Impact of the COVID-19 Pandemic on Allied Health University Education Programs: A Scoping Review.

The COVID-19 pandemic triggered the mass transition of tertiary education to virtual delivery or a hybrid learning approach. This scoping review aims to identify the nature and extent of the current literature on how the COVID-19 pandemic impacted the allied health student education experience and the delivery of teaching and learning materials. A scoping review, performed following the PRISMA-ScR guidelines, was conducted for standard databases and the grey literature published after 2019 that focused on allied health education. Study quality was critically appraised and narrative analysis was performed. Of 6,509 papers identified from the literature search, a total of 68 articles were selected for data extraction. Out of the final 68 studies selected for inclusion in the scoping review, all universities were impacted by the transition to virtual or hybrid learning. Students reported that virtual learning increased flexibility and examinations were considered less stressful. Negative aspects of virtual learning were health issues such as anxiety and depression, technical difficulties, and the lack of interaction with peers and educators. Overall, the studies included in the scoping review reported that allied health students preferred conventional face-to-face learning opportunities over virtual learning experiences. High student satisfaction levels in institutions using a hybrid approach were common. Further research is needed on a wider range of educational experiences (e.g., placements and academic performance).

Relationships and Within-Group Differences in Physical Attributes and Golf Performance in Elite Amateur Female Players.

The aim of the present study was to examine the association between a comprehensive physical testing battery and measures of golf performance in elite female amateur players. Nineteen category one (handicap ≤ 5) or better golfers (age: 16.26 ± 1.28 years, height: 166.26 ± 3.62 cm, mass: 64.04 ± 11.27 kg, wingspan: 146.53 ± 15.59 cm, handicap: +1.45 ± 0.7) volunteered to participate in this investigation. All golfers attended a single 90 min testing session where golf shot data (clubhead speed [CHS], ball speed, carry distance, and smash factor) were measured with a Trackman 4 launch monitor and a battery of physical assessments were carried out. These included anthropometric data and assessments for seated thoracic rotation, the isometric mid-thigh pull (IMTP), isometric bench press, countermovement jump (CMJ), and seated medicine ball throws for distance. Pearson's r correlations showed CHS was the golf metric that most commonly demonstrated large associations with physical testing data, most notably with force at 100 ms during the isometric bench press (r = 0.70). Median split analysis was also conducted for the IMTP (force at 200 ms), isometric bench press (force at 100 ms), and CMJ (positive impulse). The results showed that players who produced more force at 200 ms during the IMTP exhibited a greater CHS (g = 1.13), ball speed (g = 0.90), and carry distance (g = 1.01). In addition, players with a greater positive impulse during the CMJ showed a greater ball speed (g = 0.93), carry distance (g = 1.29), and smash factor (g = 1.27). Collectively, these results highlight the relevance of explosive force production capabilities in both the lower and upper body for female golfers. This information can be used by practitioners to better target key physical attributes during testing and training of female players.

Practices and perceptions of strength and conditioning training in female golf: A cross-sectional survey study of high-level amateur players.

This study aims to ascertain an in-depth understanding of current practices and perceptions of S&C training in high-level amateur female golfers. A cross-sectional, explorative survey study was constructed which asked questions relating to four key areas: i) general participant information, ii) current strength and conditioning (S&C) practices, iii) the perceived influence of S&C training on golf performance, and iv) knowledge and awareness of S&C. Results showed that the majority of female players had participated in some form of S&C training in the past, with the majority believing that clubhead speed and carry distance were the primary golfing metrics which could be positively impacted. More specifically, 91-97% of the players "Strongly agreed" or "Agreed" that the key physical characteristics for golf were strength and power for the lower and upper body, and flexibility. Interestingly, 58% of the players believed that S&C training should mimic the movement of the golf swing, which based off current evidence, is not how drive metrics and ultimately shots gained, can be maximised. This survey study provides useful information relating to the practices and perceptions of S&C training in high-level female amateur players and areas where education may be able to further advance player understanding of physical preparation.

Scar massage as an intervention for post-surgical scars: A practice survey of Australian hand therapists.

Introduction: Scar massage is a commonly used treatment in hand therapy. The current empirical evidence that supports it is disparate and of variable quality, with no established effective dosage and method proposed. This study aimed to identify the current practice among Australian hand therapists using massage as an intervention for scarring following surgery to the hand and upper limb. Methods: A purposely designed self-report online survey was emailed to current members of the Australian Hand Therapy Association (n = 958). Data collected included demographics, intervention techniques, conditions treated and protocols, scar assessment and knowledge and training about scar massage as a clinical intervention. Results: A total of 116 completed questionnaires were received (a response rate of 12.1%). All respondents used scar massage as part of their clinical practice with 98% to improve soft tissue glide (n = 114), 92% for hypersensitivity (n = 107), and 84% to increase hand function (n = 97). Only 18% (n = 21) of respondents used standardised outcome measures, and most therapists had learned scar massage from a colleague (81%). Conclusions: Commonalities in how respondents implemented scar massage were found. Participants reported relying primarily on clinical experience to inform their practice. Whilst scar massage was widely used, few respondents had received formal skills training or completed outcome measures regularly to formally evaluate its clinical efficacy or impact. Replication of this study with a larger international sample of participants is warranted to determine if these findings reflect general practice.

Research capacity and culture among hand therapists in Australia: A cross-sectional survey.

BACKGROUND: Identifying the factors influencing engagement in research capacity and culture (RCC) in hand therapy practice is essential to inform strategies to support contributions to high-quality research and its implementation in clinical practice. However, the RCC of clinicians providing hand therapy services in Australia has not been investigated. PURPOSE: This study aimed to measure RCC among hand therapists in Australia to identify perceived barriers, motivators, and skills related to undertaking research. STUDY DESIGN: Cross-sectional survey. METHODS: All Australian Hand Therapy Association members were invited to complete the RCC tool, which includes three domains: i) individual, ii) professional group (team), and iii) organization. RESULTS: One hundred twenty-two therapists (13.6% response rate) completed the survey. Survey findings indicate that the RCC of hand therapists in Australia is relatively low across all RCC domains, with scores on these items being either moderate or low. The findings from this study suggest that the areas or skills that respondents felt most confident with were more closely aligned to the clinical skills required as evidence-based practitioners, compared to other skills more closely aligned with the clinician-researchers, such as data analysis or writing proposals. CONCLUSIONS: Hand therapists in Australia may not possess the research experience or skills required to confidently complete a range of research-related activities. Future support strategies should focus on improving hand therapist knowledge and confidence regarding common research tasks and provide funding and mentoring for additional hand therapist clinician-researcher roles.

Effects of Physical Training and Associations Between Physical Performance Characteristics and Golf Performance in Female Players: A Systematic Review With Meta-Analysis.

ABSTRACT: Robinson, L, Murray, A, Ehlert, A, Wells, J, Jarvis, P, Turner, A, Glover, D, Coughlan, D, Hembrough, R, and Bishop, C. Effects of physical training and associations between physical performance characteristics and golf performance in female players: A systematic review with meta-analysis. J Strength Cond Res 37(12): e646-e655, 2023-The aims of this systematic review were to assess the association between physical performance and measures of golf performance, and the effects of physical training on measures of golf performance, in female golfers. A systematic literature search was conducted in PubMed, SPORTDiscus, Medline, and CINAHL. Inclusion criteria required studies to (a) have conducted a physical training intervention of any duration in female players and determine the effects on measures of golf performance, (b) determine the association between physical performance in at least one test and golf performance in female players, and (c) be peer-reviewed and published in English language. Methodological quality was assessed using a modified version of the Downs and Black Quality Index tool, and heterogeneity was examined through the Q statistic and I2 . Pooled effect sizes were calculated using standardized mean differences (SMDs) (with 95% confidence interval [CI]s) within a random-effects model, with Egger's regression test used to assess small study bias (inclusive of publication bias). Of the 2,378 articles screened, only 9 were included in the final review, with 3 of these being associative by design and 6 being training interventions. From an associative standpoint, clubhead speed (CHS) was reported in all 3 studies and was associated with measures of strength ( r = 0.54), lower-body power ( r = 0.60), upper-body power ( r = 0.56-0.57), and flexibility ( r = 0.52-0.71). When assessing the effects of physical training interventions, CHS was again the most commonly reported golf outcome measure ( n = 5). The random-effect model indicated that CHS significantly improves within each training group following training interventions (SMD = 0.73 [95% CIs: 0.32-1.14], Z = 3.50, p < 0.001), with trivial heterogeneity ( I2 = 0.00%, Q = 0.18; p = 0.9963) and no prevalence of small study bias depicted through the Egger's regression test ( z = -0.28, p = 0.78). From the available research, it seems that CHS can be positively affected from strength, power, and flexibility training interventions. From an associative standpoint, only 3 studies have been conducted solely in female players, with one showcasing questionable methodology. Future research should aim to carefully select test measures which better represent the physical capacities needed for the sport when determining the effects of and relationships with golf performance.

Reliability and clinical utility of a novel telehealth-based goniometry approach to measure range of motion of the digits of the hand.

BACKGROUND: Range of motion (ROM) is an outcome measure commonly used when treating acute and chronic hand injuries and conditions. Increased adoption of telehealth service provision in hand therapy practice, influenced by the advent of COVID-19, has led to the need for a valid and reliable approach to measure the range of motion of the digits of the hand when providing hand therapy services using telehealth. PURPOSE: To determine if performing manual goniometry during a livestream teleconsultation is reliable and clinically useful to measure the range of motion of the fifth digit when providing hand therapy services using telehealth. STUDY DESIGN: Clinical measurement, repeated-measures study. METHODS: According to a measurement protocol, 12 independent raters (who currently provide hand therapy services) each obtained several screen-based goniometric range of motion measurements of the fifth digit at 2-time points. Raters were surveyed on the clinical utility of the telehealth-based goniometry approach. Measures of relative and absolute reliability were calculated to evaluate test-retest and inter-rater reliability. Free-text responses were analyzed using content analysis. RESULTS: Inter-rater reliability was excellent for all flexion and extension measures (intraclass correlation coefficient [ICC] ≥ 0.89) but poor for the arc of motion (ICC ≤ 0.67). Test-retest reliability was poor (ICC ≤ 0.43). No statistically significant differences between test and retest measurements were observed (P ≥ 0.24). The overall coefficient of variation indicated good precision (14.69%). Measurement error (≤6.07º) and limits of agreement (≤6.33) had acceptable levels to support clinical use. Content analysis revealed several practical considerations. CONCLUSIONS: This study suggests that performing manual goniometry during a livestream teleconsultation is unreliable for measuring the range of motion of the fifth digit. However, when combined with patient-reported and functional outcomes, this approach may be suitable to facilitate a range of motion assessment for certain functions of telehealth service provision in hand therapy practice.

Multi-omic single cell sequencing: Overview and opportunities for kidney disease therapeutic development.

Single cell sequencing technologies have rapidly advanced in the last decade and are increasingly applied to gain unprecedented insights by deconstructing complex biology to its fundamental unit, the individual cell. First developed for measurement of gene expression, single cell sequencing approaches have evolved to allow simultaneous profiling of multiple additional features, including chromatin accessibility within the nucleus and protein expression at the cell surface. These multi-omic approaches can now further be applied to cells in situ, capturing the spatial context within which their biology occurs. To extract insights from these complex datasets, new computational tools have facilitated the integration of information across different data types and the use of machine learning approaches. Here, we summarize current experimental and computational methods for generation and integration of single cell multi-omic datasets. We focus on opportunities for multi-omic single cell sequencing to augment therapeutic development for kidney disease, including applications for biomarkers, disease stratification and target identification.

Predictors of undergraduate occupational therapy students' academic performance during the Covid-19 pandemic: A hierarchical regression analysis.

BACKGROUND: The rapid switch to online learning in response to the Covid-19 pandemic affected occupational therapy students' education delivery. It is, therefore, important to investigate these impacts. AIMS/OBJECTIVES: This study investigated the potential predictors of academic performance in undergraduate occupational therapy students after moving to online or blended learning post-Covid-19. MATERIAL AND METHODS: A total of 208 students from three Australian universities completed a demographic questionnaire and the Distance Education Learning Environment Scale (DELES). Hierarchical linear regression analyses were completed to identify significant students' academic performance predictors. RESULTS: Hierarchical regression explained a cumulative total variance of 24.6% of students' academic performance. The following independent variables were significant predictors: DELES student autonomy (p = 0.033), number of hours per semester week dedicated to indirect online study (p = 0.003), number of hours per semester week dedicated to indirect offline study time (p = 0.034), gender (p = 0.005) and English as a first language (p = 0.045). CONCLUSIONS: The findings add to the knowledge base on the range of factors that have impacted occupational therapy students' academic performance during the Covid-19 pandemic. SIGNIFICANCE: The outcomes will assist faculty in developing supportive and pedagogically sound learning modes across online, hybrid and traditional forms of instruction within occupational therapy curricula.

Improved Resource Utilization Using WALANT Hand Surgery in Adolescents.

BACKGROUND: Cost, efficiency, patient preference, and safety have driven utilization of wide awake, local anesthesia, no tourniquet (WALANT) in hand surgery. This is not well documented in adolescents. We hypothesize that the use of WALANT with adolescents reduced time spent in the operating room (OR) and in the hospital when compared with patients who underwent surgery with traditional anesthesia (TA). METHODS: After institutional review board approval, we performed a retrospective review of patients aged 10 to 17 who underwent surgery at a regional hospital system including the level 1 pediatric trauma hospital. Operative notes were assessed for use of WALANT. We excluded those operations not traditionally amenable to WALANT. Using a propensity matched cohort, hospital time, OR time, and perioperative complications were recorded and compared to evaluate efficiency and perioperative safety. RESULTS: There were 28 cases in the WALANT group and 28 cases in the TA group after excluding cases not amenable to WALANT, and cases were propensity matched. Although the operative time (incision to closure) was similar, for WALANT patients, the in-room to procedure time (15 vs 22 minutes), procedure end to out-room time (5 vs 10 minutes), total room time (52.81 vs 63.68), and length of hospital stay (222 vs 342 minutes) were shorter than patients in the TA group. CONCLUSION: Our case series demonstrates time-savings both in the OR and in the hospital overall. Avoiding TA when WALANT is feasible may result in significant savings to hospital systems, patients, and payers while also freeing up anesthesia staff and perioperative nurses.

The Impact of Health Care Funding on Interprofessional Collaboration and Integrated Service Delivery in Primary and Allied Care: Protocol for a Scoping Review.

BACKGROUND: Improving funding models and implementing policies that facilitate greater interprofessional collaboration and integration at the primary and allied health level could improve the ongoing quality and safety and future sustainability of the wider health care system by reducing inefficiencies and inequalities. Defining these key health care funding-related models, policies, and concepts, identifying research gaps, and systematically mapping the associated literature will inform future research on this topic. OBJECTIVE: The aim of this scoping review is to provide a descriptive overview of contemporary health care funding models and the key policies involved in the delivery of primary and allied health care. Further, it will investigate the impact these models and policies have on interprofessional collaboration and integrated service delivery at the primary and allied health care levels. METHODS: A search of published and grey literature will be conducted using the following databases: the Allied and Complementary Medicine Database, CINAHL, Embase, Emcare, MEDLINE, PsycINFO, Scopus, Open Access Theses and Dissertations, and Web of Science. The search will be limited to resources available in the English language and published since 2011. Following the search, an independent screening of titles and abstracts will be undertaken by 2 independent reviewers, with a third reviewer available to resolve any potential disagreements. Full-text resources will then be assessed against the inclusion criteria following the same process. Extracted data will be presented using a convergent narrative approach, accompanied by tables and figures. RESULTS: Electronic database searches have retrieved 8013 articles. The results of this scoping review are expected in May 2022. CONCLUSIONS: The findings from this review will be used to inform future research projects investigating the role of primary health care funding, interprofessional collaboration, and service integration in improving health care access, efficiency, effectiveness, and sustainability. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/36448.

Online Learning During the COVID-19 Pandemic: Comparing the Perceptions of Domestic and International Occupational Therapy Students.

PURPOSE: To investigate differences between domestic and international occupational therapy students in their perceptions and experiences of online learning during the COVID-19 pandemic. METHODS: Cross-sectional study of 151 occupational therapy students enrolled in the 4-year Bachelor of Occupational Therapy (Honours) courses at the University of Canberra and Monash University in Australia. Students completed the Student Engagement in the e-Learning Environment Scale (SELES) and the Distance Education Learning Environment Scale (DELES). Both instruments have established validity and reliability. ANOVA analysis with bootstrapping was completed to examine potential differences in domestic and international students' experiences and perceptions of online learning. RESULTS: Statistically significant differences were observed between domestic and international students' scores on the DELES Student Autonomy (p=0.001), Personal Relevance (p=0.001) and Student Interaction and Collaboration (p=0.037) subscales. CONCLUSION: International students experienced greater difficulties during online learning in relation to taking control of their own learning, connecting acquired knowledge with real-world settings, and forging collaborative and interactive working relationships with their peers. Academic, technological, and social support measures are recommended to strengthen students' self-directed learning skills, facilitate them to link what they have learned beyond online settings, and encourage active and collaborative engagement with peers and instructors.

Hand therapy role in return to work for patients with hand and upper limb conditions.

STUDY DESIGN: Electronic Web-based survey INTRODUCTION: Evidence supports the use of health-focused interventions combined with service coordination and work modification components to reduce the individual, community, and societal burden associated with acute and chronic musculoskeletal conditions. The levels of engagement, skill, and confidence of Australian hand therapists in assisting their patients to return to work (RTW) are currently unknown. PURPOSE OF THE STUDY: To identify current practices, skill, and the need for additional training in management of the RTW process from a sample of Australian hand therapists. METHODS: An electronic survey was sent to current members of the Australian Hand Therapy Association. Data collected included training and/or professional experience, caseload and/or workplace, scope of and barriers to vocational practice, and satisfaction with own contribution to the RTW process for patients. RESULTS: A total of 99 individual responses (12.4% of total membership) were included, with most indicating a limited role in the RTW process. Only 52.7% said they regularly monitored and adjusted their patients' RTW program. Most plans were informed by formal tests of underlying body structure and function components rather than the patient's ability to perform of a specific work role or task. Median satisfaction with the quality of RTW service they provided was 6 of 10, with 42% scoring ≤ 5 of 10, indicating considerable scope for improvement. CONCLUSIONS: Practice patterns are described for planning and monitoring RTW, and these did not always align with the evidence-base. Further exploration of clinician barriers to implementing RTW interventions is warranted, as is upskilling for those indicating a lack of confidence in this field.

Simplifying the Volar Distraction Osteotomy for Distal Radius Malunion Repair.

Background Extra-articular fractures of the distal radius are often treated with a trial of nonoperative management if radiographic parameters are within an acceptable range, especially in the elderly population. Unfortunately, some malunions become symptomatic or become grossly misaligned during nonoperative management which require corrective surgery to restore the normal osseous anatomy and restore function. Description of Technique We describe correction of a distal radius malunion utilizing a distraction-type volar osteotomy, a volar plate specific distraction device, and a novel resorbable calcium phosphate bone cement (Trabexus) designed to withstand compressive loads. Patients and Methods Twelve patients with 13 distal radius fractures were included in this study. The average patient age was 60.9 years and average time from injury to corrective osteotomy was 96.3 days. Radiographic measures (radial inclination, volar tilt, and ulnar variance) and clinical assessment (wrist/forearm range of motion and grip strength) were done pre- and postoperatively and compared. Results The average time from corrective surgical osteotomy to final clinical follow-up was 375.8 days. After surgical intervention, there was a statistically significant improvement in mean volar tilt (-19.8 vs. +0.5 degrees) and mean ulnar variance (+2.8 vs. -0.4 mm). Improvements were also seen in grip strength (1.7 vs. 43.6 lb), wrist flexion (30.5 vs. 48.3 degrees), wrist extension (33.3 vs. 53.8 degrees), forearm pronation (75.0 vs. 88.8 degrees), and forearm supination (53.8 vs. 81.3 degrees). On average, 56.0% of Trabexus bone substitute remained on final clinical radiographs. Conclusion This simplified technique of distraction corrective osteotomy after distal radius malunion results in improved clinical and radiographic outcomes for patients.

'Learning in and out of lockdown': A comparison of two groups of undergraduate occupational therapy students' engagement in online-only and blended education approaches during the COVID-19 pandemic.

INTRODUCTION: In many countries, the COVID-19 pandemic resulted in sudden changes to the delivery of health professions education in response to local and national lockdowns. Within occupational therapy, university education programs traditionally delivered in face-to-face classroom, and clinical settings, the transition to online learning presented unique issues and challenges for faculty and students. This study compared the experiences and perceptions of learning in two groups of occupational therapy students during the pandemic: one group converted to online learning only and the other had a blended approach that combined face-to-face on-campus learning with some online lecture content delivery. METHODS: Two hundred and eight (n = 208) undergraduate occupational therapy students from three Australian universities completed an online self-report demographic questionnaire and two standardised instruments: the Student Engagement in the e-Learning Environment Scale and the Distance Education Learning Environment Scale. An independent-samples t test with bootstrapping was completed to examine differences in students' scores. RESULTS: Statistically significant differences were observed between the online and blended learning groups across a range of the SELES and DELES subscales. The strongest findings related to psychological motivation (p = 0.001), personal relevance (p = 0.001), interactions with instructors (p = 0.002), instructor support (p = 0.001), student interaction & collaboration (p = 0.001), and cognitive problem solving (p = 0.001). CONCLUSION: Occupational therapy students who transitioned to online-only learning experienced higher levels of motivation, interactions with instructors and peers, and self-directed learning than students who experienced a blended education delivery approach of face-to-face and online learning. The findings extend educators' understanding of the matrix of factors that have impacted students' education during COVID-19 and support the development of contemporary and pedagogically sound online and traditional modes of occupational therapy instruction. The results provide evidence of the importance of well-structured programs that facilitate active and flexible learning, provide meaningful and positive experiences, and promote initiatives safeguarding social and personal well-being. Further research in this area is recommended.

Is massage an effective intervention in the management of post-operative scarring? A scoping review.

BACKGROUND: Scar massage is a widely used treatment modality in hand therapy. This intervention is thoroughly discussed in the literature relating to burns rehabilitation, however, the evidence for its use in treating linear scars following surgery is limited. PURPOSE OF STUDY: To collate the empirical literature on scar massage for the treatment of postsurgical cutaneous scars. STUDY DESIGN: Scoping review. METHODS: Medline, EMBASE, CINAHL, AMED, Scopus, ProQuest Dissertations & Theses Global, and the Joanna Briggs Institute were searched from inception to December 2020. Two researchers used a data extraction tool to record key demographic, intervention and outcome data, and to apply the Oxford Levels of Evidence for each study. RESULTS: Twenty-five studies met the inclusion criteria, reporting on a combined sample of 1515 participants. Only two papers addressed hand or wrist scars (92 participants). While all studies reported favorable outcomes for scar massage, there were 45 different outcome measures used and a propensity towards non-standardized assessment. Intervention protocols varied from a single session to three treatments daily for 6 months. The results from 13 studies were confounded by the implementation of additional rehabilitation interventions. CONCLUSIONS: The overall findings suggest that while there may be benefits to scar massage in reducing pain, increasing movement and improving scar characteristics; there is a lack of consistent research methods, intervention protocols and outcome measures. This scoping review highlights the heterogenous nature of research into scar massage following surgery and supports the need for further research to substantiate its use in the clinical setting.

Headless Compression Screw Fixation for Proximal Phalanx Fractures: A Biomechanical Study.

Background: Proximal phalanx fractures are common injuries of the hand with multiple treatment options. Intramedullary (IM) screw fixation has become more widely used, and early outcomes are promising. However, biomechanical data regarding this type of fixation are sparse. Methods: Two methods of IM screw fixation of proximal phalanx fractures were tested in cadaver specimens. All specimens were treated with a single antegrade headless compression screw, with half getting the addition of a blocking screw. To test the most common deforming force of flexion-extension, each phalanx was subjected to apex volar 3-point bending using the Materials Testing System test frame. Results: There was no significant difference in the stiffness of 3-point bending with single antegrade screws alone and with a blocking screw (mean, 63.1 vs 52.2 N/mm; P = .27). When comparing smaller with larger specimens, stiffness of the small group was significantly greater than that of the large group when both fixation methods were included (85.3 vs 30.1 N/mm; P < .0002). When comparing stiffness with percent fill of the screw within bone, there was a moderately positive correlation (0.51). Conclusions: Addition of a blocking screw did not increase the stability of the IM screw fixation construct for proximal phalanx fractures. When comparing specimen size, the smaller bones were stiffer under 3-point bending load, regardless of the type of fixation. In addition, those specimens that had a larger longitudinal screw length to bone length ratio were stiffer. These findings provide valuable information as techniques for IM screw fixation of proximal phalanx fractures continue to evolve.

Young carers and educational engagement: Quantitative analysis of bursary applications in Australia.

Young carers support family members affected by disability or a health condition. The Young Carer Bursary Program aims to support young carers' education. This paper analysed data from consenting bursary applicants (2017-2019) to investigate relationships between wellbeing, educational attendance, home study and other factors. Descriptive statistics, correlation and regression analysis determined significant issues, relationships and influential factors related to young carer (N = 1,443) wellbeing and education. Sixty-eight percent were aged between 13 and 18 years and attended secondary school. One third of the sample reported that they were the main carer in their family and 29% reported receiving no support. Female applicants from single parent households who were the main carer attended educational settings less often. Eighteen percent (n = 267) rated their wellbeing as poor/very poor. Better wellbeing was associated with increased educational attendance (rs  = 0.33, p < 0.001) and home study (rs  = 0.34, p < 0.001). Wellbeing was associated with main carer status, caring for a parent, having a disability, being older and having few supports. Educational attendance was associated with main carer status, higher care load and fewer supports. Home study was associated with having a disability, caring for a sibling, caring for more than 11 hr per week and having fewer supports. Important factors about the age, life situation and challenges experienced by young carers identified in this paper indicate that further research into preferred supports and effectiveness of the bursary in improving educational engagement is warranted.

Use of the Antegrade Posterior Interosseous Artery Flap for Coverage of Complex Elbow Wounds.

SUMMARY: One of the most versatile soft-tissue flaps available for elbow coverage that is reliable, quick, and easy to perform, with minimal donor defect and without the sacrifice of a major blood vessel, is the antegrade posterior interosseous artery flap. A large amount of vascularized fascia can be dissected with the flap, and it can be useful in lining the elbow joint or any exposed implant(s). After flap harvest, the donor site is often amenable to primary closure or requires a simple skin graft for closure. This article explains the technique for harvesting an antegrade posterior interosseous artery flap and describes 10 cases in which the flap was used for complex soft-tissue defects of the elbow not amenable to local wound care or skin grafting.

Cost, profile, and postoperative resource use for surgically managed acute hand and wrist injuries with emergency department presentation.

STUDY DESIGN: Retrospective cost-of-illness study. INTRODUCTION: Injuries to the hand and wrist are common. Most uncomplicated and stable upper extremity injuries recover with conservative management; however, some require surgical intervention. The economic burden on the health care system from such injuries can be considerable. PURPOSE OF THE STUDY: To estimate the economic implications of surgically managed acute hand and wrist injuries at one urban health care network. METHODS: Using 33 primary diagnosis ICD-10 codes involving the hand and wrist, 453 consecutive patients from 2014 to 2015 electronic billing records who attended the study setting emergency department and received consequent surgical intervention and outpatient follow-up were identified. Electronic medical records were reviewed to extract demographic data. Costs were calculated from resource use in the emergency department, inpatient, and outpatient settings. Results are presented by demographics, injury type, mechanism of injury, and patient pathway. RESULTS: Two hundred and twenty-six individuals (n 1/4 264 surgeries) were included. The total cost of all injuries was $1,204,606. The median cost per injury for non-compensable cases (n = 191) was $4508 [IQR $3993-$6172] and $5057 [IQR $3957-$6730] for compensable cases (n = 35). The median number of postoperative appointments with a surgeon was 2.00 (IQR 1.00-3.00) for both compensable and non-compensable cases. The number of hand therapy appointments for non-compensable cases and compensable cases was 4 [IQR 2-6] and 2 [IQR 1-3], respectively. DISCUSSION: Findings of this investigation highlight opportunities for health promotion strategies for reducing avoidable injuries and present considerations for reducing cost burden by addressing high fail to attend (FTA) appointment rates. CONCLUSION: Surgically managed hand and wrist injuries contribute to a significant financial burden on the health care system. Further research using stringent data collection methods are required to establish epidemiological data and national estimates of cost burden.