Achieving Limb-Length Equality in Femoral Shaft Fractures.

VIDEO AVAILABLE AT: https://ota.org/education/ota-online-resources/video-library-procedures-techniques/achievinglimb-length-equality.

ChatGPT's Ability to Assist with Clinical Documentation: A Randomized Controlled Trial.

INTRODUCTION: Clinical documentation is a critical aspect of health care that enables healthcare providers to communicate effectively with each other and maintain accurate patient care records. Artificial intelligence tools, such as chatbots and virtual assistants, have the potential to assist healthcare providers in clinical documentation. ChatGPT is an artificial intelligence conversational model that generates human-like responses to text-based prompts. In this study, we sought to investigate ChatGPT's ability to assist with writing a history of present illness based on standardized patient histories. METHODS: A blinded, randomized controlled study was conducted to compare the use of typing, dictation, and ChatGPT as tools to document history of present illness (HPI) of standardized patient histories. Eleven study participants, consisting of medical students, orthopaedic surgery residents, and attending surgeons, completed three HPIs using a different documentation technique for each one. Participants were randomized into cohorts based on the type of documentation technique. Participants were asked to interview standardized patients and document the patient's history of present illness using their assigned method. RESULTS: ChatGPT was found to be intermediate for speed; dictation was fastest, but produced markedly longer and higher quality patient histories based on Physician Documentation Quality Instrument score compared with dictation and typing. However, ChatGPT included erroneous information in 36% of the documents. Poor agreement existed on the quality of patient histories between reviewers. DISCUSSION: Our study suggests that ChatGPT has the potential to improve clinical documentation by producing more comprehensive and organized HPIs. ChatGPT can generate longer and more detailed documentation compared with typing or dictation documentation methods. However, additional studies are needed to investigate and address concerns regarding privacy, bias, and accuracy of information.

Procedural Technique for Wide Awake Local Anesthesia No Tourniquet Injection for Endoscopic Carpal Tunnel Release.

Carpal tunnel syndrome is the most common upper extremity peripheral neuropathy syndrome. Treatment ranges from nonsurgical methods, including night-orthosis fabrication and corticosteroid injections to surgical management via a carpal tunnel release (CTR). Carpal tunnel release alleviates nerve compression by releasing the transverse carpal ligament, and performed as either an open CTR (OCTR) or endoscopic CTR (ECTR) procedure. However, there is no consensus on the superiority of the 2 approaches. Practitioners may be limited to 1 technique because of surgeons' comfort, access to an operating room versus a procedure room, and cost. The purpose of this article was to describe the surgical technique for wide awake, local anesthesia, no tourniquet ECTR performed in an office-based setting, which would decrease operating room demand and cost.

Animal rights, environment, or health? Effects of argument type and dissonance on the attitudes toward the consumption of animals.

The scientific literature and advocacy organisations highlight three harm-related arguments as paramount reasons for the reduction and cessation of the consumption of animal-derived products (ADP) - violence toward animals, damage to the environment, and human health. However, research on their comparative effects is scarce and there is no clear definition of which type of argument is the most effective in restricting ADP consumption. Based on cognitive dissonance theory, this study aimed to investigate the effects of these types of arguments on meat-eaters' attitudes and beliefs toward the propositions of reducing and ceasing ADP consumption. The study sample comprised 545 Brazilian adults. We adopted an experimental between-subjects design based on the presentation of vignettes. Each participant responded to one of the vignettes (animal rights, environmental, or health arguments) or a control condition. Results showed that greater levels of ADP-related dissonance provoked greater positive attitudes toward the reduction and cessation of ADP consumption. Compared to baseline, the animal rights and environmental messages significantly increased dissonance and positive attitudes toward ADP restriction, but not the health argument. Participants most frequently adopted the dissonance-management strategies of denial of responsibility, denial of harm, and the articulation of beliefs favourable to change. The discussion highlights that the different effects of social influence contexts and argument types depend on their capacity to reveal ADP consumption as morally problematic behaviour. To our knowledge, this is the first study to experimentally compare the effects of animal rights, environmental and health-related arguments in generating ADP-related dissonance and attitude change.

Rehearsing post-Covid-19 citizenship: Social representations of UK Covid-19 mutual aid.

People across the world have responded to the pandemic by mobilizing and organizing to support their communities, setting up mutual aid groups to provide practical, financial, and social support. Mutual aid means short-term 'crisis response' for some, while for other groups, it is a chance to radically restructure society, and what it means to be a member of that society. Drawing on social representations theory and previous work on citizenship in social and political psychology, we examined the ways in which mutual aid was understood and performed by members of UK Covid-19 mutual aid groups. We conducted 29 interviews with members of these groups in May/June 2020. A reflexive thematic analysis showed that mutual aid groups were characterized as complex, efficient, and non-hierarchical units, operating on the principles of solidarity, kindness, and trust. Two tensions were evident in the data, specifically between (1) collaboration with existing organizations and structures (e.g., local government and the police), and resistance to it and (2) maximizing group inclusivity and sustaining political critique. Findings are discussed in relation to existing theoretical and empirical work on citizenship and mutual aid groups.

The targeting rule does not increase the rate of lower extremity injuries in NFL players over two seasons.

OBJECTIVES: In 2018 the NFL instituted playing rule article 8, which aimed to help decrease sport related concussion (SRC) by broadening the helmet-hit rule, making it a foul when a player lowers his head to make contact with his helmet against an opponent. Previous studies have demonstrated that the rate of lower extremity injuries increased following the institution of the targeting rule in NCAA football. The objective of this study was to determine if playing rule article 8 unintentionally led to a significant increase in the rate of lower extremity injuries sustained by NFL players during regular season games. METHODS: This study was a retrospective review of all NFL players who were placed on the publically available injury reports for a lower extremity injury from the 2016-2017 through 2019-2020 regular seasons. With article 8 taking effect starting with the 2018-2019 season, players were assigned to a pre- or post-rule cohort based on date of injury for purposes of injury rate comparison. Injury rates were calculated per 1000 athletic exposures (AE). Incidence rate ratio (RR) with 95% confidence intervals (CI) compared injury rates between the two cohorts. RESULTS: There was a 3% decrease in the lower extremity injury rate in 2018-2019 to 2019-2020 compared with 2016-2017 to 2017-2018, however this was not statistically significant (33.6 versus 34.3/1000 AEs, respectively; RR, 0.97; 95% CI 0.92-1.04). There was a 40% decrease in the SRC rate when comparing the post- to the pre-article-8 cohort (3.3 vs. 5.5/1000 AEs, respectively; RR 0.60; 95% CI 0.50-0.73). CONCLUSIONS: The rate of lower extremity injuries and players placed on the injury reserve over the past two NFL seasons following the enactment of playing rule article 8 has not significantly increased. However, the average games missed due to lower extremity injuries significantly increased under playing rule article 8, which suggests that the severity of lower extremity injuries possibly increased. LEVEL OF EVIDENCE: IV Diagnostic.

Mitigating the identity and health threat of COVID-19: Perspectives of middle-class South Asians living in the UK.

The recognition and representation of BAME community as 'high risk' of Covid-19 in the UK presents both a health and an identity threat to this ethnic group. This study employed thematic analysis to explore response to these threats as related by a sample of 13 middle class members of the South Asian community. This work advances both health and identity psychological theory by recognising the affinity between expressions of health efficacy and identity. Our findings identify South Asian intragroup stigmatisation and commonalities that have implications for the promotion of health behaviour and health communications for minority groups.

The amplifying effect of perceived group politicization: Effects of group perceptions and identification on anxiety and coping self-efficacy among members of UK COVID-19 mutual aid groups.

Mutual aid groups developed and mobilized in communities across the UK and globally at the outset of the pandemic in order to support vulnerable community members with practical assistance and emotional support, with some understanding their work in political terms. This study adopted a "social cure" lens to investigate the effects of group identification and group perceptions on anxiety and coping self-efficacy among members of UK Covid-19 mutual aid groups. Survey data were collected from self-identified members of these groups (N = 844) during the initial period of "lockdown" restrictions in April - May 2020. Correlational analyses showed that identification with the mutual aid group was linked to more positive group perceptions and better self-reported psychological outcomes. Perceived group politicization showed the reverse pattern. Mixed support for the "social cure" model was evident; the effect of group identification on coping self-efficacy (but not anxiety) was serially mediated by perceived support and collective efficacy. Perceived group politicization was a significant moderator, seeming to amplify the indirect effect of group identification on coping self-efficacy via perceived support. Results are discussed in light of previous empirical work on the social cure and Covid-19 mutual aid groups. Please refer to the Supplementary Material section to find this article's Community and Social Impact Statement.

Dysphonia and dysphagia consequences of paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS).

IMPORTANCE: Paediatric inflammatory multisystem syndrome, temporally associated with SARS-CoV-2 (PIMS-TS) is a novel disease first identified in 2020. Recent cohort studies have described the complex presentation and symptomatology. This paper provides detailed description of the dysphagia and dysphonia symptoms, management, and outcome. OBJECTIVE: To describe dysphagia and dysphonia in PIMS-TS. DESIGN: Retrospective cohort study. SETTING: Single tertiary and quaternary children's hospital. PARTICIPANTS: All 50 children treated for paediatric multisystem inflammatory disease between April and June 2020 were included in this study. MAIN OUTCOME(S) AND MEASURE(S): Dysphonia: GRBAS Perceptual Severity Scores, Vocal Handicap Index scores and the Vocal Tract Discomfort Scale. Dysphagia: Functional Oral Intake Scale. RESULTS: Fifty children met the diagnostic criteria for PIMS-TS. 33 (66%) were male. Median age was 10 years (range: 1-17). 36 (72%) were of Black, Asian or minority ethnic background. Nine (18%) required specialist assessment and management of dysphagia and/or dysphonia. Five (55%) were male with a median age of 9 years 7 months (range: 1-15 years). Symptoms typically resolved within three months. Two children presented with persisting dysphonia three months post-presentation. Neurological, inflammatory, and iatrogenic causes of dysphagia and dysphonia were identified. CONCLUSIONS AND RELEVANCE: Dysphonia and dysphagia are present in children with PIMS-TS. Further data is required to understand pathophysiology, estimate incidence, and determine prognostic factors. This preliminary data highlights the need for dysphagia and dysphonia screening and timely referral for specialist, multidisciplinary assessment and treatment to ensure short-term aspiration risk is managed and long-term, functional outcomes are optimised.

Venous thromboembolism after hospital discharge in pelvic and acetabular fracture patients treated operatively.

PURPOSE: The purposes of this study were to determine the rate of venous thromboembolism (VTE) after discharge from the hospital in patients treated operatively with a pelvic ring or acetabular fracture and to define the main time frame in which VTE occurs within the 90-day period after hospital discharge. METHODS: California and Florida State Inpatient Databases from 2005 to 2009 were used to identify patients with clinically significant VTEs within 90 days of hospital discharge. ICD-9 diagnosis codes identified patients with a pelvic ring or acetabular fracture and a VTE. Procedure codes distinguished patients having surgical fracture treatment. Deep vein thrombosis (DVT) and pulmonary embolus (PE) were included. RESULTS: Overall, 13,589 patients had a pelvic ring or acetabular fracture and operative treatment. One hundred thirteen patients (0.83%) had a VTE within 90 days after hospital discharge: 69 (0.51%) had a DVT, 28 (0.21%) had a PE, and 16 (0.12%) had both. Twenty-four (28%) of DVTs and 10 (23%) of PEs occurred >35 days after discharge, being evenly distributed out to 90 days. There were five fatal PEs, occurring 2, 3, 7, 31, and 51 days after discharge. Therefore, overall, <0.2% of patients developed a DVT and <0.1% were diagnosed with a PE (only 1 fatal; <0.01%) >35 days after the index hospitalization. CONCLUSIONS: A substantial proportion of VTE events occur over 35 days after discharge; however, the overall risk is low with fatal PE being extremely low (<0.01%). Given the diminished VTE risk after 35 days, the decision to further extend antithrombotic drug therapy may be guided by patient-specific factors, such as prolonged immobility.