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

Purpose: Arthrogryposis multiplex congenita (AMC) describes a heterogeneous group of rare congenital conditions. Health-related quality of life (HRQL) may be reduced in AMC due to broadly heterogeneous physical impairments and participation limitations. This study described HRQL in children and youth with AMC, compared HRQL between child self- and parent-proxy reports, and identified factors associated with better/worse HRQL., Methods: Data on 205 children with AMC (age 8-21 years) from a North American AMC registry across eight hospital sites was used. HRQL was assessed cross-sectionally using the Patient Reported Outcome Measurement Information System (PROMIS) and European Quality of Life-5 Dimensions-Youth-3 Levels (EQ-5D-Y-3 L) by self-report, parent proxy-report or both., Results: Mean child-reported PROMIS T-scores were significantly lower than the normal mean for the Upper Extremity (mean = 33.0) and Mobility (mean = 37.2) but in the normal range for Pain Interference (mean = 46.6) and Peer Relationships (mean = 51.7). A lot of problems in EQ-5D-Y-3 L was reported by 37% in Feeling Worried/ Sad/ Unhappy, 46% in Having Pain/Discomfort, 50% in Doing Usual Activities, 56% in Mobility, and 57% in Looking After Myself. Compared to child-report, parents reported significantly worse PROMIS T-scores and higher problems in EQ-5D domains. Wheelchair use, being small for gestational age, prolonged hospitalization after birth, increased number of orthopedic surgeries, and caregiver's stress were associated with lower HRQL scores., Conclusion: Findings indicate the importance of considering both the child's and parents' reports of HRQL, and to provide multimodal interventions that focus on the effect of childhood and parental characteristics to promote HRQL among children with AMC., (© 2024. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

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

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

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

Screening, brief intervention, and referral to treatment (SBIRT) is an intervention originally developed to prevent and deter substance abuse. Adaptation of the SBIRT model to prevent post-traumatic stress disorder (PTSD) may potentially reduce acute stress symptoms after traumatic injury. We conducted a prospective randomized control study of adult patients admitted for gunshot wounds. Patients were randomized to intervention (INT) vs. treatment as usual (TAU) groups. INT received the newly developed SBIRT Intervention for Trauma Patients (SITP)-a 15-minute session with elements of cognitive behavioral therapy techniques. SITP took place during the index hospitalization; both groups had followup at 30 and 90 days at which time a validated PTSD screening tool, PCL-5, was administered. Most of the 46 participants were young (mean age = 30.5y), male (91.3%), and black (86.9%). At three-month follow-up, SBIRT and TAU patients had similar physical healing scores but the SBIRT arm showed reductions in PTSD symptoms.

Background: There is sparse literature demonstrating the relationship between lower limb pediatric idiopathic rotational malalignment (IRM) and patient-reported outcomes measurement information system (PROMIS) scores. Our goal is to determine and quantify the amount that IRM deformities, as measured with the 3D gait analysis, affect childrens' pain interference, mobility, and peer relationship PROMIS domains. Secondary outcomes include investigating the potential relationships between IRM and various subgroups (Pediatric Outcomes Data Collection Instrument (PODCI), gender, Body Mass Index (BMI), femur Versus tibia). We also examine whether the PROMIS domains correlate with PODCI in this population., Methods: This study was a retrospective cohort, single institution, and consecutively recruited cases series. We identified 47 children over a 3-year period who were evaluated at the motion analysis center at our tertiary care hospital, with increased torsion of the femur or tibia. After exclusions, 25 children with IRM, documented PROMIS data and gait analysis were considered., Results: Femoral malrotation had a significant relationship with female gender ( P =0.001) and increased BMI ( P <0.001). Femoral malrotation had a correlation with PROMIS pain interference ( P =0.016), whereas tibial rotation did not achieve significance ( P =0.084). In the ANOVA regression analysis, there was a strong prediction of the PROMIS mobility domain when both malrotation and pain interference were present ( P =0.007). There were Pearson Correlations of PROMIS and PODCI domains for Mobility Versus Sports ( P =0.007) and Pain Interference Versus Comfort/Pain ( P =0.004), respectively., Conclusion: The evident relationship between lower limb rotational malalignment and PROMIS scores signifies the likelihood for gait and pain disturbance. This in turn could show us that children are likely to be more debilitated and thus may benefit from timely correction. We aim to conduct this as a multicentre trial to confirm our findings., Level of Evidence: Level IV., Competing Interests: D.B. is consultant for Medtronic. The remaining authors have no conflict of interest to declare., (Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc.)

Purpose: The impact of goal setting in pharmacy preceptor development was evaluated using the Habits of Preceptors Rubric (HOP-R), a criterion-referenced assessment developed to assess, quantify, and demonstrate growth across 11 preceptor habits., Methods: This study retrospectively evaluated initial and follow-up survey responses from the 2019-2020 Clinician Educators Program cohort at Midwestern University College of Pharmacy, Glendale Campus. Enrollees in this teaching and learning curriculum (TLC) were invited to assess their precepting habits using the HOP-R after attending the first seminar and again toward the end of the longitudinal program. Using online surveys, participants rated their precepting capabilities as developing, proficient, accomplished, or master level for each habit. In the initial survey, each participant selected a habit of focus for deliberate development and established an individualized goal using the specific, measurable, achievable, relevant, and time-bound (SMART) framework. In the follow-up survey, participants indicated their satisfaction with and progress toward accomplishing their precepting goal., Results: Initial survey results from 55 study participants identified developing as the most frequently self-reported habit level (53%; n = 605 ratings), while master was the least frequently reported (1%). In the follow-up assessment, accomplished (45%) was the most frequently self-reported habit level, while master (5%) remained the least reported. The cohort reported a median progress in SMART goal accomplishment of 69% (range, 12% to 100%; n = 54)., Conclusion: Preceptor and resident pharmacists reported perceived advancement in precepting capabilities within the conceptual framework of the HOP-R encompassing both their self-selected habit of focus and adjacent habits while enrolled in a TLC. SMART goals facilitated qualitative and quantitative assessment of development., (© American Society of Health-System Pharmacists 2022. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

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

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

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

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

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

Purpose: Present the research performed to identify and describe habits of effective pharmacy preceptors and provide a framework for targeted preceptor assessment and development., Methods: A 5-round Delphi consensus-building process was used to refine the initial Habits of Preceptors Rubric (HOP-R) developed by the research team. Twenty experts in pharmacy experiential education participated. During the Delphi process, feedback and agreement on all parts of the HOP-R were sought, including the premise, introductory content, framework, preceptor domains, habits, habit level descriptions, and continuous professional development (CPD) plan. After each Delphi round, the research team grouped responses into themes and modified the draft rubric accordingly. These themes were used to frame the response document sent to the expert panel for the following Delphi round; this document explained modifications made to the HOP-R. Consensus was defined as a mean score of ≥3.25 on a 4-point scale (4 = strongly agree, 1 = strongly disagree) for posed statements or ≥70% agreement for ranked items., Results: In the final Delphi round (response rate, 95%), consensus was achieved for all HOP-R individual structural and content elements except the habit level descriptors, for which a secondary rank order analysis was performed. The final HOP-R has 3 domains encompassing 11 preceptor habits that can be displayed across 4 habit levels progressing from developing to master., Conclusion: The HOP-R was developed to assess, quantify, and demonstrate growth across a wide variety of pharmacy preceptor habits. Potential utility includes use as a framework to articulate the knowledge, skills, and behaviors of effective preceptors, facilitate the creation of individualized CPD plans, and assess the impact of participation in teaching and learning curricula., (© American Society of Health-System Pharmacists 2019. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objectives: As class sizes in pharmacy education increase, faculty must develop new assessment strategies for essay writing assignments. This study evaluated accuracy and student perceptions of an innovative grading process that utilizes both peer- and self-assessment., Methods: Four SOAP note sessions were evaluated. Each session included four activities: a writing workshop, assessment workshop, and reflection session. For each assessment workshop students scored their note and a blinded peer's note using a grading form, facilitated by a faculty-led discussion. In a subsequent reflection session, students reviewed their peer- and self-assigned grades and could petition for faculty review if desired. The average self-, peer-, and final-grades were compared for each of the four SOAP note sessions using ANOVA. After the fourth session, students completed an anonymous 10-question Likert-scale survey regarding their perceptions of the process and three open-response questions. Survey results were analyzed with descriptive statistics., Results: Approximately 140 students participated. No difference was found between the average self-, peer-, and final-grades for all four sessions (p > 0.05). The survey response rate was 65% (91/140). Survey questions were grouped into three themes. The majority of students either strongly agreed or agreed that sessions were well organized and effective (≥84%), assessment workshops enhanced learning (≥68%), and the scoring method was fair (≥72%). The lowest score (mean 2.53 on a 4-point scale) reflected satisfaction with peer-provided feedback. When asked what they liked most, respondents most commonly cited that faculty-led review and discussion enhanced clinical knowledge., Implications: The combination of a peer- and self-assessment process was accurate, well-received, and can be used to decrease faculty workload., (Copyright © 2019 Elsevier Inc. All rights reserved.)

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

Cerebral palsy (CP) is a common motor disability that may be congenital or acquired. Children with CP often have gait, balance, and posture abnormalities, some of which may be severe enough to interfere with safe ambulation or other activities of daily living. Nonsurgical and surgical interventions are part of the management plan for children with CP. Historically, surgeons addressed gait deviations individually and sequentially with single-level surgeries. However, computerized motion analysis and advances in orthopedic internal fixation devices have improved the outcomes for patients undergoing single-event multilevel surgery. This article provides perioperative RNs with a basic understanding of movement disorders that can be corrected with single-event multilevel surgery, the role of computerized motion analysis in making treatment decisions for ambulatory pediatric orthopedic patients with CP, and various treatment options for the movement disorders of children with CP., (© AORN, Inc, 2018.)

Accumulation of metal and the accompanying increase in oxidative stress and inflammation plays an important role in neurodegenerative disease. Deferoxamine (DFO) is a metal chelator found to be beneficial in several animal models of neurodegenerative disease and insult including Alzheimer's disease, Parkinson's disease, stroke, and subarachnoid hemorrhage. In this study, we determine whether intranasally (IN) administered DFO is beneficial in the intracerebroventricular streptozotocin (ICV STZ) rat model of sporadic Alzheimer's disease, which is different from previous models in that it exhibits dysregulation of insulin metabolism as well as oxidative stress and inflammation. Surgical induction of the model included ICV injections of either STZ or citrate buffer (sham in rats), which were treated IN with either saline or DFO (n=10-15/group). Treatment started either before or after injection of STZ to induce the model, and continued throughout the study. IN treatment continued three times per week for three weeks before behavior tests started followed by eventual euthanasia with tissue collection. Spatial memory tests with the Morris water maze showed that STZ rats treated with IN DFO both before and after model induction had significantly shorter escape latencies. Pre-treatment with IN DFO also significantly decreased footslips on the tapered balance beam test. Brain tissue analyses showed DFO treatment decreased oxidation as measured by oxyblot and increased insulin receptor expression. These results further support the potential of IN DFO for use as a treatment for Alzheimer's disease, and show benefit in a non-amyloid/tau rodent model., (Copyright © 2017 Elsevier B.V. All rights reserved.)

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

The aim of this study was to describe the design and baseline characteristics of participants enrolled in the prospective randomized-controlled Clubfoot Foot Abduction Brace Length of Treatment Study (FAB24). Foot abduction bracing is currently the standard of care for preventing clubfoot relapse. Current recommendations include full-time bracing for the first 3 months and then 8-12 h a day for 4 years; however, the optimal length of bracing is not known. The FAB24 trial is a clinical randomized study to determine the effectiveness of 2- versus 4-year foot abduction bracing. Participant enrollment for FAB24 was conducted at eight sites in North America and included enrollment and randomization of 139 participants with isolated clubfoot. This clinical trial will generate evidence-based data that will inform and improve patient care.

Purpose - The purpose of this paper is to determine whether there were differences in clinical encounter time between patients who speak English and those who require an interpretation service in an ethnically diverse pediatric clinic. Design/methodology/approach - Encounter time with patients requiring interpretation was compared to encounter time with patients who spoke English. The sample consisted of 310 encounters at a pediatric orthopedic clinic where patients spoke over 18 primary languages. Data were analyzed using ANOVA to compare four types of encounters. Findings - Approximately 12 percent (n=38) required interpretation and encounters requiring interpretation took 30 percent (nine minutes) longer than those that did not, p < 0.01(25 vs 16 minutes). Furthermore, this difference was mainly among new patients: Approximately, 53 percent increase in time for new patient encounters requiring interpretation (36 vs 23 minutes) while only 25 percent increase in encounter time for established patients (20 vs 16 minutes) was detected. Research limitations/implications - Preventing problems due to language barriers requires time for interpretation which places demands on staff resources and presents clinical challenges. However, long-term benefits of quality health care outweigh the costs associated with interpretation service. Originality/value - To the knowledge, this is the first study to investigate actual encounter time differences in a pediatric clinical setting. The authors found that clinical encounters requiring interpretation took approximately nine minutes longer in general and four minutes longer for established patients. These findings could give much needed information for hospital administrators to allocate appropriate amounts of time and resources to care for those who need interpretation services. However, they also indicate a broader concern of the reduction of clinical encounter time for overall health care system in the country that might need further investigation.

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

Smoking cessation lowers the risk of death substantially in patients with cardiovascular disease. Although varenicline is an effective medication for smoking cessation, its safety in this population has been questioned and evaluated in several studies. In 2 randomized controlled trials of patients with cardiovascular disease, the rates of serious cardiovascular events were up to 2% higher in patients receiving varenicline than placebo, though the differences were not statistically significant. In the first meta-analysis of mostly trials involving patients with a history of cardiovascular disease, varenicline was found to significantly increase the risk of cardiovascular events by 72%; however, a second meta-analysis did not find a significant increased risk. In an observational study, varenicline was not associated with an increased risk of events when compared to bupropion in a subgroup analysis of patients with a history of cardiovascular disease. Because the evidence on the safety of varenicline in this population is limited and conflicting, additional data are needed to formulate stronger conclusions. In the meantime, health care professionals should consider individual smoking patterns, concomitant medical conditions, and cost when recommending smoking cessation pharmacotherapy for patients with cardiovascular disease.

Although biallelic mutations in non-collagen genes account for <10% of individuals with osteogenesis imperfecta, the characterization of these genes has identified new pathways and potential interventions that could benefit even those with mutations in type I collagen genes. We identified mutations in FKBP10, which encodes the 65 kDa prolyl cis-trans isomerase, FKBP65, in 38 members of 21 families with OI. These include 10 families from the Samoan Islands who share a founder mutation. Of the mutations, three are missense; the remainder either introduce premature termination codons or create frameshifts both of which result in mRNA instability. In four families missense mutations result in loss of most of the protein. The clinical effects of these mutations are short stature, a high incidence of joint contractures at birth and progressive scoliosis and fractures, but there is remarkable variability in phenotype even within families. The loss of the activity of FKBP65 has several effects: type I procollagen secretion is slightly delayed, the stabilization of the intact trimer is incomplete and there is diminished hydroxylation of the telopeptide lysyl residues involved in intermolecular cross-link formation in bone. The phenotype overlaps with that seen with mutations in PLOD2 (Bruck syndrome II), which encodes LH2, the enzyme that hydroxylates the telopeptide lysyl residues. These findings define a set of genes, FKBP10, PLOD2 and SERPINH1, that act during procollagen maturation to contribute to molecular stability and post-translational modification of type I procollagen, without which bone mass and quality are abnormal and fractures and contractures result.

Orthopedists' lack of consensus on treatment regimens for bicondylar fractures of the distal humerus warrants further review of this uncommon fracture. We present a series of 17 bicondylar fractures of the distal humerus that had a minimum follow up of 2 years. Of these fractures, the 13 that were treated exclusively with internal fixation had 92% excellent or good results. The operative technique we describe is modified from the technique recommended by the AO group. We have found it helpful to use the radial column as the site of primary fixation with a 3.5 mm dynamic compression plate in the sagittal plane. Additional fixation is provided by a reconstruction plate placed posteriorly on the ulnar column in the coronal plane. This system of dual plates in perpendicular planes provides rigidity for early motion which, when supervised, is beneficial to a satisfactory outcome.

Caudal regression consists of sacral agenesis combined with variable lower extremity deformities. The patients have contractures of the lower extremities, hip dislocations, neurologic impairment, and spine instability. Treatment consists of soft tissue releases, osteotomies, or orthotics. The goal of orthopaedic intervention is proper seating and standing, which may be achieved without amputation. In our patients, the lower extremity deformities were corrected surgically, but long-term function is unknown. We report the problems and treatment of seven patients with caudal regression syndrome, including the only known survivor with sirenomelia (mermaid syndrome), who underwent separation of the lower extremities.