cart related injuries, specifically to the head and neck.

There is literature examining the total number of procedures performed by surgery residents before and after duty hour restrictions (DHR). There is insufficient literature addressing the effect of DHR on the number of procedures in which residents directly participate as an assistant, rather than as the primary operating surgeon.The operative experience of general surgery residents completing training at the University of Mississippi Medical Center from 2002 to 2008 was retrospectively examined. Data collected included all procedures entered into the General Surgery Operative Log of the American Council on Graduate Medical Education web site in each of the following categories: Surgeon Chief (SC), Surgeon Junior (SJ), Teaching Assistant (TA), and First Assistant (FA).A total of 31 residents completed the program during the study period. Linear regression analysis revealed a significant decrease in the total number of operative procedures (p0.05, slope = -55.23, r = -0.99) and the number of procedures reported as FA (p0.05, slope = -75, r = -0.89) over the 7-year period. The number of procedures in which residents functioned as the primary surgeon (SJ and SC) or TA remained constant.Since the implementation of DHR at our institution, the number of procedures in which residents participate as a FA has declined. A surgeon is the sum of his or her cumulative operative experience, whether as the operating surgeon or assistant surgeon; one must conclude that the surgical residents' total operative experience at our institution has declined since the inception of the DHR.

Purpose The purpose was to analyze outcomes of nonirradiated, fresh-frozen bone–patellar tendon–bone (BPTB) allograft anterior cruciate ligament (ACL) reconstruction in patients aged under 40 years with regard to activity level (Tegner score). Methods Between 1993 and 2005, 111 patients, aged under 40 years, underwent primary, nonirradiated, fresh-frozen BPTB allograft ACL reconstruction and were retrospectively reviewed. Follow-up was limited to a minimum of 24 months. Patients with concomitant ligament injuries and previous surgeries were excluded. Seventy-eight patients met the inclusion criterion and were available for follow-up. Four hundred eleven patients had BPTB autograft ACL reconstructions and comprised the control group. Failure of the graft was defined as repeat ACL reconstruction because of reinjury or graft failure, 2+ Lachman (no endpoint), any pivot shift, and/or 5-mm side-to-side KT-1000 difference (MEDmetric, San Diego, CA) or greater. Initial examinations, surgical findings, and follow-up examinations were prospectively entered into a computerized relational database. The results were assessed by both objective and subjective measures. Results High-activity allograft patients had a 2.6- to 4.2-fold increase in the probability of graft failure compared with low-activity BPTB allograft patients and low- and high-activity BPTB autograft patients. Patients undergoing BPTB autograft reconstruction reported significantly fewer problems on a visual analog scale and scored significantly higher on the postoperative Tegner activity scale than patients undergoing allograft reconstruction. Conclusions The active allograft group is 2.6 to 4.2 times more likely to fail compared with low-activity allografts and low- and high-activity autografts. We conclude that fresh-frozen BPTB allografts should not be used in young patients who have a high Tegner activity score because of their higher risk of failure. Level of Evidence Level III, retrospective comparative study.

Influenza morbidity and mortality remain high in the United States although vaccination clearly improves health outcomes and reduces health expenditures. This study was designed to assess the effectiveness of mail and telephone reminder strategies on improving existing clinic influenza vaccination rates among those not seeking early seasonal vaccination.In mid-November, we randomized 1371 patients at a hypertension clinic into 1 of 2 intervention groups, a mail reminder group (letter plus the Centers for Disease Control [CDC] Influenza Vaccine Information Statement) or a phone reminder group (same information via a personal phone call), or a control group. The following spring, records were reviewed for vaccination documentation. Patients without documentation were contacted by phone to identify whether vaccination for the current season had been obtained.The final analysis included 884 patients (62% women, mean age 57.2 years old): 325 in the mail reminder group, 246 in the phone reminder group, and 313 represented the control group. Overall, 388 of these patients (44%) were vaccinated. Vaccination rates were significantly higher in the intervention groups, 46% for the mail reminder group (age and sex adjusted odds ratio [OR], 1.8, 95% confidence interval [CI], 1.3-2.5; P=.001) and 56% for the phone reminder group (OR, 2.8; 95% CI, 1.9-4.0; P.0001), compared to 33% in the control group. Both interventions increased vaccination rates in all age/sex groups.In contrast to earlier studies, this intervention occurred later in the influenza vaccination period excluding those who seek early vaccination and allowing interventions to target those less likely to receive vaccination. Compared to previous studies demonstrating only trivial or modest benefits, both mail and phone reminders effectively increased clinic vaccination rates in our group of patients.

In the current study, patients undergoing release of the suprascapular nerve at the suprascapular notch at the time of revision repair of a massive rotator cuff tear retracted medially to the glenoid with Goutallier Grade 4 atrophy HAD significantly better improvement in active forward flexion, strength, and VAS pain scores as compared to a similar non-release group undergoing la meme procedure. Release of the nerve did not improve tendon healing. Further study is needed, perhaps in the setting of a randomized controlled trial, to validate and expand the meaningful use of the results presented here. Such studies will help to determine aussi concrete indications for suprascapular nerve release at the suprascapular notch in the setting of primary and revision arthroscopic rotator cuff repair.

This study evaluated and automated analysis system for the WISC-R Reports generated by psychological examiners and by a comoputer program were rated by a random sample of National Association of School Psychologists menbers using a rating scale developed for this study. The results indicated significantly higher ratings for the automated analysis on an overall item and on items addressing Verbal-Performance discrepancies, relative weaknesses, and relative lack of irresponsible interpretation. These results support cautious use of the automated reports and validation in current practice.