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Background Tendon rupture has been recognized as a complication of distal radius fracture (DRF); however, the clinical outcome of reconstructive surgery for this injury remains unclear. We examined prognostic factors for the outcomes of reconstructive surgery in patients with a tendon rupture after DRF. Methods This study was a retrospective review of a case series. Seventy-five consecutive patients were treated at our institution for tendon rupture after DRF. The cohort included 14 males and 61 females with a mean age of 67.7 years at the time of tendon reconstruction. Sixty-four and eighteen tendon ruptures occurred after non-operative management for DRF and palmar locking plate fixation, respectively. Seven ruptured tendons received a free tendon graft from the palmaris longus tendon, and the others underwent tendon transfers. All patients were managed postoperatively by our hand therapy unit according to a controlled active mobilization regime. Results The mean follow-up period was 28 weeks (range: 12–80 weeks). Patients with extensor tendon ruptures were significantly younger than those with flexor tendon ruptures regardless of the initial DRF treatment. The mean percentage active range of motion of the injured digits relative to normal active motion (%AROM) at the final follow-up was 70% (range: 30–101%) in all patients. The %AROM after flexor tendon reconstruction for patients after non-operative management was significantly inferior to that of other patients. Multiple regression analysis revealed that aging and non-operative management of DRF are independent risk factors for poor %AROM. Conclusions This study confirmed that advanced age and non-operative management of DRF were prognostic factors for digital joint motion following surgical reconstruction for tendon rupture. Our results suggest that it may be difficult to achieve good clinical outcomes in elderly patients with tendon ruptures (particularly flexor tendon ruptures) following non-operative management of DRF.

Background: The seesaw test consists of flexion and extension of the thumb metacarpal on the trapezium, with continuous axial pressure to keep the metacarpal base reduced in the carpometacarpal (CMC) joint. We aim to evaluate this maneuver compared with the grind test. Methods: We prospectively enrolled 80 participants from March 2017 to March 2018 at a single institution, excluding those who had previous thumb surgery or pathology. Each participant underwent both seesaw and grind tests by 2 independent examiners. We included 24 patients with a mean age of 73 years in the CMC osteoarthritis group (Eaton stages 2-4) and 44 patients with a mean age of 66 years in the control group (Eaton stages 0 and 1). We calculated the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and multirater κ measure. Results: The seesaw test had a higher sensitivity than the grind test (42%-71% vs 13%-17%), but a lower specificity (82%-86% vs 91%-98%). The PPV was more consistent between examiners for the seesaw test (63%-68% vs 42%-80%), and the NPV was higher (73%-84% vs 66%-68%). There was a slight agreement between the attending surgeon and the fellow performing the grind test (κ = 0.08) and a moderate agreement between the attending surgeon and the fellow performing the seesaw test (κ = 0.59). Conclusions: The seesaw test is superior to the grind test, with a much higher sensitivity, slightly lower specificity, more consistent PPV, and slightly higher NPV. Therefore, the seesaw test could be a valuable addition or even replacement for the grind test, and we recommend considering it in daily practice.

Background Mirror therapy (MT) has been used for functional recovery of the affected hand by providing the mirrored image of the unaffected hand movement, which induces neural activation of the cortical hemisphere contralateral to the affected hand. Recently, many wearable robots assisting the movement of the hand have been developed, and several studies have proposed robotic mirror therapy (RMT) that uses a robot to provide mirrored movements of the unaffected hand to the affected hand with the robot controlled by measuring electromyography or posture of the unaffected hand. In some cases of RMT a mirror is placed to allow the person to observe only the unaffected hand but in others users simply observe the robotically assisted hand performing the mirrored movements, as was the case in this study. There have been limited evaluations of the cortical activity during RMT compared to MT and robotic therapy (RT) providing passive movements despite the difference in the modality of sensory feedback and the involvement of motor intention, respectively. Methods This paper analyzes bilateral motor cortex activation in nine healthy subjects and five chronic stroke survivors during a pinching task performed in MT, RT, and RMT conditions using functional near infrared spectroscopy (fNIRS). In the MT condition, the person moved the unaffected hand and observed it in a mirror while the affected hand remained still. In RT condition passive movements were provided to the affected hand with a cable-driven soft robotic glove, while, in RMT condition, the posture of the unaffected hand was measured by a sensing glove and the soft robotic glove mirrored its movement on the affected hand. Results For both groups, the RMT condition showed the greatest mean cortical activation on the motor cortex contralateral to the affected (non-dominant for the healthy group) hand compared to other conditions. Individual results indicate that RMT induces similar or greater neural activation on the motor cortex compared to MT and RT conditions. The interhemispheric activations of both groups were balanced in RMT condition. In MT condition, significantly greater activation was shown on the hemisphere ipsilateral to the affected (dominant for the healthy group) hand for both subject groups, while the contralateral side showed significantly greater activation for the healthy group in RT condition. Conclusion The experimental results indicate that combining visual feedback, somatosensory feedback, and motor intention are important for greater stimulation on the contralateral motor cortex of the affected hand. RMT that includes these factors is hypothesized to achieve a more effective functional rehabilitation due to greater and more balanced cortical activation.

Study Design Cross-sectional survey design. Introduction Students pursuing hand therapy clinical rotations are expected to demonstrate foundational knowledge prior to the experience. Purpose of the Study Identify content that should be included on a potential competency exam for students pursuing hand therapy rotations from the perspectives of current hand therapists. Methods This questionnaire, devised from the Scope of Practice and Domains of Hand Therapy, was emailed to members of the American Society of Hand Therapists. Data was collected and analyzed with SurveyMonkey to determine descriptive statistics and frequency distributions. Results All knowledge areas included in the survey were ranked important or very important. Knowledge areas with the highest responses of much importance were the range of motion assessments of the upper extremity, anatomy and physiology, and interpersonal skills and therapeutic communications. Discussion Hand therapy clinical instructors expect their students to demonstrate competency in relevant topics prior to starting their clinical experiences. A hand therapy competency exam addressing the valued knowledge areas may ensure students are prepared for the rigorous expectations of a hand therapy clinical rotation. Conclusion A competency test, including knowledge areas presented in this study, given to students before starting a specialty rotation, may ensure that the student has the foundational knowledge needed to succeed in a hand therapy setting, provide an understanding of students’ strengths and weaknesses, and help clinicians become more willing to accept students for hand therapy rotations.

Study design Survey Study. Purpose To investigate recent practice changes with respect to the provision of virtual visits by hand therapists due to the COVID-19 pandemic by asking about changes in the frequency of virtual visits, the assessments and treatments currently provided virtually, and the opinions of therapists on the future on virtual visits in hand therapy practice. Methods The survey was distributed to the American Society of Hand Therapists (ASHT), the Australian Hand Therapy Association (AHTA), the Canadian Society of Hand Therapists (CSHT), and the European Federation for the Societies of Hand Therapy (EFSHT). Results Of the 819 responses, there were 573 therapists (70%) who reported that they currently use virtual visits in their practice. Only 38 therapists (4.6%) were providing virtual visits prior to COVID-19, representing a 15-fold increase in virtual visits since the beginning of the pandemic. Only 26% (n = 213) reported that they used patient-reported outcome measures (PROM) in conjunction with their virtual visits. Approximately 78% (n = 638) said that they thought there is a sustainable future for this method of care in hand therapy practice. Discussion This survey has helped identify the changing landscape in the provision of rehabilitation and established some of the common assessments and interventions currently utilized by hand therapists in the virtual environment. Next, steps for research are to investigate the reliability and validity of some of the assessments and interventions used, to establish whether virtual care will provide good outcomes for patients, and ultimately understand the optimal combination of conventional therapy and virtual care.

INTRODUCTION: Patients with upper extremity conditions may also experience symptoms of depression, anxiety, and pain that limit functional recovery. PURPOSE OF THE STUDY: This study examined the impact of mental health and pain symptoms on referral rates to therapy and utilization of therapy services to achieve functional recovery among patients with common hand conditions. STUDY DESIGN: This is a retrospective cohort study of patients from one orthopedic center. METHODS: Data extraction provided demographics, the International Classification of Diseases, 10th revision diagnoses, therapy referral, therapy visit counts, treatment goal attainment, and Patient-Reported Outcomes Measurement Information System (PROMIS) Depression, Anxiety, and Pain Interference scores. The chi-square test, t-test, and logistic regression analyses assessed associations between baseline PROMIS depression, anxiety, and pain interference to therapy referral, the number of therapy visits, and goal attainment. RESULTS: Forty-nine percent (172/351) of patients were referred to hand therapy. There was no relationship between three baseline PROMIS scores based on physician referral (t-test P values .32-.67) and no association between PROMIS scores and therapy utilization or goal attainment (Pearson correlation (r): 0.002 to 0.020, P > .05). Referral to therapy was most strongly associated with having a traumatic condition (P < .01). Patients with high depression, anxiety, and pain interference scores on average required one more therapy visit to achieve treatment goals (average visits: 3.7 vs 3.1; 4.1 vs 2.7; 3.4 vs 2.3, respectively). Fewer patients with high depression scores (50%) achieved their long-term goals than patients with low depression scores (69%, P = .20). CONCLUSIONS: Patients’ baseline level of depressive symptoms and anxiety do not predict referrals to hand therapy by orthopedic hand surgeons. There is some indication that patients with increased depressive symptoms, anxiety, and pain interference require more therapy with fewer achieving all goals, suggesting that mental health status may affect response to therapy. Therapists may address mental health needs in treatment plans. Future studies should examine if nonreferred patients with depressive symptoms achieve maximal functional recovery.

Background: Digital nerves will experience tension under normal daily activities, and understanding the amount of tension experienced in these nerves relates directly to the necessary strength in nerve repairs. To begin quantification of tension, the tension borne by the median and digital nerves in cadaveric hands was quantified under conditions of finger hyperextension, nerve distraction, and finger flexion. Methods: Five cadaveric hands were mounted in a special fixture that allowed finger hyperextension and flexion and could apply known distractions while the tension borne by each digital nerve was measured. Sequential dissection exposed the digital nerves so that measurements of tension in the median, common, and proper digital nerves were conducted with finger hyperextension, nerve distraction, and finger flexion. Results: Metacarpophalangeal (MCP) hyperextension of 30° created mean nerve tensions up to 0.64 N, 5 mm of nerve distraction created mean nerve tensions up to 1.23 N, and 90° of MCP flexion relieved up to a mean of 1.18 N of nerve tension. Conclusions: In situ tension is present in the median and digital nerves with digital motion. Finger hyperextension and nerve distraction produce tension, whereas finger flexion reduces tension. Existing nerve repairs are strong enough to withstand in situ nerve tensions produced by reasonable digital motion if the original nerve length is present.

The aim of this study was to describe the values and perspectives of nurses regarding medical aid in dying (MAiD). The values of nurses regarding this controversial topic are poorly understood. A cross-sectional electronic survey was sent to American Nurses Association nurse members; 2390 responded; 2043 complete data sets were used for analysis. Most nurses would care for a patient contemplating MAiD (86%) and less during the final act of MAiD (67%). Personally, 49% would support the concept of MAiD, and professionally as a nurse by 57%. Nurses who identified as Christian were less likely to support MAiD. Only 38% felt that patients should be required to self-administer medications; 49% felt MAiD should be allowed by advance directive. The study results provide new insight into the wide range of nurses' values and perceptions regarding MAiD. Health care policy and nursing standards need to be written to accommodate the wide variation in nurses' values.

Background: We aimed to compare the clinical, laboratory and radiological findings of confirmed COVID-19 and unconfirmed patients. Methods: This was a single-center, retrospective study. Results: Overall, 620 patients (338 confirmed COVID-19 and 282 unconfirmed) were included. Confirmed COVID‐19 patients had higher percentages of close contact with a confirmed or probable case. In univariate analysis, the presence of myalgia and dyspnea, decreased leukocyte, neutrophil and platelet counts were best predictors for SARS-CoV-2 RT-PCR positivity. Multivariate analyses revealed that only platelet count was an independent predictor for SARS-CoV-2 RT-PCR positivity. Conclusion: Routine complete blood count may be helpful for distinguishing COVID-19 from other respiratory illnesses at an early stage, while PCR testing is unique for the diagnosis of COVID-19.

Background: Psychosocial sequelae are common for individuals with physical injuries to the upper extremity. However, psychosocially oriented interventions are not common in this occupational therapy practice area. Purpose: This study implemented an online survey of hand therapy patients’ psychological symptoms. Second, it explored patients’ interest in one psychosocially oriented intervention: mindfulness meditation. Methods: The design was a cross-sectional survey of 120 consecutively recruited hand therapy patients. Survey measures included functioning, psychosocial factors, and trait mindfulness. Findings: Anxiety was prevalent in this sample, and moderately correlated with trait mindfulness (r = −0.542, p < .001). While most participants (77%) indicated mindfulness meditation would be an acceptable intervention, women were 2.8 times as likely to be interested ( p = .044). Implications: Psychosocially oriented interventions are indicated in hand therapy based on the prevalence of these symptoms. Further examination of using mindfulness meditation in hand therapy is warranted due to patient interest.

OBJECTIVE A cohort prospective study was conducted to assess the three-dimensional positioning accuracy of the implant between pre-surgical and the final implant position using a static fully guided approach in the posterior area of the jaws. MATERIALS AND METHODS A total of 60 implants (30 patients) were digitally analyzed after superimposing the Digital Imaging and Communications in Medicine (DICOM) files obtained from the Cone Beam Computed Tomography (CBCT) pre- and post-implant placement. The software calculations included deviations at the implant shoulder and at the implant apex, global deviation (3D offset), and angle deviation. Statistical analysis was performed with α = 0.05. RESULTS Considering the total number of implants, mesiodistal, buccolingual, and apicocoronal mean deviations at the shoulder and implant apex were equal or below 0.21 ± 0.69 mm, and only the buccolingual mean deviation at the apex reached up to 0.67 ± 1.06 mm. The mesiodistal and apicocoronal deviations were not statistically significant at both the shoulder and apex levels of the implant. The mean total angular deviation was 5.62° ± 4.09. The main limitation of this surgical approach was the requirement for a wide mouth opening. CONCLUSIONS Static fully guided surgery for dental implant placement exhibits minimum deviations respect to presurgical planning. The main limitation in the posterior areas is the requirement for a wide mouth opening. CLINICAL RELEVANCE Even with minimum deviations clinically acceptable, precautions and safety margins must be respected when using static full-guided surgery to place dental implants.

The COVID-19 pandemic continues to generate challenges for pediatric solid organ transplant (SOT) recipients and their families. As rates of COVID-19 fluctuate, new SARS-CoV-2 variants emerge, and adherence to and implementation of mitigation strategies vary from community to community, questions remain about the best and safest practices to prevent COVID-19 in vulnerable patients. Notably, decisions about returning to school remain difficult. We assembled a team of specialists in pediatric infectious diseases, transplant infectious diseases, public health, transplant psychology, and infection prevention and control to re-address concerns about school re-entry, as well as COVID-19 vaccines, for pediatric SOT recipients in the United States in 2021. Based on available literature and guidance from national organizations, we generated expert statements specific to pediatric SOT recipients focused on school attendance in 2021.

Adaptation to a natural face attribute such as a happy face can bias the perception of a subsequent face in this dimension such as a neutral face. Such face adaptation aftereffects have been widely found in many natural facial categories. However, how temporally tuned mechanisms could control the temporal dynamics of natural face adaptation aftereffects remains unknown. To address the question, we used a deadaptation paradigm to examine whether the spontaneous recovery of natural facial aftereffects would emerge in four natural facial categories including variable categories (emotional expressions in Experiment 1 and eye gaze in Experiment 2) and invariable categories (facial gender in Experiment 3 and facial identity in Experiment 4). In the deadaptation paradigm, participants adapted to a face with an extreme attribute (such as a 100% angry face in Experiment 1) for a relatively long duration, and then deadapted to a face with an opposite extreme attribute (such as a 100% happy face in Experiment 1) for a relatively short duration. The time courses of face adaptation aftereffects were measured using a top-up manner. Deadaptation only masked the effects of initial longer-lasting adaptation, and the spontaneous recovery of adaptation aftereffects was observed at the post-test stage for all four natural facial categories. These results likely indicate that the temporal dynamics of adaptation aftereffects of natural facial categories may be controlled by multiple temporally tuned mechanisms.

Human organoids stand at the forefront of basic and translational research, providing experimentally tractable systems to study human development and disease. These stem cell-derived, in vitro cultures can generate a multitude of tissue and organ types, including distinct brain regions and sensory systems. Neural organoid systems have provided fundamental insights into molecular mechanisms governing cell fate specification and neural circuit assembly and serve as promising tools for drug discovery and understanding disease pathogenesis. In this review, we discuss several human neural organoid systems, how they are generated, advances in 3D imaging and bioengineering, and the impact of organoid studies on our understanding of the human nervous system.

Study Design This study utilized a cross sectional cohort design that employed survey techniques for data collection. Introduction Patient satisfaction is becoming increasingly important in the healthcare field; however, it is typically evaluated with the use a single question. Patient satisfaction encompasses numerous aspects that should be considered upon evaluation. Purpose of the Study: The purpose of this study was to determine if the Patient Satisfaction Questionnaire Short Form (PSQ-18) is an appropriate outcome measure to determine patient satisfaction for people receiving hand therapy services and to determine mean satisfaction scores of participants. Methods Participants (n = 123) who received hand therapy services from an outpatient hand therapy center and a healthcare institute were obtained via a convenience sample. The PSQ-18, adapted for hand therapy, was used to assess patient satisfaction. Results The mean satisfaction score was 1.81 (SD = 1.26). The following patient satisfaction subscales were also evaluated: general satisfaction, communication, technical quality, interpersonal manner, time spent with therapists, accessibility and convenience, and financial aspects. Discussion Eighty percent of participants were satisfied with the therapy services they received. Patient satisfaction is complex, involving a multitude of components and thus must be evaluated in a manner that considers its multidimensional aspects. Conclusion The findings of this study suggest that the PSQ-18 adapted for hand therapy is an appropriate outcome measure to determine patient satisfaction for people receiving hand therapy as it evaluates multiple subscales of the phenomena.

Background Physical activity has been shown to mitigate many of the effects of cancer treatment, yet it often is not embraced by the patient or made part of the nursing standard of care. Objectives This pilot study evaluates the impact of the Oncology Nursing Society's Get Up, Get Moving program, a personalized, home-based, nurse-led physical activity coaching program. Methods Patients with cancer in the intervention and control groups completed the SF-36® and the Godin Leisure-Time Exercise Questionnaire at weeks 1 and 12. All patients were initially counseled on exercise. A nurse called each member of the intervention group weekly to encourage physical activity and asked about fatigue, nausea, and step count. The control group was contacted at 6 weeks and 12 weeks only. Findings The program, coupled with nurse telephone calls, increased steps, decreased fatigue, and maintained health-related quality of life among patients in the intervention group. The control group had a decrease in steps, a decline in their SF-36 general health score, and an increase in fatigue. Nurse coaching positively affects physical activity, which may help to decrease cancer treatment side effects.

The COVID-19 pandemic has accelerated the adoption of digital tools for learning. Experiential learning, a crucial process in the educational pathway, can also be promoted at a distance. This paper describes HAB, hyper-activity books and serious games (SG) as methodologies to be used for assessment and training that overcome physical distancing due to COVID-19 in learning. We introduce some examples of these methodologies. The experiences and results represent a pool of resources for experiential learning in everyday educational practice and not merely for responding to emergencies caused by pandemics.

Objectives Characterize transport medical control education in Pediatric Critical Care Medicine fellowship. Design Cross-sectional survey study. Setting Pediatric Critical Care Medicine fellowship programs in the United States. Subjects Pediatric Critical Care Medicine fellowship program directors. Interventions None. Measurements and main results We achieved a 74% (53/72) response rate. A majority of programs (85%) require fellows to serve as transport medical control, usually while carrying out other clinical responsibilities and sometimes without supervision. Fellows at most programs (80%) also accompany the transport team on patient retrievals. Most respondents (72%) reported formalized transport medical control teaching, primarily in a didactic format (76%). Few programs (25%) use a standardized assessment tool. Transport medical control was identified as requiring all six Accreditation Council for Graduate Medical Education competencies, with emphasis on professionalism and interpersonal and communication skills. Conclusions Transport medical control responsibilities are common for Pediatric Critical Care Medicine fellows, but training is inconsistent, assessment is not standardized, and supervision may be lacking. Fellow performance in transport medical control may help inform assessment in multiple domains of competencies. Further study is needed to identify effective methods for transport medical control education.

This consensus statement by the Society for Healthcare Epidemiology of America (SHEA) and the Society for Post-Acute and Long-Term Care Medicine (AMDA), the Association for Professionals in Epidemiology and Infection Control (APIC), the HIV Medicine Association (HIVMA), the Infectious Diseases Society of America (IDSA), the Pediatric Infectious Diseases Society (PIDS), and the Society of Infectious Diseases Pharmacists (SIDP) recommends that coronavirus disease 2019 (COVID-19) vaccination should be a condition of employment for all healthcare personnel in facilities in the United States. Exemptions from this policy apply to those with medical contraindications to all COVID-19 vaccines available in the United States and other exemptions as specified by federal or state law. The consensus statement also supports COVID-19 vaccination of nonemployees functioning at a healthcare facility (eg, students, contract workers, volunteers, etc).

Background: Headache is one of the most common causes of emergency care and migraines are the most common primary headache in this regard. Objective: The aim of this research study was to assess the incidence of medical consultations due to headache, along with demographic characteristics and treatments pertaining to cephalalgia that were offered to patients cared for in supplemental healthcare emergency rooms. Methods: In 2017, a total of 11,105 consultations took place, and 4,865 (43.8%) of them were complaints relating to headache. 407 records of patients with headache were randomly selected and assessed. Demographic, clinical and therapeutic data were collected using a structured form. Results: The cause of headache was diagnosed as migraine in 60.0% of the patient records. Patients were mostly female (75.2%), with an average age of 33.9 ± 13.7 years. Patient management consisted of administering dipyrone in 62.4% of cases, antiemetics in 66.9%, corticosteroids in 58.9%, opioids in 24.3% and NSAIDs in 13.5%. Use of opioids was associated with a diagnosis of migraine (OR 2.4; CI 1.4-3.9; p = 0.001). Patients who received opioids were kept under observation for longer periods of time (OR 3.4; CI 2.1-5.4; p < 0.001) and exhibited a higher rate of use of antiemetics (OR 11.0; CI 4.7-25.9; p < 0.001), compared with patients who did not receive opioids. Conclusion: Dipyrone and antiemetics were administered to most of the patients. Opioids were used for a significant proportion of these individuals, despite the diagnosis of migraine, a condition for which their use is discouraged. RESUMO Introdução: Cefaleia é uma das causas mais frequentes de atendimentos de emergência, sendo que a migrânea é a cefaleia primária mais comum nesse contexto. Objetivo: Avaliar a frequência de atendimentos por cefaleias, bem como as características demográficas e o tratamento oferecido aos pacientes atendidos em Pronto Atendimento da Saúde Suplementar. Métodos: No ano de 2017 foram realizados 11.105 atendimentos, sendo 4.865 (43,8%) por queixa de cefaleia. Foram selecionados randomicamente a analisados 407 prontuários de pacientes com cefaleia. Os dados demográficos, clínicos e terapêuticos foram coletados através de formulário estruturado. Resultados: A causa da cefaleia foi diagnosticada como migrânea em 60,0% dos prontuários. Os pacientes eram em sua maioria do sexo feminino (74,9%), com média de idade de 33,9±13,7 anos. O manejo dos pacientes constitui-se na administração de dipirona em 62,4%, antiemético 66,9%; corticóide 58,9%, opióide 24,3% e, por fim, AINE foi utilizado em 13,5% dos casos. O uso de opióide foi associado ao diagnóstico de migrânea (OR 2,4; CI 1,4-3,9; p=0,001). Pacientes que receberam opióide também tiveram maior tempo de permanência (OR 3,4; IC 2,1-5,4; p

Study Design This is a longitudinal, observational, multicenter, cohort study. Introduction Thumb carpometacarpal (CMC) osteoarthritis (OA) is associated with more pain and restrictions than other hand OA. The use of patient-identified occupational performance goals to guide hand therapy treatment and to measure clinical outcomes is fundamental for a patient-centered intervention. The COPM enables subjects to identify goals for hand therapy and engage in a subject-specific therapeutic process. Purpose of the Study The purpose of this study is to evaluate the convergent validity and responsiveness of the COPM to evaluate the relationship between the patient’s self-perception and satisfaction of performance in everyday living and pain intensity, upper limb function, and manual ability. Methods Eligible participants to multiple hand therapy centers were recruited. Outcomes measures (VAS scale, QuickDASH, MAM-36, and the COPM questionnaire) were measured at the baseline and 3 months after. Results One hundred forty-five (n = 145) consecutive patients for five different hand rehabilitation centers with symptomatic thumb CMC OA were screened for eligibility criteria. COPM-P and COPM-S were the most responsive instruments, with an area under the curve of 0.88 (95% CI 0.79-0.96) and 0.88 (95% CI 0.80-0.96), respectively. Conclusions Although more investigation in this area is necessary to conclude that the COPM is the best option to evaluate the effectiveness of hand therapy interventions for thumb OA. The COPM focuses on function and occupation and, in comparison with others upper limb scales, does not require the use of another complementary scale for addressing both satisfaction and ADL status. COPM is an instrument with a good convergent validity and responsiveness to evaluate the relationship between the patient’s self-perception and satisfaction in thumb CMC OA.

Over recent years, the research community has been increasingly using preprint servers to share manuscripts that are not yet peer-reviewed. Even if it enables quick dissemination of research findings, this practice raises several challenges in publication ethics and integrity. In particular, preprints have become an important source of information for stakeholders interested in COVID19 research developments, including traditional media, social media, and policy makers. Despite caveats about their nature, many users can still confuse pre-prints with peer-reviewed manuscripts. If unconfirmed but already widely shared first-draft results later prove wrong or misinterpreted, it can be very difficult to “unlearn” what we thought was true. Complexity further increases if unconfirmed findings have been used to inform guidelines. To help achieve a balance between early access to research findings and its negative consequences, we formulated five recommendations: (a) consensus should be sought on a term clearer than ‘pre-print’, such as ‘Unrefereed manuscript’, “Manuscript awaiting peer review” or ‘’Non-reviewed manuscript”; (b) Caveats about unrefereed manuscripts should be prominent on their first page, and each page should include a red watermark stating ‘Caution—Not Peer Reviewed’; (c) pre-print authors should certify that their manuscript will be submitted to a peer-review journal, and should regularly update the manuscript status; (d) high level consultations should be convened, to formulate clear principles and policies for the publication and dissemination of non-peer reviewed research results; (e) in the longer term, an international initiative to certify servers that comply with good practices could be envisaged.

Background Migraine and trigemino-autonomic cephalalgia attacks are associated with an increase of α-calcitonin-gene related peptide levels in the ipsilateral jugular vein. It is however unknown whether trigeminal pain stimulation in healthy subjects without headache disorders also induces increase of calcitonin-gene related peptide levels. Findings We measured α-calcitonin-gene related peptide levels in eight healthy subjects after subcutaneous injection of capsaicin in the forehead and in the mandibular region and after injection of sodium chloride in the forehead. We observed a significant increase of α-calcitonin-gene related peptide level only after injection of capsaicin in the forehead (i.e. first trigeminal branch). We also observed trigemino-autonomic activation (lacrimation, rhinorrhea etc.) only after injection of capsaicin in the forehead. Conclusion Increase of α-calcitonin-gene related peptide levels do not only occur in primary headache attacks but also after experimental trigeminal pain of the first branch. This finding suggests that α-calcitonin-gene related peptide elevation is, at least an additional, unspecific effect of first trigeminal branch stimulation following pain activation and not a specific mechanism of idiopathic headache disorders.

Understanding how hospitalization affects cognitive development is crucial to safeguard children’s cognition; however, there is little research evaluating the associations between NICU or PICU hospitalization and survivors’ cognition. The objective of this study is to identify and characterize the associations between a neonatal or pediatric ICU hospitalization and the short- and long-term cognition of survivors. The databases Cochrane Library, Medline, EBSCO, Embase, and Google Scholar and the journals JAMA Pediatrics, Journal of Pediatrics, Pediatrics, Archives of Disease in Childhood, Academic Pediatrics, Pediatric Critical Care Medicine and Child Development were searched until April 2021. Retrieved article references were analyzed. Included articles investigated cognition as an outcome of ICU hospitalization in non-preterm neonatal or pediatric patients. Case studies and studies analyzing diagnosis or treatment interventions were excluded. Four prospective cohort or case-control studies and two retrospective cohort studies were included, totaling 2172 neonatal and 42368 pediatric patients. Quality assessment using the BMJ Criteria and Cochrane Collaboration’s Risk-of-Bias tool displayed good results. Significant negative associations were found between neonatal cognition and length-of-ICU-stay at 9- (pppConclusion: There is a significant negative correlation between NICU and PICU hospitalization and the short- and long-term cognitive status. Future research must identify patient- and hospital-related risk factors and develop management strategies. What is Known:• Cognitive development relies on the presence of stimulating factors and absence of risk factors, and is hypothesized to be directly and indirectly affected by hospitalization in the short and long term.• No research examines the relation between survivor cognition post-discharge of a general pediatric hospitalization, and scarcely more of a neonatal or pediatric intensive care hospitalization. What is New:• NICU and PICU hospitalization is independent risk factors for survivor impaired cognition in the short and in the long term with a dose-response effect. High risk patients for cognitive impairment should be identified and appropriately followed-up.• Patients with an ICU hospitalization of over 2.5 days and two or more of the following factors should be considered high risk: increased mortality risk, invasive interventions, neurological or oncological diagnosis, postnatal complications or decreased maternal mental health status.

Finnish biobanks have started to recruit children. The national supervising authority has emphasized the centrality of providing children with age-appropriate information. We analyzed one such campaign. We argue that by simplifying the complex socio-technical arrangements of biobanking with the introduction of a new metaphor-like concept, “Bio-me,” the campaign presents a misleading and reductionist picture of data-driven biomedicine and biobank participation. First, the Bio-me character seems to bear similarities to the seventeenth-century explanations of embryological development. Second, the focus in the campaign is on biological material while crucial connections to different sorts of data are ignored. Third, we point to the absence of verbal references to genes and DNA, although the prevailing visualization comprises the double helix. We argue that the campaign has potential to contribute to public misunderstanding of science by introducing a new term that has little connection to actual biology or scientific practices it tries to promote.

Spasticity is the most common motor disturbance in cerebral palsy (CP). Lockdown in the COVID-19 outbreak has profoundly changed daily routines, and similarly caused the suspension of spasticity treatment plans. Besides, the delay in botulinum toxin (BoNT) injection, which is important in the management of focal spasticity, led to some problems in children. This consensus report includes BoNT injection recommendations in the management of spasticity during the COVID-19 pandemic in children with CP. In order to develop the consensus report, physical medicine and rehabilitation (PMR) specialists experienced in the field of pediatric rehabilitation and BoNT injections were invited by Pediatric Rehabilitation Association. Items were prepared and adapted to the Delphi technique by PMR specialists. Then they were asked to the physicians experienced in BoNT injections (PMR specialist, pediatric orthopedists, and pediatric neurologists) or COVID-19 (pediatric infectious disease, adult infectious disease). In conclusion, the experts agree that conservative management approaches for spasticity may be the initial steps before BoNT injections. BoNT injections can be administered to children with CP with appropriate indications and with necessary precautions during the pandemic.

Task specific dystonia (TSD) is a subtype of dystonia with no cure and significant limitations on treatments. Few studies have investigated the outcomes of rehabilitative therapy from the patient's perspective.This study explored the interventions that patients have utilized and their perceived effectiveness in treating and managing their TSD, specifically musicians' dystonia (MD) and writer's dystonia (WD). Symptoms and the effect of TSD on the perceived performance of every day and specific tasks, and possible reasons why the condition developed, were also investigated.Descriptive survey.Patients diagnosed with TSD, treated at a private hand therapy unit, who had consented to being contacted for research purposes, were emailed a link to an online survey (or posted if email was not available), administered via KwikSurveys. The survey consisted of 4 subsections: personal information, general medical history, dystonia medical history and dystonia treatment history.Invitations were sent to 105 patients of whom 90% (n = 95/105) responded. Results for both the MD and WD groups were similar. There was a significant association between the 2 groups as to what they viewed may have led to the development of TSD (a change in technique; P.001) and the most effective treatments (massage P.043, modifications to the instrument P.002; ultrasound therapy P.013.) All reported that daily activities were affected by their condition.Although full levels of task specific function (playing their instrument or writing) were not usually regained, participants with both MD and WD perceived improvement in symptoms with rehabilitation intervention. Three treatments were perceived to be most effective in achieving this, suggesting that these should be considered for inclusion within treatment plans.From the perspective of people with TSD, a range of rehabilitation interventions are effective in enhancing symptom management, providing further evidence to support their use.

Background: A significant challenge facing nursing is new graduate RNs' unreadiness for practice. To better understand the issue, this study presents the challenges nursing faculty encounter in preparing nursing students for clinical practice through semi-structured interviews. Method: Eight faculty from a private midwestern university's prelicensure Bachelor of Science in Nursing (BSN) program participated in the study. A modified version of Colaizzi's data analysis method was used to interpret the data. Results: Three main interrelated themes were identified: Facilitating Learning Among Today's Nursing Students, Teaching in an Era of Information Explosion and Health Care Reform, and Providing High-Quality Clinical Education. Conclusion: Findings from this study contribute to a deeper understanding of the challenges in preparing competent future nurses and offer insight into factors influencing the underpreparation of some new graduate BSN RNs. [ J Nurs Educ . 2021;60(4):225–228.]

Presenting to the fracture clinic carries economic, social and societal consequences. The virtual fracture clinic (VFC) has proven to be a safe, patient-focused, cost-effective means of delivering trauma care, whilst reducing unnecessary clinic attendances. Within our institution, a Satellite VFC was established, so as to accommodate an offsite referring emergency department. The VFC database was accessed to identify the first 500 patients who were referred to the Satellite VFC. The decision made for each patient, the rate of returns to the clinic, and the rate of referrals requiring surgical intervention, following discussion at the VFC, ,were identified. A cost analysis and cost comparison was carried out between the Satellite VFC and the traditional "face to face" fracture clinic. There were 500 patients referred to the Satellite VFC within the study period. Of such patients, 288 (58%) were discharged directly following review at the Satellite VFC, 141 patients (28%) were referred to physiotherapy, 50 (10%) were redirected to the trauma clinic, 11 (2%) were sent directly to hand therapy, and 10 (2%) were sent to the ED review clinic. Patients who returned to the fracture clinic accounted for 3.8% of all referrals, and 0.2% of all referrals necessitated surgical intervention. This pilot initiative saved the Dublin Midlands Hospital Group over €50,000. The Satellite VFC is the first of its kind in the literature. Rural communities worldwide would benefit from remote orthopaedic management of suitable fracture patterns. The true value of the Satellite VFC process comes from its use of robust patient care pathways, rationalising resource use and minimising patient travel, whilst demonstrating reliable outcomes and promoting safety.

Background: Current standards of practice are necessary to ensure safe nursing practice in Canada and across the world. This article aimed to describe and present findings from the rigorous review process undertaken to update the 2011 Canadian Community Health Nursing Standards of Practice. Method: A revision process included a scoping review of the literature, focus groups, and a modified Delphi method. Results: Through the inclusive consultation process, 495 community health nurses enhanced the content of the standards with respect to cultural safety, cultural humility, Indigenous health and ways of knowing, health equity, and evidence-informed practice. Conclusion: This comprehensive revision process can guide other nursing specialty groups developing or revising specialized practice standards in Canada and across the world. [ J Contin Educ Nurs . 2021;52(4):168–175.]

Background Methicillin-resistant Staphylococcus aureus (MRSA) strains are prevalent in healthcare services. Medical students are at risk for MRSA carriage, subsequent infection and potential transmission of nosocomial infection.Few studies have examined MRSA carriage among medical students. Methods In this prospective cohort study, between July 2016 and June 2017, two nasal swab samples were taken per student 4 weeks apart during their pediatric internship. MRSA typing was performed by staphylococcal cassette chromosome mec (SCCmec) types, Panton Valentine leukocidin (PVL) encoding genes. Results A total of 239 sixth year medical students, 164 (68.6%) male (M/F:2.1),with median age 25 years (min–max; 23–65 years) were included in this prospective cohort study. Among 239 students, 17 students (7.1%) were found to be colonized with methicillin-sensitive S. aureus (MSSA) at the beginning of pediatric internship. After 4 weeks, at the end of pediatric internship totally 52 students were found to be S. aureus colonized (21.8%). Three of 52 S. aureus isolates were MRSA (1.3%) and the rest was MSSA (20.5%), all were PVL gen negative. Two of three MRSA isolates were characterized as SCCmec type IV, one isolate was untypeable SCCmec. Nasal carriage of S. aureus increased from 7.1% to 21.5% (p S. aures colonization ratio was higher in students working in pediatric infectious disease service (p = 0.046). Smoking was found to be associated with a 2.37-fold [95% CI (1.12–5.00); p = 0.023] and number of patients in pediatric services was 2.66-fold [95% CI (1.13–6.27); p = 0.024] increase the risk of nasal S. aureus colonization. Gender was not found to increase risk of MRSA carriage. Conclusion MSSA nasal carriage increased at the end of pediatric internship and significantly high in students working in pediatric infectious diseases services. Smoking and high number of patients in pediatric services significantly increase S.aureus colonization.

Purpose To determine the effect of the COVID‐19 pandemic on antenatal depression in Turkish pregnant women. Design and Methods In this cross‐sectional study, data were collected from 497 pregnant women between May and July 2020 using the Edinburgh Depression Scale (EDS) to determine the effect of obstetrics history, fear of hospitalization, concerns about the pandemic, birth, and the health of both mother and infant, on antenatal depression during the COVID‐19 outbreak in Turkey. Findings The general EDS mean score of the total group was determined as mean 13.70 ± 6.22, which was higher than the critical cutoff point of 13. According to the multiple linear regression model applied in the study, the best predictive variables for the mean EDS score were determined to be concerned about completing a healthy pregnancy (r = −0.45), social media and news programs related to COVID‐19 increasing levels of concern (r = −0.31), fear of hospitalization as the birth approaches (r = −0.45), having bad dreams during the COVID‐19 pandemic (r = −0.41), the request for an elective cesarean delivery because of fear of catching COVID‐19 (r = −0.40), fear of breastfeeding the infant (r = −0.45), and concerns that their own health would be negatively affected because of the pandemic (r = − 0.39), and these variables affected the mean EDS score negatively (total variance 40.5%, R = 0.642). Practical Implications The COVID‐19 pandemic has created an urgent need to implement specific antenatal programs to promote the psychological health of pregnant women and reduce antenatal depression during this or similar crises.

Purpose The rapid implementation of electronic health records (EHRs) resulted in a lack of data standardization and created considerable difficulty for secondary use of EHR documentation data within and between organizations. While EHRs contain documentation data (input), nurses and healthcare organizations rarely have useable documentation data (output). The purpose of this article is to describe a method of standardizing EHR flowsheet documentation data using information models (IMs) to support exchange, quality improvement, and big data research. As an exemplar, EHR flowsheet metadata (input) from multiple organizations was used to validate a fall prevention IM. Design A consensus-based, qualitative, descriptive approach was used to identify a minimum set of essential fall prevention data concepts documented by staff nurses in acute care. The goal was to increase generalizable and comparable nurse-sensitive data on the prevention of falls across organizations for big data research. Methods The research team conducted a retrospective, observational study using an iterative, consensus-based approach to map, analyze, and evaluate nursing flowsheet metadata contributed by eight health systems. The team used FloMap software to aggregate flowsheet data across organizations for mapping and comparison of data to a reference IM. The FloMap analysis was refined with input from staff nurse subject matter experts, review of published evidence, current documentation standards, Magnet Recognition nursing standards, and informal fall prevention nursing use cases. Findings Flowsheet metadata analyzed from the EHR systems represented 6.6 million patients, 27 million encounters, and 683 million observations. Compared to the original reference IM, five new IM classes were added, concepts were reduced by 14 (from 57 to 43), and 157 value set items were added. The final fall prevention IM incorporated 11 condition or age-specific fall risk screening tools and a fall event details class with 14 concepts. Conclusion The iterative, consensus-based refinement and validation of the fall prevention IM from actual EHR fall prevention flowsheet documentation contributes to the ability to semantically exchange and compare fall prevention data across multiple health systems and organizations. This method and approach provides a process for standardizing flowsheet data as coded data for information exchange and use in big data research. Clinical relevance Opportunities exist to work with EHR vendors and the Office of the National Coordinator for Health Information Technology to implement standardized IMs within EHRs to expand interoperability of nurse-sensitive data.

Background Maternal stress and depression are associated with infections in offspring, but there is a paucity of data for other mental disorders. Methods We conducted a retrospective cohort study of 832,290 children born between 2006 and 2016 in hospitals of Quebec, Canada. We identified maternal mental disorders before and during pregnancy, and admissions for otitis media, pneumonia, infectious enteritis and other infections in children before 13 years of age. We used Cox proportional hazards regression to estimate hazard ratios (HRs) with 95% confidence intervals (CI) for the association between maternal mental disorders and the risk of pediatric infectious diseases, adjusted for maternal age, comorbidity, socioeconomic disadvantage, and other confounders. Results The incidence of pediatric infection hospitalization was higher for maternal mental disorders compared with no disorder (66.1 vs. 41.1 cases per 1000 person-years). Maternal mental disorders were associated with 1.38 times the risk of otitis media (95% CI: 1.35-1.42), 1.89 times the risk of bronchitis (95% CI: 1.68-2.12), and 1.65 times the risk of infectious enteritis in offspring (95% CI: 1.57-1.74). Stress and anxiety disorders (HR 1.49, 95% CI: 1.46-1.53) and personality disorders (HR 1.55, 95% CI: 1.49-1.61) were more strongly associated with the risk of pediatric infection hospitalization than other maternal mental disorders. Associations were prominent in the first year of life and weakened with age. Conclusions Maternal mental disorders are risk factors for infectious disease hospitalization in offspring. Women with mental disorders may benefit from psychosocial support to reduce the risk of serious infections in their children.

How protein dynamics contribute to developmental processes is a critical biological question. In this issue of Developmental Cell, Ju et al. show that subcellular localization of NORTIA in the female gametophyte is required for pollen reception. NORTIA redistribution boosts cues that drive pollen tube bursting, thus promoting male gamete release and fertilization.

Sitting in the lecture hall, the first-year medical student, an American Indian first-generation college graduate, was shocked and dismayed when learning about antimicrobial agents and their side effects as the professor described “red man syndrome” (RMS). The student was relieved when other students in the course discussed the racial insensitivity of this term and cited recent articles calling for the removal of this language. However, this feeling of isolation and damage was already inflicted. Unfortunately, this experience is not rare. Minority medical trainees experience microaggressions and bias daily.1 As a medical community, we must do better. Konold et al present a strong example of using rapid-cycle quality improvement methodology to purge the antiquated, racially insensitive term RMS from the medical record.2 They describe how the documentation of 274 pediatric patients who had been diagnosed with RMS within their hospital was successfully removed from charts.2 In addition, the success of this intervention is supported by the reduction of the use of this language 3 months after the intervention, with only 29 of 65 charts with vancomycin allergies listed citing RMS. Importantly, the rate of use revealed a statistically significant difference preintervention and postintervention ( P < .001).2 This approach is used to substitute more medically descriptive and correct terminology, “vancomycin flushing reaction” or “vancomycin infusion reaction”, as recently recommended by the Infectious Diseases Society of America and Pediatric Infectious Diseases Society.3–5 The quality improvement project by Konold et al serves as a simple and disseminatable action that other hospitals can emulate.2 They describe how others can use electronic medical records to address the racial injustice of terminology with further education to continue to make positive changes toward equality in the …

Children recognize race and skin color from a young age. Given the important role of play in the development of children's understanding of social norms and cultural values, it is essential to incorporate toys and other educational materials with diverse skin tones to teach children about race and skin color. Analyses of children's books and toys have shown a lack of diversity in representation of races and skin types. Pediatric dermatologists are uniquely positioned to foster conversations about skin tone and advocating for more diverse materials in classrooms and clinics. In this manuscript, we discuss best practices and resources for facilitating discussions on skin tone with children in the dermatology clinic.

1. Ganga S. Moorthy, MD* 2. Michael J. Smith, MD, MSCE* 3. Betty B. Staples, MD† 1. *Division of Pediatric Infectious Diseases and 2. †Division of Primary Care Pediatrics, Duke University Medical Center, Durham, NC This In Brief was accepted July, 2021. Due to the Pediatrics in Review process from authorship to publication and the rapidly evolving nature of the COVID-19 pandemic, this In Brief may not reflect the most recent events. Severe acute respiratory syndrome coronavirus 2 has infected hundreds of millions of individuals globally, and millions have died as a result of the associated coronavirus disease 2019 (COVID-19). Although severe COVID-19 disease has predominantly affected older adults, children have also been affected. As of early May 2021, nearly 4 million total cases of COVID-19 were reported in children, representing 14% of all cases. With wider availability and uptake of vaccination by adults, increased rates of infection are being reported in the unvaccinated pediatric population. New COVID-19 variants, loosening of public health measures, and lifting of restrictions on school activities are also driving increased infections in children. Serious illness and death are lower in children; however, after symptomatic or asymptomatic infection, they are vulnerable to multisystem inflammatory syndrome in children (MIS-C). This postinfectious, immune-mediated syndrome can lead to serious, life-threatening illness in otherwise healthy children. Children can also experience post–COVID-19 syndrome or long COVID-19 and suffer from persistent symptoms at the postviral stage of the disease. The COVID-19 pandemic has disrupted children’s education and recreational activities and has had a substantial effect on children’s physical, mental, and emotional health. Data suggest that vaccines are highly effective in preventing severe COVID-19, act against many new variants, and are incredibly safe. The Pfizer-BioNTech (mRNA) COVID-19 vaccine was initially authorized for those 16 years and older and the Moderna (mRNA) and Johnson and Johnson (adenovirus-vectored) vaccinations for those 18 years and older. Recently the Food and Drug Administration (FDA) provided Emergency Use Authorization for adolescents 12 to 15 years old to receive the Pfizer-BioNTech vaccination …

BACKGROUND Hand-injured patients seen in the emergency department can often be followed as outpatients for definitive care and rehabilitation. Many face barriers to continuing care in the outpatient setting that impact quality of care delivery. The authors aimed to evaluate patterns of outpatient follow-up after initial emergency department evaluation of traumatic hand injuries, identify factors associated with poor follow-up, and suggest areas for improvement. METHODS In this retrospective cohort study, the authors reviewed records of adult patients with acute hand injuries referred for outpatient follow-up after initial plastic surgery consultation in the emergency department of a single urban Level I trauma center over a 12-month period (n = 300). Patients were grouped by insurance (i.e., no insurance, Medicaid, Medicare, or private). Outcomes included completion of outpatient follow-up, hand therapy participation, and emergency department return visits. RESULTS Factors significantly associated with failure to follow up included male sex (OR, 3.58; 95 percent CI, 1.57 to 8.16), uninsured status (OR, 3.47; 95 percent CI, 1.48 to 8.16), Medicaid insurance (OR, 4.46; 95 percent CI, 1.31 to 15.25), and lack of a driver's license (OR, 3.35; 95 percent CI, 1.53 to 7.34). Hand therapy attendance and unexpected emergency department return visits also varied significantly by insurance type (p < 0.001). CONCLUSIONS There is a significant disparity in the use of outpatient care after emergency department visits for acute hand injuries. Uninsured and Medicaid-insured patients are significantly less likely to initiate recommended hand specialty follow-up, and significantly less likely to complete follow-up even when established with an outpatient clinic. Future research should evaluate targeted interventions for at-risk patients.

Autism spectrum disorder (ASD) is characterized by social deficits and atypical facial processing of emotional expressions. The underlying neuropathology of these abnormalities is still unclear. Recent studies implicate cerebellum in emotional processing; other studies show cerebellar abnormalities in ASD. Here, we elucidate the spatiotemporal activation of cerebellar lobules in ASD during emotional processing of happy and angry faces in adolescents with ASD and typically developing (TD) controls. Using magnetoencephalography, we calculated dynamic statistical parametric maps across a period of 500 ms after emotional stimuli onset and determined differences between group activity to happy and angry emotions. Following happy face presentation, adolescents with ASD exhibited only left‐hemispheric cerebellar activation in a cluster extending from lobule VI to lobule V (compared to TD controls). Following angry face presentation, adolescents with ASD exhibited only midline cerebellar activation (posterior IX vermis). Our findings indicate an early (125–175 ms) overactivation in cerebellar activity only for happy faces and a later overactivation for both happy (250–450 ms) and angry (250–350 ms) faces in adolescents with ASD. The prioritized hemispheric activity (happy faces) could reflect the promotion of a more flexible and adaptive social behavior, while the latter midline activity (angry faces) may guide conforming behavior., The present study demonstrates distinct spatiotemporal patterns of cerebellar activity during happy and angry face processing in adolescents with autism spectrum disorder (ASD). ASD‐related emotional face processing during adolescence relates to a progression of overactivation of both hemispheric and midline cerebellar lobules. Our findings highlight that adolescents with autism spectrum disorder do not integrate cerebellar regions into the processing of emotional facial stimuli in a fashion similar to that of typically developing controls.

Background: Concern with patient safety necessitates valid and reliable measures to evaluate clinical judgment. The purpose of this article is to describe how the Lasater Clinical Judgment Rubric (LCJR) has been used to evaluate the effectiveness of educational interventions to promote clinical judgment and its psychometric properties. Method: Search terms included nurse , student , clinical judgment , and Lasater Clinical Judgment Rubric in Scopus, ERIC, and CINAHL with EBSCOhost databases. The final review included 20 studies. Results: Researchers reported alphas for total scales as .80 to .97, subscales as .89 to .93, and students' self-scored as .81 to .82. Themes were: Individual Versus Group Evaluations, Clinical Judgment Scenarios, and Adaptation for Nonobservation Activities. Conclusion: Results of this review indicate that the LCJR can be used to evaluate clinical judgment, but educators need to consider inter- and intrarater reliability, individual versus group evaluation, clinical judgment scenarios, and adapting the rubric for nondirect observation activities. [ J Nurs Educ . 2021;60(2):67–73.]

Objective The aim of this retrospective and observational study was to compare the accuracy of two different virtual surgical planning (VSP) protocols, namely, the CASS method and the modified CASS method. Materials and methods The patients underwent bimaxillary orthognathic surgery, planned using either the CASS method or the modified CASS method. Linear and angular discrepancies between the VSP outcome and postoperative outcome for both groups were compared for maxilla, mandible, and chin segments. Aside from the comparison between both groups, additional criteria were used to determine the accuracy of the protocol based on a linear and angular difference between planned and actual outcomes of less than 2 mm and 4°, respectively. The intergroup comparisons were performed by one-way ANOVA, with the level of significance set at 5%. Results A total of 21 patients, of both genders, were assigned into group I (n = 11), planned with the CASS method, and group II (n = 10), planned with the modified CASS method. Both the CASS and modified CASS methods presented similar accuracy with regard to linear differences for the maxilla, mandible, and chin segments, except for ΔX for the mandibular segment, where the modified CASS method showed slightly better accuracy. However, there was a statistically significant difference with regard to angular differences in the chin segment, with the CASS method shown to be the more accurate. Aside from Δpitch for the chin segment, no linear or angular differences exceeded 2 mm or 4°. Conclusion Although statistically significant differences were found with regard to angular measurements in the chin segment, the accuracy of the modified CASS method for virtual planning can be considered as clinically equivalent, with a performance comparable to that of the CASS method.

This case series determines the clinical outcomes of relative motion extensor splints (RMES) in extensor mechanism repairs. Nine patients who underwent extensor tendon repair, juncturae tendinum or sagittal band repair were included. A forearm-based volar blocking wrist splint was applied after surgery. The RMES was configured at the initial hand therapy appointment. Total active motion (TAM) at 4 and 8 weeks after surgery and return to work were assessed. There were 7 males and 2 females with a mean age of 28 (16-53 years). The mean TAM of the uninjured digits was 270° (245°-290°). The mean TAM of the injured digits was 209° (125°-275°) at week 4 and 245° (185°-290°) at week 8. The mean return to work time was 25 days. None of the patients had tendon ruptures and required secondary procedures. In our study, active movement with RMES was allowed immediately after surgery. The RMES program supported safer and earlier recovery of motion. All patients were able to perform activities of daily living while wearing the splint.

Like morphine, methadone is a pure agonist at the µ opioid receptor. However, in distinction to morphine which has an elimination half-life of 2-3 h, methadone has an elimination half-life of 24-36 h. In addition to its effects at the µ opioid receptor, methadone is an antagonist at the N-methyl-D-aspartate (NMDA) receptor and also inhibits the reuptake of the neurotransmitters, serotonin and norepinephrine, in the central nervous system. Given its long half-life and high oral bioavailability, methadone has had a primary role in the outpatient treatment of patients with a history of opioid abuse or addiction. However, its unique pharmacology and cellular effects make it a valuable agent in the treatment of both acute and chronic pain of various etiologies. The following manuscript reviews the pharmacologic properties of methadone and discusses its clinical applications in the practice of pediatric anesthesiology and pediatric critical care medicine.

The coronavirus-2019 (COVID-19) pandemic has resulted in turbulent times challenging nurse leaders to adopt, adapt, and develop new leadership competencies to navigate current and future challenges. In never-imagined approaches, nurse leaders have responded to a different type of crisis management. In this new era, nursing leadership will need competencies to reshape the future of nursing and nurses' role in caring for patients, families, and promotion of healthy communities along with a focus on reducing health disparities. The pandemic has drawn critical focus on the health and well-being needs of nurses. The American Organization for Nursing Leadership and the Association for Leadership Science in Nursing have offered insights of nursing leadership competencies critical for practice and education in shaping the future.

Study Design Case series. Introduction Pain and injury at the radial and ulnar aspects of the wrist due to overuse or trauma are commonly treated in hand therapy clinics. Purpose of Study Describe two orthoses that allow targeted rest and recovery of involved anatomical structure(s) while preserving function of surrounding uninvolved structures in patients who have sustained overuse or traumatic injury at the radial or ulnar aspect of the wrist. Methods Outline the fabrication of the Ulnar-Wrist Articulating Control Orthosis (U-WACO) and Radial-Wrist Articulating Control Orthosis (R-WACO) as well as presents case examples for each orthosis. Results The U-WACO and R-WACO designs may improve comfort, compliance, and functional ability to complete daily tasks while allowing targeted rest and recovery of involved anatomical structure(s) at the radial and ulnar aspects of the wrist due to overuse or trauma. Conclusion Dynamic orthoses that allow for movement in one plane while restricting movement in another may overcome the shortcomings of some static orthotic designs.

Study Design Electronic Web-based survey. Introduction Therapists participating in an international survey selected relative motion extension (RME) as the “most used” approach for the postoperative management of zones V and VI extensor tendon repairs. A subgroup of respondents identified RME as their preferred approach and were asked about their routine RME practices. Purpose of the Study The purpose of this study was to capture data from routine RME users about their practices and compare this with the RME evidence. Methods An English-language survey was distributed to 36 International Federation of Societies for Hand Therapy full-member countries. Participation required therapists to have postsurgically managed at least one extensor tendon repair within the previous year. Those who selected RME as their “most used” approach were asked to identify which variation of the RME approach they favored: RME plus (with wrist orthosis), RME only, or “both” RME plus and RME only, and then were directed to additional questions related to their choice. Results Respondents from 28 International Federation of Societies for Hand Therapy full-member countries completed the survey. RME users (N = 368; 41.5% of sample) contributed to this secondary data. Respondents favored the RME variation “RME plus” (47%), followed by “both” (44%), then “RME only” (9%) with most managing single digit/simple injuries (n = 287, 81%) versus multiple digit/complex injuries (n = 96, 27%), and partial repairs (n = 278, 79%). Discussion Practices not aligning with limited level II-IV evidence includes half of RME only users not adding/substituting an overnight orthosis; use of RME plus versus RME only for both repairs of independent extensor tendons and repairs proximal to the juncturae tendinum; fabrication of three not four-finger orthotic design; and restricting use to only repairs of one or two fingers. Conclusions RME plus and RME only are used interchangeably depending on surgeon preferences and patient/tendon factors. Compared with RME plus, from this survey, it appears that the RME only approach yields similar uncomplicated, early return of motion and hand function.

Study Design Electronic Web-based survey. Introduction Evidence supports early motion over immobilization for postoperative extensor tendon repair management. Various early motion programs and orthoses are used, with no single approach recognized as superior. It remains unknown if and how early motion is used by hand therapists worldwide. Purpose of the Study The purpose of this study was to determine if there is a preferred approach and identify practice patterns for constituents of International Federation of Societies for Hand Therapy full-member countries. Methods Participation in this English-language survey required respondents to have postoperatively managed at least one extensor tendon repair within the previous year. Approaches surveyed included programs of immobilization, early passive (EPM), and early active (EAM) with motion delivered by resting hand, dynamic, palmar/interphalangeal joints (IPJs) free, or relative motion extension (RME) orthoses. Survey flow depended on the respondent's answer to their “most used” approach in the previous year. Results There were 992 individual responses from 28 International Federation of Societies for Hand Therapy member countries including 887 eligible responses with an 81% completion rate. The order of most used program was EAM (83%), EPM (8%), and immobilization (7%). The two most used orthoses for delivery of EAM were RME (43%) and palmar/IPJs free (25%). The RME orthosis was preferred for earlier recovery of hand function and motion. Barriers to therapists wanting to use the RME/EAM approach related to preference of surgeon (70%) and clinic (24%). Discussion In practice, many therapists select from multiple approaches to manage zone V and VI extensor tendon repairs. Therapists believed TAM achieved with the RME/EAM approach was superior to the other approaches. Contrary to the literature, in practice, many therapists modify forearm-based palmar/IPJs free orthosis to exclude the wrist to manage this diagnosis. Conclusions The RME/EAM approach was identified as the favored approach. Practice patterns and evidence did not always align.

The nursing profession faces both a labor shortage and a diversity problem. Nine proactive strategies-rooted in the disruptive demographic trends that are transforming our nation-are advanced to address these 2 critical issues.