Visual aid for pediatric virtual musculoskeletal exams: A Barbie girl in a telehealth world.

BACKGROUND: Telehealth is rapidly advancing, yet musculoskeletal physical examinations pose a unique challenge with limited clinically tested tools. OBJECTIVE: To measure whether visual aid use improves accuracy and efficiency of musculoskeletal exam maneuvers within a mock pediatric telehealth encounter. DESIGN: Randomized controlled trial. SETTING: Mock telehealth encounter. PARTICIPANTS: A total of 30 volunteer dyads of children aged 4-17 years old and their parent/guardian. To be eligible to participate, the parent/guardian was required to speak and read English proficiently and have access to Zoom technology on a personal electronic device. INTERVENTION: The control group received verbal prompts to complete 12 musculoskeletal exam maneuvers. The intervention group had the addition of a Barbie (Mattel) visual aid. MAIN OUTCOME MEASURES: Primary outcomes were accuracy (number of completed maneuvers) and efficiency (total verbal prompts, total time). Secondary outcomes were ratings of comfort using telehealth technology, ease of understanding, and perceived usefulness of the visual aid. Standard multiple regression analysis was employed, with significance defined as a p value <.05. RESULTS: The intervention group completed an average of 11.67 ± 0.7 maneuvers versus 11.27 ± 1.0 in the control group (p = .21), 13:31 ± 4.02 total time (mm:ss) versus 14:47 ± 4:04 (p = .05), and 4.87 ± 4.4 verbal prompts versus 8.40 ± 4.6 (p = .04), respectively. The overall model of group allocation controlling for age was not statistically significant for total maneuvers (p = .255), total time (p = .061) or total verbal prompts (p = .095). However, group allocation significantly predicted total verbal prompts (p = .032), with participants in the intervention group requiring an average of 4.1 fewer prompts. All participants in the intervention group rated the visual aid as 'definitely helpful'. CONCLUSION: Visual aid use improved virtual musculoskeletal exam maneuver ease and efficiency in a pediatric population.

Similar rates of reoperation for neuroma after transtibial amputations with and without targeted muscle reinnervation.

Objective: To compare the rates of revision surgery for symptomatic neuromas in patients undergoing primary transtibial amputations with and without targeted muscle reinnervation (TMR). Design: Retrospective cohort study. Setting: Level I trauma hospital and tertiary military medical center. Patients/Participants: Adult patients undergoing transtibial amputations with and without TMR. Intervention: Transtibial amputation with targeted muscle reinnervation. Main Outcome Measurements: Reoperation for symptomatic neuroma. Results: During the study period, there were 112 primary transtibial amputations performed, 29 with TMR and 83 without TMR. Over the same period, there were 51 revision transtibial amputations performed, including 23 (21%) in the patients undergoing primary transtibial amputation at the study institution. The most common indications for revision surgery were wound breakdown/dehiscence (42%, n = 25), followed by symptomatic neuroma 18% (n = 9/51) and infection/osteomyelitis (17%, n = 10) as the most common indications. However, of the patients undergoing primary amputation at the study's institution, there was no difference in reoperation rates for neuroma when comparing the TMR group (3.6%, n = 1/28) and no TMR group (4.0%, n = 3/75) (P = 0.97). Conclusions: Symptomatic neuroma is one of the most common reasons for revision amputation; however, this study was unable to demonstrate a difference in revision surgery rates for neuroma for patients undergoing primary transtibial amputation with or without targeted muscle reinnervation. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Three derivatives of phenacyldiphenylphosphine oxide: influence of aromatic and alkyl substituents on the luminescence sensitization of four Ln(NO3)3 salts.

A series of four ß-carbonylphosphine oxide compounds have been synthesized, and their complexes with the nitrate salts of Sm3+, Eu3+, Tb3+ and Dy3+ have been characterized in solution and in the solid state. Analysis of the complexes using IR and NMR suggests that metal-ligand binding occurs mainly through the phosphine oxide group of the ligand, with some involvement of the carbonyl group. All 16 complexes luminesce in solutions of acetonitrile, albeit with varying degrees of intensity. The highest quantum yield values obtained for this series are those where the ligand contains an aryl carbonyl group paired with an electron rich phosphine oxide group (29.8 and 11% for the Tb3+ and Eu3+ complexes, respectively). In contrast, the longest emission lifetime values were found for complexes where the ligand contains a bulky substituent on the carbonyl group paired with an electron rich phosphine oxide (1.86, 1.402, 0.045 ms for the Tb3+, Eu3+ and Sm3+ complexes, respectively).

Exercise During Pregnancy: What Do OB/GYNs Believe and Practice? A Descriptive Analysis.

Introduction: Although regular exercise is recommended during non-complicated pregnancies to promote maternal and fetal/infant health, estimates suggest that only 15% of expectant mothers achieve current exercise recommendations. Although lack of motivation and fear related to potential fetal injury are often cited as reasons for not engaging in regular physical activity/exercise during pregnancy, less is understood about individual attitudes and practice habits of obstetrician and gynecologists (OB/GYNs) regarding exercise recommendations that may influence patient engagement in exercise during pregnancy. Purpose: To describe the attitudes, knowledge, and clinical practice of OB/GYNs regarding exercise during pregnancy. Methods: Surveys were sent via U.S. mail to 950 practicing OB/GYNs identified via publicly available databases. The survey included 11 questions regarding demographic information, exercise physiology knowledge, as well as their attitudes and clinical practice recommendations regarding exercise during pregnancy. Results: One hundred thirty-nine completed surveys were returned (14.6% response rate). Ninety-four percent of physicians surveyed agreed that there are benefits of exercise during pregnancy and/or the benefits of exercise during pregnancy outweigh the risks. Ninety-eight percent of physicians surveyed reported that they (or their medical staff) routinely advise their patients to exercise during pregnancy and 46% reported discussing exercise guidelines related to time, intensity, and type of exercise. Only 13% of physicians surveyed reported taking a semester-long exercise physiology course, yet 27% of physicians surveyed reported developing personalized exercise prescriptions for all (6%) or some (21%) of their patients. Conclusions: Low exercise engagement among expectant mothers does not appear to be due to a lack of guidance or negative views of OB/GYNs regarding exercise during pregnancy.

Incidence of Flexor Pollicis Longus Complications Following Volar Locking Plate Fixation of Distal Radius Fractures.

Background: Distal radius fractures are among the most common orthopedic injuries presenting to emergency departments. The complications of distal radius open reduction and internal fixation (ORIF) range from paresthesia to tendon ruptures. The Soong grading system was designed to evaluate volar plate position to predict postoperative flexor pollicis longus (FPL) ruptures. This study evaluates post-distal radius volar fixation FPL ruptures and other postoperative complication rates relative to Soong grade, surgical training, and plate design. Methods: A retrospective chart review was conducted to assess recorded complications after distal radius ORIF. Soong grade was determined on postoperative radiographs. Other demographic features, along with the surgeon fellowship training and plate design, were noted. Analysis was performed via t test, χ2 test, rank sum test, and Fisher exact test. Results: A total of 522 patients met inclusion criteria. Flexor tenosynovitis was the most commonly recorded complication (21% of total complications). No FPL ruptures were recorded. Soong grades between patients with and without complications were not significantly different. Soong grades between patients with flexor tenosynovitis and other complications were not significantly different. Flexor tenosynovitis had higher odds of occurring compared with other complications when the surgeon was hand-trained or when the plate type was designed by Acumed. These higher odds were not maintained under multivariate regression analysis. Conclusion: Lack of FPL ruptures in this large series may reflect improved plate technology and increased awareness. The association between flexor tenosynovitis and hand fellowship-trained surgeons may be associated with more complex cases being referred to specialists.

Hearing assessment data in HIV-infected and uninfected children of Cape Town, South Africa.

Researchers are showing that the rate of hearing loss in children with perinatal HIV infection (PHIV) is higher than in HIV-unexposed, uninfected children. These data, however, have been collected mostly in the USA; extensive hearing data from low- and middle-income countries are lacking. The purpose of this study was to collect audiometric data in PHIV and HIV-uninfected children living in Cape Town, South Africa. Questionnaire data along with distortion product otoacoustic emissions (DPOAEs) and pure-tone testing were completed. Hearing loss was determined using the pure-tone thresholds defined as a pure-tone average (PTA) of 500, 1000, 2000, and 4000 Hz of >15 dB HL in the poorer ear. All data were compared between PHIV and HIV-uninfected children. Sixty-one (37 PHIV and 24 HIV-uninfected) children had hearing data. HIV status was not significantly associated with DPOAEs. The rate of conductive hearing loss was 11.5%; five PHIV and two HIV-uninfected children. The rate of any hearing loss was higher in PHIV children, but this difference was not statistically significant. PHIV children had a significantly higher mean PTA in the poorer ear than HIV-uninfected children. Conductive type of hearing loss was more common than sensorineural hearing loss. The underlying cause of hearing loss in the present study therefore remains unclear. Future research should include an examination of auditory neural function in an effort to determine the possible reason for differences in hearing.

The prevalence of medical student mistreatment and its association with burnout.

PURPOSE: Medical student mistreatment has been recognized for decades and is known to adversely impact students personally and professionally. Similarly, burnout has been shown to negatively impact students. This study assesses the prevalence of student mistreatment across multiple medical schools and characterizes the association between mistreatment and burnout. METHOD: In 2011, the authors surveyed a nation ally representative sample of third-year medical students. Students reported the frequency of experiencing mistreatment by attending faculty and residents since the beginning of their clinical rotations. Burnout was measured using a validated two-item version of the Maslach Burnout Inventory. RESULTS: Of 960 potential respondents from 24 different medical schools, 605 (63%) completed the survey, but 41 were excluded because they were not currently in their third year of medical school. Of the eligible students, the majority reported experiencing at least one incident of mistreatment by faculty (64% [361/562]) and by residents (76% [426/562]). A minority of students reported experiencing recurrent mistreatment, defined as occurring "several" or "numerous" times: 10% [59/562] by faculty and 13% [71/562] by residents. Recurrent mistreatment (compared with no or infrequent mistreatment) was associated with high burnout: 57% versus 33% (P < .01) for recurrent mistreatment by faculty and 49% versus 32% (P < .01) for recurrent mistreatment by residents. CONCLUSIONS: Medical student mistreatment remains prevalent. Recurrent mistreatment by faculty and residents is associated with medical student burnout. Although further investigation is needed to assess causality, these data provide impetus for medical schools to address student mistreatment to mitigate its adverse consequences.

Teaching and assessment of ethics and professionalism: a survey of pediatric program directors.

OBJECTIVE: The Accreditation Council for Graduate Medical Education requires residency programs to provide instruction in and evaluation of competency in ethics and professionalism. We examined current practices and policies in ethics and professionalism in pediatric training programs, utilization of newly available resources on these topics, and recent concerns about professional behavior raised by social media. METHODS: From May to August 2012, members of the Association of Pediatric Program Directors identified as categorical program directors in the APPD database were surveyed regarding ethics and professionalism practices in their programs, including structure of their curricula, methods of trainee assessment, use of nationally available resources, and policies regarding social media. RESULTS: The response rate was 61% (122 of 200). Most pediatric programs continue to teach ethics and professionalism in an unstructured manner. Many pediatric program directors are unaware of available ethics and professionalism resources. Although most programs lack rigorous evaluation of trainee competency in ethics and professionalism, 30% (35 of 116) of program directors stated they had not allowed a trainee to graduate or sit for an examination because of unethical or unprofessional conduct. Most programs do not have formal policies regarding social media use by trainees, and expectations vary widely. CONCLUSIONS: Pediatric training programs are slowly adopting the educational mandates for ethics and professionalism instruction. Resources now exist that can facilitate curriculum development in both traditional content areas such as informed consent and privacy as well as newer content areas such as social media use.

Young physicians' recall about pediatric training in ethics and professionalism and its practical utility.

OBJECTIVE: To assess the adequacy of ethics and professionalism education in residency by examining the recollections of young pediatricians in practice. STUDY DESIGN: We surveyed a random sample of members of the American Academy of Pediatrics Section on Young Physicians between February and June 2012. RESULTS: The majority of young pediatricians reported that ethics and professionalism were taught ad hoc in their training programs. Compared with physicians in practice for >5 years, those in practice for ≤ 5 years were significantly more likely to report having had an organized curriculum (72 of 181 [40%] vs 27 of 113 [24%]; P < .01) and that the ethics and professionalism training in their program was adequate (124 of 180 [69%] vs 62 of 113 [55%]). Of the topics encountered in practice by at least two-thirds of pediatricians, more than two-thirds of the respondents stated that residency training adequately prepared them to address issues of consent, privacy, truth-telling, and child abuse/neglect, but less than one-third felt adequately prepared to address conduct on social media and requests for prescriptions by family, friends, and colleagues outside of clinical encounters. CONCLUSION: The majority of recent graduates from pediatric training programs described themselves as competent to address the ethical and professionalism issues faced in practice, but nonetheless reported gaps in their education. As pediatric residency programs adopt more structured curricula for ethics and professionalism education, issues commonly faced by practitioners should be incorporated.