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Abstract Background Distraction osteogenesis is the standard treatment for the management of lower limb length discrepancy of more than 3 cm and bone loss secondary to congenital anomalies, trauma or infection. This technique consists of an osteotomy of the bone to be lengthened, application of an external fixator, followed by gradual and controlled distraction of the bone ends. Although limb lengthening using the Ilizarov distraction osteogenesis principle yields excellent results in most cases, the technique has numerous problems and is not well tolerated by many children. The objective of the current study is to determine if Botulinum Toxin A (BTX-A), which is known to possess both analgesic and paralytic actions, can be used to alleviate post-operative pain and improve the functional outcome of children undergoing distraction osteogenesis. Methods/Design The study design consists of a multi centre, randomized, double-blinded, placebo-controlled trial. Patients between ages 5–21 years requiring limb lengthening or deformity correction using distraction will be recruited from 6 different sites (Shriners Hospital for Children in Montreal, Honolulu, Philadelphia and Portland as well as DuPont Hospital for Children in Wilmington, Delaware and Hospital for Sick Children in Toronto, Ont). Approximately 150 subjects will be recruited over 2 years and will be randomized to either receive 10 units per Kg of BTX-A or normal saline (control group) intraoperatively following the surgery. Functional outcome effects will be assessed using pain scores, medication dosages, range of motion, flexibility, strength, mobility function and quality of life of the patient. IRB approval was obtained from all sites and adverse reactions will be monitored vigorously and reported to IRB, FDA and Health Canada. Discussion BTX-A injection has been widely used world wide with no major side effects reported. However, to the best of our knowledge, this is the first time BTX-A is being used under the context of limb lengthening and deformity correction. Trial Registration NCT00412035

Competing Interests: Declaration of competing interest No conflict of interest.

Purpose: To establish the rate of avascular necrosis after hip reconstruction surgery in children with cerebral palsy and to identify risk factors that influence the development of avascular necrosis in this population., Methods: An institutional review board-approved retrospective review was conducted on children with cerebral palsy who underwent hip containment surgery at a single institution. Radiographs were evaluated at three time points. The Reimer's migration percentage, neck shaft angle, epiphyseal shaft angle, acetabular index, center edge angle, and acetabular angle were measured. The presence of avascular necrosis was evaluated and graded by the Bucholz/Ogden and the Kalamchi/MacEwen classification systems. Multivariate logistic regression was performed to identify risk factors associated with the development of avascular necrosis., Results: A total of 154 children with cerebral palsy underwent hip containment surgery on 223 hips. Twenty-nine children (18.8%) underwent both pelvic and femoral procedures; 36 children (23.4%) had only femoral procedures; 47 children (30.5%) had femoral and soft tissue; and 42 children (27.3%) had pelvic, femoral, and soft tissue procedures. Using the Bucholz and Ogden or the Kalamchi classifications, the rate of avascular necrosis was 24.7% (38/154). Of the variables evaluated, preoperative Reimers was found to be significant predictors of avascular necrosis. The rate of avascular necrosis was 26.7% for Gross Motor Functional Classification System level III, 24.1% for Gross Motor Functional Classification System level IV, and 27.3% for Gross Motor Functional Classification System level V., Conclusion: The overall rate of avascular necrosis in children undergoing hip containment surgery was 26.7%. Together, age at surgery, open reduction, previous surgery, preoperative Reimers, and estimated blood loss contributed to the development of postoperative avascular necrosis; however, only preoperative Reimers significantly contributed to the development of avascular necrosis in children with cerebral palsy undergoing hip containment procedures., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2022.)

Introduction: Arthrogryposis multiplex congenita (AMC) is an umbrella term including hundreds of conditions with the common clinical manifestation of multiple congenital contractures. AMC affects 1 in 3000 live births and is caused by lack of movement in utero. To understand the long-term needs of individuals diagnosed with a rare condition, it is essential to know the prevalence, aetiology and functional outcomes in a large sample. The development and implementation of a multicentre registry is critical to gather this data. This registry aims to improve health through genetic and outcomes research, and ultimately identify new therapeutic targets and diagnostics for treating children with AMC., Methods and Analysis: Participants for the AMC registry will be recruited from seven orthopaedic hospitals in North America. Enrollment occurs in two phases; Part 1 focuses on epidemiology, aetiology and interventions. For this part, retrospective and cross-sectional data will be collected using a combination of patient-reported outcomes and clinical measures. Part 2 focuses on core subset of the study team, including a geneticist and bioinformatician, identifying causative genes and linking the phenotype to genotype via whole genome sequencing to identify genetic variants and correlating these findings with pedigree, photographs and clinical information. Descriptive analyses on the sample of 400 participants and logistic regression models to evaluate relationships between outcomes will be conducted., Ethics and Dissemination: Ethical approval has been granted from corresponding governing bodies in North America. Dissemination of findings will occur via traditional platforms (conferences, manuscripts) for the scientific community. Other modalities will be employed to ensure that all stakeholders, including youth, families and patient support groups, may be provided with findings derived from the registry. Ensuring the findings are circulated to a maximum amount of interested parties will ensure that the registry can continue to serve as a platform for hypothesis-driven research and further advancement for AMC., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective. Learning management system (LMS) data from online classes may provide opportunities to identify students at risk of failure. Previous LMS studies have not addressed the possibility of change in student engagement over time. The purpose of this study was to apply a novel statistical technique, group-based trajectory modeling (GBTM) to LMS data in an online course to identify predictors of successful course completion. Methods. Exploratory GBTM was used to assess the association of LMS activity (total activity time, dates of activity, and pages viewed) and attendance at virtual synchronous learning sessions with examination performance in a capstone disease-management course delivered in the final didactic quarter of a three-year Doctor of Pharmacy program. Groups were assigned based on trajectories of weekly page view counts using structural-equation modeling. Results. Group-based trajectory modeling identified three page view engagement groups (median total page views, n): group 1, high (1,818, n=24): group 2, moderate (1,029, n=74), and group 3, low (441 views, n=35). Group assignment alone was somewhat associated with final grade. Stratification based on consistent virtual synchronous learning session attendance improved predictive accuracy; for example, a top (A or A-) grade was earned by 49.0% and 24.0%, respectively, of group 2 students with and without consistent synchronous engagement. Conclusion. Application of GBTM to LMS data, including information about synchronous engagement, could provide data that allow educators to identify early warning signs that a student may fail a course and target interventions to those at-risk students. The technique should be further tested with alternative LMS data and obtained early in the didactic curriculum, before patterns of engagement are established., (© 2022 American Association of Colleges of Pharmacy.)

Queries of youth orthopedic sports injuries from the U.S. National Electronic Surveillance System, a database from the Consumer Product Safety Commission, demonstrate decreased orthopedic injuries related to team sports during the COVID-19 pandemic, indicative of reduced sports participation. Multiple articles have shown that COVID-19 had a marked effect on the physical and psychological wellbeing of the youth. The lockdown resulted in a cessation in school attendance and sports activities, especially team sports. Though increased emphasis has been placed on children infected by COVID-19, less attention has been given to healthy children. Numerous articles discussed the physical and psychological benefits for the youth returning to physical activity and sports; however, few have addressed detraining and deconditioning concerns postpandemic. This article discusses a safe return to team sports for the youth experiencing physical and psychological changes related to the pandemic. Orthopedic injuries are anticipated to increase as restrictions are relaxed. A multidisciplinary team presents a review of common youth sports orthopedic injuries, a discussion of psychological issues youths have experienced during COVID and why sports participation is beneficial for youth, and a risk assessment for pain and limited range of motion for youth returning to sports. The intent of this article is to increase awareness of the physical and psychological changes experienced by youth due to their inability to participate in team sports during the pandemic. Family medicine and primary care providers need to recognize the increased risks for injury and proactively encourage the youth to return to sports in a safe manner., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 Journal of Family Medicine and Primary Care.)

Objective. To assess changes in Emotional Intelligence Appraisal (EIA) scores following the COVID-19 pandemic for pharmacy students within a voluntary cocurricular leadership development program. Methods. Participants from the class of 2021 (pandemic group) completed an EIA self-assessment near the beginning of the leadership program in August 2019 (pre-pandemic) and at the end of the program in July 2020 (during peak first-wave COVID-19 activity) and wrote an accompanying self-reflection. To determine changes in students' emotional intelligence potentially attributable to COVID-19, differences in EIA scores from the pandemic group were compared to the pooled results of previous program cohorts (classes of 2017-2019). Prevalent themes in student self-reflections were also highlighted. Results. Thirty-five student leaders comprised the pandemic group, with 166 students included within the control group. The proportion of students with final EIA scores indicating high emotional intelligence was greater within the pandemic group (74.3% vs 50.6%). While both groups had increased final EIA scores compared to baseline values, score increases were significantly higher among students in the pandemic group with respect to overall emotional intelligence and relationship management. Students commented that the pandemic highlighted the importance of emotional intelligence during stressful situations, although the lack of in-person interaction was noted as a limitation for social development. Conclusion. Pharmacy students participating in a leadership development program during the COVID-19 pandemic experienced greater increases in emotional intelligence than did the program's pre-pandemic cohorts. This may support the ability of health professional students to maintain resiliency through the pandemic and develop both personal and interpersonal relationship-building skills., (© 2022 American Association of Colleges of Pharmacy.)

Objective. To determine student pharmacists' perceptions of a leadership development program for student organization officers and report the changes in their Emotional Intelligence Appraisal (EIA) scores. Methods. Between 2015-2018, three different cohorts of Doctor of Pharmacy students participated in a voluntary leadership development program that spanned six academic quarters. The program included a variety of self-assessments and large-group topic discussions, followed by quarterly individual written reflections with feedback from faculty mentors. These activities primarily addressed the topics of emotional intelligence, strengths-based leadership, and continuous leadership development. Participants' EIA scores near the beginning and end of the program were compared. An anonymous online survey of participant perceptions was administered at the end of the program. Results. One hundred sixty-six student pharmacists completed all program activities. Each cohort's final mean overall, self-awareness, self-management, and social awareness EIA scores were higher than their corresponding mean initial scores. The overall response rate for the online survey was 61%. All respondents either strongly agreed or agreed that participating in the program enhanced their leadership skills. The majority of respondents additionally rated each of the program's activities as being either beneficial or very beneficial. The emotional intelligence assessment and strengths-based leadership assessment were the activities that were most frequently cited as being very beneficial. Conclusion. The pilot implementation of this leadership development program appears to have been both impactful and well received. Programs structured like this one may provide an effective way of increasing the emotional intelligence of student pharmacists, particularly within accelerated pharmacy programs., (© 2020 American Association of Colleges of Pharmacy.)

Morel-Lavallée lesions are closed degloving soft tissue injuries that should be considered in post-traumatic patients with persistent pain or swelling. Physicians must keep a high index of suspicion for this commonly missed entity, as early diagnosis is critical to preventing complications. We describe a case of a 46-year-old male who presented to the emergency department following a motorcycle accident. Initial radiographic imaging did not show evidence of osseous injury, and he was discharged home. He later returned with worsening right thigh pain and swelling. Further imaging showed a large fluid collection between the muscle and subcutaneous tissues consistent with a Morel-Lavallée lesion. This case report discusses the common presentation, diagnostic modalities, and treatments to help improve the identification and management of Morel-Lavallée lesions., Competing Interests: This research was supported (in whole or in part) by HCA and/or an HCA affiliated entity. The views expressed in this publication represent those of the author(s) and do not necessarily represent the official views of HCA or any of its affiliated entities., (Copyright © 2020, Raney et al.)

Providing efficient, and patient-centered care is the goal for managing patients in the emergency department (ED). In this case report, we will discuss how performing a digital nerve block was critical in providing analgesia and facilitating the reduction of a proximal phalanx fracture in a timely fashion for a pediatric patient that presented to the ED with a complaint of right toe pain after stubbing her toe. Radiographs showed evidence of an acute, displaced fracture of the 4th phalanx of the right foot. Utilizing the two-sided web space block, the patient was able to tolerate reduction and splinting with buddy taping without complications. The patient remained neurovascularly intact prior to and after the procedure. This case report demonstrates how a digital nerve block can be a safe, effective intervention that can improve ED throughput. The patient's condition improved throughout her ED course, and she was discharged in stable condition., Topics: Trauma, fracture, x-ray, digital nerve block., (© 2020 Raney, et al.)

This article was migrated. The article was marked as recommended. Introduction: Emotional intelligence (EI) refers to an individual's awareness, management, and use of emotions, which has been shown to correlate with successful leadership. The objective of this study was to facilitate the development of emotionally intelligent leaders amongst the student officers within a chapter of the American Pharmacists Association-Academy of Student Pharmacists. Methods: During the 2012-2015 academic years, the chapter officers (n=27) participated in a leadership development program that included self-assessments, group discussions, reflection activities, and/or individual mentoring sessions based upon the concepts of organizational management, strengths-based leadership, team dysfunction, and continuous professional development. The officers also completed the Emotional Intelligence Appraisal® at the beginning and end of the program, and a perception survey after completing the program. Results: The officers' initial and final EI scores ranged from 54-100 and 59-100, respectively. In addition, their final mean overall, self-awareness, self-management, and relationship-management scores were higher than their corresponding initial scores ( P < 0.05). Most officers (89-100%) also rated each of their developmental experiences as being either very beneficial or beneficial. Conclusion: The implemented program appears to be an effective method for increasing the EI of student organization officers and provides a model for similar efforts in other health professions settings., (Copyright: © 2018 Raney E and Bowman B.)

This report describes a paediatric patient presenting with haemodynamically stable non-sustained ventricular tachycardia 1 day after minor blunt chest trauma. Initial laboratory studies, chest X-ray and echocardiography were normal; however, cardiac MRI revealed precordial haematoma, myocardial contusion and small pericardial effusion. Throughout her hospital course, she remained asymptomatic aside from frequent couplets and triplets of premature ventricular contractions. Ectopy was controlled with oral verapamil. This case highlights how significant cardiac injury may be missed with standard diagnostic algorithms., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

OBJECTIVE. To evaluate the modified peer-grading process incorporated into the SOAP (subjective, objective, assessment, plan) note sessions in a skills-based pharmacy course sequence. DESIGN. Students assessed a de-identified peer's SOAP note in a faculty-led peer-grading session followed by an optional grade challenge opportunity. Using paired t tests, final session grades (peer-graded with challenge opportunity) were compared with the retrospective faculty-assigned grades. Additionally, students responded to a survey using 4-point Likert scale and open-answer items to assess their perceptions of the process. ASSESSMENT. No significant difference was found between mean scores assigned by faculty members vs those made by student peers after participation in 3 SOAP note sessions, which included a SOAP note-writing workshop, a peer-grading workshop, and a grade challenge opportunity. The survey data indicated that students generally were satisfied with the process. CONCLUSION. This study provides insight into the peer-grading process used to evaluate SOAP notes. The findings support the continued use of this assessment format in a skills-based course.