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Michael D McKee,1 Robert Litchfield,2 Jeremy A Hall,3 Tawana Wester,4 John Jones,4 Andrew J Harrison51Department of Orthopaedic Surgery, University of Arizona College of Medicine, Phoenix, AZ, USA; 2Department of Surgery, Fowler Kennedy Sport Medicine Clinical, London, ON, Canada; 3Department of Surgery, St Michael’s Hospital, Toronto, ON, Canada; 4Research and Development, Bioventus LLC, Durham, NC 27703, USA; 5Research and Development, Bioventus Cooperatief UA, Hoofddorp, NetherlandsBackground: Osteoarthritis of the shoulder or glenohumeral joint is a painful condition that can be debilitating. Intra-articular injection with hyaluronic acid should be considered for patients not responding adequately to physical therapy or anti-inflammatory medication.Methods: This was a single-arm, open-label, prospective study of a single intra-articular injection of NASHA (non-animal hyaluronic acid) in patients with symptomatic glenohumeral osteoarthritis. Patients were followed up for 26 weeks post-treatment, during which time rescue medication with acetaminophen was permissible. The study objective was to demonstrate that a single injection of NASHA is well tolerated with an over-6-month 25% reduction in shoulder pain on movement, assessed using a 100-mm visual analog scale.Results: Forty-one patients were enrolled, all of whom received study treatment. The mean decrease in shoulder pain on movement score over the 6-month study period was −20.1 mm (95% CI: −25.2, −15.0 mm), corresponding to a mean reduction of 29.5% (22.0, 37.0%). Statistically significant improvements were also observed in shoulder pain at night and patient global assessment. There was no clear change over time in the percentage of patients using rescue medication and mean weekly doses were below 3500 mg. Seventeen patients (41.5%) experienced adverse events, all of which were mild or moderate. Two adverse events (both shoulder pain) were deemed related to study treatment.Conclusion: This study provides preliminary evidence that a single injection of NASHA may be efficacious over 6 months and well tolerated in patients with symptomatic glenohumeral osteoarthritis. Larger studies are needed for confirmation.Keywords: Durolane®, glenohumeral joint, non-animal hyaluronic acid, osteoarthritis, shoulder, viscosupplementation

Jennifer A Hall,1 Geraldine Barrett,1 Andrew Copas,2 Judith Stephenson1 1Research Department of Reproductive Health, UCL Institute for Women’s Health, 2Department of Infection & Population Health, UCL Institute of Epidemiology and Health Care, London, UK Background: The London Measure of Unplanned Pregnancy (LMUP) is a psychometrically validated measure of the degree of intention of a current or recent pregnancy. The LMUP is increasingly being used worldwide, and can be used to evaluate family planning or ­preconception care programs. However, beyond recommending the use of the full LMUP scale, there is no published guidance on how to use the LMUP as an outcome measure. Ordinal logistic regression has been recommended informally, but studies published to date have all used binary logistic regression and dichotomized the scale at different cut points. There is thus a need for evidence-based guidance to provide a standardized methodology for multivariate analysis and to enable comparison of results. This paper makes recommendations for the regression method for analysis of the LMUP as an outcome measure. Materials and methods: Data collected from 4,244 pregnant women in Malawi were used to compare five regression methods: linear, logistic with two cut points, and ordinal logistic with either the full or grouped LMUP score. The recommendations were then tested on the original UK LMUP data. Results: There were small but no important differences in the findings across the regression models. Logistic regression resulted in the largest loss of information, and assumptions were violated for the linear and ordinal logistic regression. Consequently, robust standard errors were used for linear regression and a partial proportional odds ordinal logistic regression model attempted. The latter could only be fitted for grouped LMUP score. Conclusion: We recommend the linear regression model with robust standard errors to make full use of the LMUP score when analyzed as an outcome measure. Ordinal logistic regression could be considered, but a partial proportional odds model with grouped LMUP score may be required. Logistic regression is the least-favored option, due to the loss of information. For logistic regression, the cut point for un/planned pregnancy should be between nine and ten. These recommendations will standardize the analysis of LMUP data and enhance comparability of results across studies. Keywords: ordinal outcomes, multivariate regression, London Measure of Unplanned Pregnancy, pregnancy intention, pregnancy planning, epidemiology

OBJECTIVE: A relatively unexplored aspect of clinicians' communication skill is their interpersonal sensitivity, or ability to perceive their patients accurately with regard to patients' feelings, desires, intentions, needs, physical states, personality, attitudes, beliefs, and values. The present article argues for the importance of this skill in clinical interactions and summarizes supportive research. METHODS: Reviews approaches to measuring interpersonal sensitivity and research on correlates of clinicians' and laypersons' interpersonal sensitivity. RESULTS: Studies on clinicians' interpersonal sensitivity suggest that this skill could be improved. Furthermore, there are important correlates of clinicians' interpersonal sensitivity, including, on the patient's side, satisfaction, appointment-keeping adherence, and learning of conveyed information, and, on the clinician's side, awareness of patients' cues of anxiety and distress, commitment to patient-centered values, self-reported awareness of own emotions, and female gender. Furthermore, a very large non-clinical literature points to many other correlates of interpersonal sensitivity that are relevant to the clinical situation, including empathy, prosocial behavior, skill in negotiating, selling, teaching, and managing, better personal adjustment, and better interpersonal relationships. Research also suggests that interpersonal sensitivity is a trainable skill that could realistically be included in clinical education. CONCLUSION: Clinicians' interpersonal sensitivity is an important component of quality of care and deserves further research. PRACTICE IMPLICATIONS: This important skill should be incorporated into training programs to improve clinician-patient communication. [ABSTRACT FROM AUTHOR]

OBJECTIVE: This research examines whether patient perceptions are equivalently associated with patient-centered behavior in male and female medical students, and tests the impact of a message emphasizing the importance of patient-centeredness on analogue patients' perceptions of male and female medical students' performance. METHODS: Sixty-one medical students interacting with standardized patients (SPs) were viewed by 384 analogue patients (APs). APs were randomly assigned to receive a message emphasizing the value of patient-centeredness or of technical competence, or a neutral message, and then evaluated the medical students' competence in the interactions. Students' patient-centeredness was measured using the Four Habits Coding Scheme and Roter Interaction Analysis System. RESULTS: APs in the neutral and technical competence conditions gave higher competence ratings to more patient-centered male students, but not to more patient-centered female students. However, APs who received the patient-centeredness message gave higher competence ratings to both male and female students who were higher in patient-centeredness. CONCLUSION: Making it clear that patient-centeredness is a dimension of physician competence eliminated a gender bias in evaluating performance. PRACTICE IMPLICATIONS: Because patient perceptions are often used in evaluations, gender biases must be understood and reduced so both male and female providers receive appropriate credit for their patient-centered behaviors. [ABSTRACT FROM AUTHOR]

This study examines factors (including gender, self-monitoring, the big five personality traits, and demographic characteristics) that influence online dating service users' strategic misrepresentation (i.e., the conscious and intentional misrepresentation of personal characteristics). Using data from a survey of online dating service users (N = 5,020), seven categories of misrepresentation -- personal assets, relationship goals, personal interests, personal attributes, past relationships, weight, and age -- were examined. The study found that men are more likely to misrepresent personal assets, relationship goals, personal interests, and personal attributes, whereas women are more likely to misrepresent weight. The study further discovered that self-monitoring (specifically other-directedness) was the strongest and most consistent predictor of misrepresentation in online dating. Agreeableness, conscientiousness, and openness also showed consistent relationships with misrepresentation. [ABSTRACT FROM AUTHOR]

The purpose of this research was to evaluate the relationship between past traumatic events and the level ofcurrent traumatic stress among mothers experiencing homelessness.The data for this study were gathered from 75 homeless mothers between May 2006 and October 2006 using a cross-sectional survey design with purposive sampling. All mothers were interviewed in a face-to-face, semistructured interview format using standardized questionnaires and measures, including the Global Appraisal ofIndividual Needs-Quick, Williams' Life History Calendar ofTraumatic Events, the Traumatic Stress Index, and the Davidson Trauma Scale. The mothers ranged in age from 18 to 50. Forty-four percent were white, 21% were African American, 3% were Native American, 31 % identified themselves as multiracial, and 9% reported Hispanic ethnicity. The analysis indicated that the average level of traumatic stress from past traumatic events and the number ofdistressing (but nontraumatic) events did not influence current traumatic stress; however, the number ofpast traumatic events significantly influenced the current level of traumatic stress among mothers experiencing homelessness. Recommendations for future research include investigating how traumatic stress affects a mother's ability to locate, find, and retain housing and how trauma interventions influence mothers to exit homelessness. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To examine the consequences of expressions of uncertainty (EOUs) in medical student interactions, with a particular focus on the gender of the expressor. METHODS: EOUs were identified in 147 videotaped interactions between third-year medical students and standardized patients enacting four medical scenarios. The encounters were also analyzed using the Roter Interaction Analysis System (RIAS). A subset of these interactions was shown to 244 analogue patients who rated satisfaction, liking, and perceived competence and confidence. RESULTS: Female medical students used more EOUs but not when adjusted for total number of statements. The EOU rate varied across scenarios. A higher EOU rate was perceived as more affectively negative by both RIAS trained coders and analogue patients. EOU rate was inversely related to analogue patient satisfaction and liking and this relationship was stronger for males than females. Female student use of EOUs was more strongly associated with ratings of anxiety than was male EOU use. CONCLUSION: There was an overall negative perception of medical students who expressed uncertainty; however, the strength of the associations varied due to medical student gender. PRACTICE IMPLICATIONS: The implications for medical education are discussed. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To measure rapport between medical students and standardized patients using observer ratings; to relate these ratings to students' emotional awareness and to behavior within the medical interaction; and to assess the relative validity of using excerpts of different lengths for the measurement of rapport. METHODS: Third-year medical students (N=141) were videotaped during a 15-min interaction with a standardized patient, and rapport as well as other communication variables were measured using trained coders. Rapport was measured with good interrater reliability by trained coders who viewed three 1-min excerpts. Emotional awareness was measured by a test of recognizing facial expressions of emotion, self-ratings of emotional self-awareness, and peer ratings of interpersonal sensitivity. Finally, participants who viewed the videotapes while imagining themselves to be the patient (analogue patients) provided impressions of the students, including satisfaction. RESULTS: Rapport based on all three minutes was positively correlated with accuracy in decoding facial expressions of emotion, self-reported attention to one's own emotions, peer ratings of sensitivity, communication behaviors of the medical student and standardized patient, and analogue patients' positive impressions and satisfaction. Rapport based on just the first minute of the interaction was significantly related to many of these variables. CONCLUSION: Rating short excerpts of behavior is a valid and efficient methodology for capturing the concept of rapport. PRACTICE IMPLICATIONS: Clinicians, researchers, and educators should focus on rapport building, even very early in the medical visit. [ABSTRACT FROM AUTHOR]

Background: Standard open reduction and internal fixation techniques have been successful in restoring osseous alignment for bicondylar tibial plateau fractures; however, surgical morbidity, especially soft-tissue infection and wound necrosis, has been reported frequently. For this reason, several investigators have proposed minimally invasive methods of fracture reduction followed by circular external fixation as an alternative approach. To our knowledge, there has been no direct comparison of the two operative approaches.Methods: We performed a multicenter, prospective, randomized clinical trial in which standard open reduction and internal fixation with medial and lateral plates was compared with percutaneous and/or limited open fixation and application of a circular fixator for displaced bicondylar tibial plateau fractures (Schatzker types V and VI and Orthopaedic Trauma Association types C1, C2, and C3). Eighty-three fractures in eighty-two patients were randomized to operative treatment (forty-three fractures were randomized to circular external fixation and forty to open reduction and internal fixation). Follow-up consisted of obtaining a history, physical examination, and radiographs; completion of the Hospital for Special Surgery (HSS) knee score, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and the Short Form-36 (SF-36) General Health Survey; and recording of complication and reoperation rates.Results: There were no significant differences between the groups in terms of demographic variables, mechanism of injury, or fracture severity and/or displacement. However, patients in the circular fixator group had less intraoperative blood loss than those in the open reduction and internal fixation group (213 mL and 544 mL, respectively; p = 0.006) and spent less time in the hospital (9.9 days and 23.4 days, respectively; p = 0.024). The quality of osseous reduction was similar in the groups. There was a trend for patients in the circular fixator group to have superior early outcome in terms of HSS scores at six months (p = 0.064) and the ability to return to preinjury activities at six months (p = 0.031) and twelve months (p = 0.024). These outcomes were not significantly different at two years. There was no difference in total arc of knee motion, and the WOMAC scores at two years after the injury were not significantly different between the groups with regard to the pain (p = 0.923), stiffness (p = 0.604), or function (p = 0.827) categories. The SF-36 scores at two years after the injury were significantly decreased compared with the controls for both groups (p = 0.001 for the circular fixator group and p = 0.014 for the open reduction and internal fixation group), although there was less impairment in the circular fixator group in the bodily pain category (a score of 46) compared with the open reduction and internal fixation group (a score of 35) (p = 0.041). Seven (18%) of the forty patients in the open reduction and internal fixation group had a deep infection. The number of unplanned repeat surgical interventions, and their severity, was greater in the open reduction and internal fixation group (thirty-seven procedures) compared with the circular fixator group (sixteen procedures) (p = 0.001).Conclusions: Both techniques provide a satisfactory quality of fracture reduction. Because percutaneous reduction and application of a circular fixator results in a shorter hospital stay, a marginally faster return of function, and similar clinical outcomes and because the number and severity of complications is much higher with open reduction and internal fixation, we believe that circular external fixation is an attractive option for these difficult-to-treat fractures. Regardless of treatment method, patients with this injury have substantial residual limb-specific and general health deficits at two years of follow-up. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Analyzes the term 'theoretical' as it applies to the area of provider-patient communication research, in order to understand better at a conceptual level what the term may mean for authors and critics. METHODS: Based on literature on provider-patient communication. RESULTS: Offers, and discusses, five definitions of the term 'theoretical' as it applies to empirical research and its exposition: (1) grounding, (2) referencing, (3) design and analysis, (4) interpretation, and (5) impact. Each of these definitions embodies a different standard for evaluating the theoretical aspects of research. CONCLUSION: Although it is often said that research on provider-patient communication is not 'theoretical' enough, the term is ambiguous and often applied vaguely. A multidimensional analysis reveals that there are several distinct ways in which empirical research can be strong or weak theoretically. PRACTICE IMPLICATIONS: Researchers, educators, editors, and reviewers could use the 'Five Ways' framework to appraise the theory-relevant strengths and weaknesses of empirical research and its exposition. [ABSTRACT FROM AUTHOR]

Objective: This study evaluated whether adherence to the Strengths-Oriented Referral for Teens (SORT) model, a motivational interviewing (MI)-consistent intervention addressing ambivalence about attending treatment, positively predicted adolescents' initial-session attendance.Method: Therapist adherence was rated in 54 audiotaped SORT sessions by coders who were blind to treatment-entry status. Higher adherence scores reflected greater use of MI and solution focused language, discussion of client strengths, and dialogue with families on treatment need and options.Results: Therapist adherence during adolescent segments interacted with adolescent problem perception. Predicted probabilities of attending initial sessions increased for low-problem-perception adolescents at increasingly higher therapist adherence.Conclusions: Although replication studies are needed, the SORT model of providing MI-consistent debriefing following initial assessments appears to be a promising approach for increasing treatment entry. Initial support for the treatment-matching hypothesis was found for substance-misusing adolescents contemplating treatment entry. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To review the literature on gender differences and issues of self-confidence in medical students and to present original research on observers' perceptions of medical student confidence. METHODS: One hundred forty-one 3rd year medical students at Indiana University School of Medicine were videotaped during their objective structured clinical examination (OSCE). Trained coders rated how confident the student appeared and coded a variety of nonverbal behaviors at the beginning, middle, and end of the interaction. Analysis focused on gender differences in coders' ratings of perceived confidence. RESULTS: Female medical students were viewed as significantly less confident than male medical students (F(1,133)=4.45, p<0.05), especially at the beginning of the interaction. CONCLUSION: Past research indicates that despite performing equally to their male peers, female medical students consistently report decreased self-confidence and increased anxiety, particularly over issues related to their competence. In a standardized patient interaction examination situation, female medical students also appeared significantly less confident than male medical students to independent observers. PRACTICE IMPLICATIONS: Medical educators should focus on issues of female students' confidence, increasing faculty sensitivity, and publicly recognizing and discussing perceptions of confidence. [ABSTRACT FROM AUTHOR]

Care providers must understand stage-appropriate treatment while using a disease management system. [ABSTRACT FROM AUTHOR]