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Background: This study aims to look at the intermediate-term clinical, functional and radiological outcomes of patients with enchondroma in hand treated with osteoscopic-assisted curettage and artificial bone substitute or bone graft. The addition of osteoscopy allows direct visualisation of the bone cavity during and after curettage of tumour tissue without the need of creating a large opening in the bone cortex. This could lead to better clearance of tumour tissue and lower risk of iatrogenic fracture. Methods: A total of 11 patients who received surgery from December 2013 to November 2020 were retrospectively reviewed. All cases had histological diagnosis of enchondroma. Patients with a follow-up period of less than 3 months were excluded. The mean duration of follow-up was 20.9 months. For the clinical outcome, we measured the total active motion (TAM) and graded with Belsky score grip strength. For the functional outcome, the Quick Disabilities of the Arm, Shoulder and Hand Questionnaire (QuickDASH) score was used. For the radiological outcome, we evaluated the X-ray for bone cavity filling defect, new bone formation according to the system proposed by Tordai. Results: The mean TAM of patients was 257º. A total of 60% patients had Belsky score grading excellent, 40% patients had Belsky score grading good. The mean percentage of grip strength compared with the contralateral side was 86.2%. The mean QuickDASH score was 7.7. For the wound aesthetic rating by patients, 81.8% patients reported as excellent. For the radiological outcome, the postoperative X-ray of all patients showed bone filling defect less than 3 mm. The mean time to complete bone consolidation was 3.8 months. None of the patients showed any radiological signs of recurrence. Conclusions: Our study showed that patients with enchondromas in hand treated with this minimally invasive method demonstrated good functional and radiological outcome. Its application may also be extended into treating other benign bone lesions in hand. Level of Evidence: Level IV (Therapeutic)

Wide-awake local anesthesia no tourniquet procedures allow the patient to remain conscious and cooperative during surgery, allowing intraoperative assessments of hand function. This is useful in spastic hand surgeries, allowing an instant assessment of the muscle releases and residual power, thus guiding an optimal balance with the best possible functional outcomes. We describe the novel use of wide-awake, local anesthesia, no tourniquet surgery in spastic upper-limb surgery in forearm flexor-pronator release, thumb-in-palm and intrinsic-plus deformity correction, and elbow flexor release.

Wrist arthroscopy has a rich history, drawing on contributions from around the world. Its foundation was laid in Japan with Kenji Takagi and Masaki Watanabe, who developed the arthroscope and the techniques for arthroscopy. Across several decades they advanced the optic and lighting technology, allowing the miniaturization which made wrist arthroscopy technologically feasible. A safe and standardized technique for wrist arthroscopy was evolved by Terry Whipple, Gary Poehling, and James Roth in the 1980s, and they shared this with their fellow surgeons through courses and publications. The techniques then spread across the world, leading to widespread uptake and exploration of new therapeutic possibilities. The worldwide spread of wrist arthroscopy was accelerated by the European Wrist Arthroscopy Society (EWAS), founded in 2005 by Christophe Mathoulin. The Asia Pacific Wrist Association (APWA), founded by PC Ho in 2015, also extended the progression of wrist arthroscopy. This article brings together this history and tells the global story of its development through the recollections of those involved. The manuscript includes some amazing videos of the early historical arthroscopy. There are also videos of Gary and Terry describing some of their special memories of the early politics, developments, and evolution of wrist arthroscopy.

Background: Differences in structure and function of the hand and wrist between distinct populations affect our approach to treatment, expectations and functional outcomes. The aim of this study is to compare wrist motion and grip strength in Caucasian, Chinese and Japanese populations. Methods: A total of 424 normal wrists were evaluated that included 99 Japanese, 139 Caucasian and 186 Southern Chinese. Demographic information collected included age, gender, hand dominance and occupation. Evaluation included measurement of active motion and grip strength. Motion was measured using a goniometer. Grip strength was evaluated using a JAMAR dynamometer. Demographic information and evaluation was compared among the three cohorts using statistical tests. Multivariate mixed-effect model was further used to assess the racial impact on each evaluation controlling for demographic factors as well as two-hand measurements of everyone. Results: There was no difference in global wrist motion between the cohorts. We did find significant differences between the cohorts in all discrete measurements. Conclusions: Differences in wrist motion and grip strength between normal Japanese, Chinese and Caucasian populations may be due to bony structure rather than soft tissue properties. Knowledge of these disparities can provide references for personalised wrist examination, diagnosis, treatment and comparison of outcomes between different cohorts. Level of Evidence: Level III (Diagnostic)

Background In nonsyndromic conotruncal cardiac defects, the use of next‐generation sequencing for clinical diagnosis is increasingly adopted, but gene‐disease associations in research are only partially translated to diagnostic panels, suggesting a need for evidence‐based consensus. Methods and Results In an exome data set of 245 patients with conotruncal cardiac defects, we performed burden analysis on a high‐confidence congenital heart disease gene list (n=132) with rare (GATA6, NOTCH1 ) and 4 candidate genes supported by the literature ( ANKRD11, DOCK6, NPHP4 , and STRA6 ). Ultrarare variant analysis was performed in combination with 3 other published studies (n=1451) and identified 3 genes ( FLT4, NOTCH1, TBX1 ) to be significant, whereas a subgroup analysis involving 391 Chinese subjects identified only GATA6 as significant. Conclusions We suggest that these significant genes in our rare and ultrarare burden analyses warrant prioritization for clinical testing implied for rare inherited and de novo variants. Additionally, associations on ClinVar for these genes were predominantly variants of uncertain significance. Therefore, a more stringent assessment of gene‐disease associations in a larger and ethnically diverse cohort is required to be prudent for future curation of conotruncal cardiac defect genes.

Background: Advocacy is core to the nursing profession as illustrated within the literature, codes of ethics, and regulatory standards. While scholars have advanced our collective understandings about how advocacy can be strengthened within the profession, the focus has remained largely situated at the individual nurse-client level, with less attention to advocacy undertaken by nursing organizations at the policy level. Across the globe, nursing organizations have a long history of engaging in policy advocacy to advance the profession, strengthen health systems, and influence public policy. While this work continues to be viewed by nurses as essential for the profession to meet its social mandate, there is a dearth of research that has critically examined the policy advocacy work of nursing organizations and the ways in which it could be strengthened given shifting social, political, and economic landscapes. The lack of literature focused on this topic and the emergence of the COVID-19 pandemic presented an opportunity to develop knowledge to advance this domain of practice within the profession. Purpose: The purpose of this dissertation is to advance our collective understanding of policy advocacy undertaken by nursing organizations to identify ways to strengthen influence and impact. The aims of this research were to a) explore what constitutes nursing policy advocacy knowledge and the ways in which it can be advanced; b) examine the existing scholarly work focused on nursing organizations and policy advocacy to identify knowledge gaps; and c) to draw on the COVID-19 pandemic as an exemplar to examine the lessons that could be learned from professional nursing associations’ policy advocacy responses to the global pandemic to inform future large-scale public health crises. Methods: I conducted three studies including a) a theoretical exploration to explore how nursing and policy theories, models, and frameworks can be developed and integrated to advance nurses’ and nursing’s policy advocacy knowledge; b) a scoping review to examine the nature, extent, and range of scholarly work focused on nursing organizations and policy advocacy; and c) an interpretive description study to explore the lessons that could be learned from professional nursing associations’ policy advocacy response to the COVID-19 pandemic. This consisted of studying four professional nursing associations (two local, one national, and one global) through key informant interviews and document analysis. Findings: The theoretical exploration highlighted the various models, theories and frameworks within the nursing and policy literature that nurses can use to develop policy advocacy knowledge within nursing. This framework focused on four key areas including policy content, context, processes, and actors. The scoping review revealed that the extant literature covered a broad range of topics ranging from the role and purpose of nursing organizations in policy advocacy, the identity of nursing organizations, the development and process of policy advocacy initiatives, the policy advocacy products of nursing organizations, and the impact and evaluation of organizations’ policy advocacy work. While the breadth and depth of literature has expanded over the years, significant knowledge gaps exist, and several areas of require further inquiry. Specifically, this includes understanding the relationships between decision-making processes and theories of policy process and change, understanding the impact of organizational factors on policy advocacy processes and outcomes, examining external perspectives to inform policy advocacy approaches, engaging in advocacy and policy change evaluation, and adopting a critical lens to challenge the status quo. Findings from the interpretive description study identified several lessons learned about professional nursing associations’ policy advocacy response to the COVID-19 pandemic including their role in supporting a wide audience (the ‘who), the breadth of their policy priorities (the ‘what’), their use of various advocacy strategies (the ‘how’), the factors that influence their decision-making processes (the ‘why), their perspectives on evaluating policy advocacy work, and the importance of capitalizing on windows of opportunity. Conclusions: The integration of studies conducted in this dissertation advances our collective understanding of the concept of advocacy and how it can be applied and studied at the policy level within the organizational context. While nursing organizations play a vital role in policy advocacy, greater scholarship is needed to build the knowledge base required to inform the ways in which this critical function can be strengthened for optimal influence and impact.