The Hand Surgeon Consultation Improves Patient Knowledge in a Hand Surgery Mission to Honduras.

BACKGROUND: The purpose of this study was to assess impact of the surgeon consultation and informed consent process on patient education in an international hand surgery mission compared with a US academic hand surgery practice. These two groups were selected to evaluate communication difficulties in a surgical mission setting compared with standard of care in a high-income country. METHODS: A multi-part survey was administered to patients presenting to a hand surgery mission during March 2012 and new patients of a university hand center in a 3-month period during 2011. Surveys were administered prior to and following surgeon consultation with one fellowship-trained hand surgeon. The survey assessed knowledge of basic hand anatomy, physiology, disease, individual diagnosis, and surgical risks. RESULTS: 71 patients participated in the study (university n=36, mission n=35). Pre-consultation quiz score averaged 58% in the university group versus 27% in the mission group. Post-consultation quiz scores averaged 62% in the university group versus 40% in the mission group. Only the mission group's quiz score increase was statistically significant. 93% of the university group reported learning about their condition and diagnosis, but only 40% demonstrated correct insight into their diagnosis. In the mission group, 73% reported learning about their condition and diagnosis while 53% demonstrated correct insight into their diagnosis. Although all consultations involved discussion of surgical risks, only 62% of the university group and 52% of the mission group recalled discussing surgical risks. CONCLUSIONS: The hand surgeon consultation was more effective in improving hand knowledge in the surgery mission group compared to in a university hand practice. This suggests that the surgeon consultation should be pursued despite communication barriers in surgical missions. However, the discrepancy between patient perception of knowledge gains and correct insight into diagnosis, and the deficit of patient retention of surgical risks need to be improved.

Effects of cyclic strain on rat tail tenocytes.

Cyclical mechanical strain is considered an important component in flexor tendon cell activation to prevent adhesions and enhance the healing process after tissue injury or surgery, but the biochemical events associated with this remain unclear. To address this, we examined the effects of cyclic tension on the expression of hyaluronic acid, an important lubricant and signal transducer in tendon, on its receptor (CD44), and on total glycosaminoglycan content in rat tail derived tendon fibroblasts in vitro. Tenocytes were plated on fibronectin coated silastic membranes and the cultures were held static or subjected to vacuum induced deformation for a period of 5 min once every 8 h as a model of cyclic mechanical stress. After 24 h medium and cell layers were collected for analyses by product specific ELISA, Western blot, and colorimetric dye-binding assays. Strained tenocytes produced a nearly two-fold increase in hyaluronic acid and a greater than 60% increase in CD44, but had an insignificant effect on total glycosaminoglycan content. Our results predict that high levels of strain may therefore rapidly enhance the expression of hyaluronic acid and cause, albeit still unresolved, downstream effects on CD44 activation, to influence tendon cell activity and enhance the process of tendon repair.

Pilot study on the value of a beta-blocking drug in initial helicopter training.

The effect on performance of a standard dose of a beta-blocking drug was examined in a controlled test situation closely approximating actual flying training conditions and involving helicopter flying skills. Pindolol or a placebo was administered 90 min before a test flight and the flying and hovering performance of five students was assessed by qualified flying instructors. No significant difference was found between assigned performance ratings of test drug flights and placebo flights. It could not be concluded that a beta-blocking drug would improve the hovering performance of ab initio helicopter trainee pilots.