Prescription medication use by emergency department doctors to improve work and academic performance, and to manage stress and anxiety.

OBJECTIVE: To determine medications used by ED doctors to improve work and academic performance, and to manage stress and anxiety. METHODS: We undertook an online, voluntary, anonymous survey of ACEM fellows and trainees. RESULTS: One hundred and thirty-nine (46.5%) respondents used a medication under examination. Sleep aids included melatonin (19.1% of respondents) and benzodiazepines (8.7%). Medications to improve performance included modafinil (4.7%), pseudoephedrine (2.0%), melatonin (2.0%) and beta blockers (1.3%). Some medications were taken prior to shifts. Medications to manage stress and anxiety included benzodiazepines (3.0%) and beta blockers (2.0%). CONCLUSION: Medication use is common and support for some doctors may be required.

Randomized comparison of tape versus semi-rigid and versus lace-up ankle support in the treatment of acute lateral ankle ligament injury.

PURPOSE: Functional treatment is the optimal non-surgical treatment for acute lateral ankle ligament injury (ALALI) in favour of immobilization treatment. There is no single most effective functional treatment (tape, semi-rigid brace or lace-up brace) based on currently available randomized trials. METHODS: This study is designed as a randomized controlled trial to evaluate the difference in functional outcome after treatment with tape versus semi-rigid versus lace-up ankle support (brace) for grades II and III ALALIs. The Karlsson score and the FAOS were evaluated at 6-month follow-up. RESULTS: One hundred and ninety-three patients (52% males) were randomized, 66 patients were treated with tape, 58 patients with a semi-rigid brace and 62 patients with a lace-up brace. There were no significant differences in any baseline characteristics between the three groups. Mean age of the patients was 37.3 years (35.1-39.5; SD 15.3). Ninety-five males (49%) were included. One hundred and sixty-one (59 + 50 + 52) patients completed the study through final follow-up; 32% lost at follow-up. In two patients treated with tape support, the treatment was changed to a semi-rigid brace because of dermatomal blisters. Except for the difference in Foot and Ankle Outcome Score sport between the lace-up and the semi-rigid brace, there are no differences in any of the outcomes after 6-month follow-up. CONCLUSION: The most important finding of current study was that there is no difference in outcome 6 months after treatment with tape, semi-rigid brace and a lace-up brace. LEVEL OF EVIDENCE: I.

Mid-term (2-8 years) follow-up of open reduction and internal fixation of patella fractures: does the surgical technique influence the outcome?

OBJECTIVE: The objective of the study was to evaluate the clinical and radiological results of internal fixation of patella fractures, comparing tension band wiring techniques with proximal only and proximally and distally bend Kirschner wires (K-wires). METHODS: Over a period of 6 years, 60 patients met the criteria to be included in this study of which 40 were available for mid-term (2-8 years) clinical and radiological follow-up. RESULTS: Out of 60, 9 failures of fixation occurred, 3 due to migration of the K-wires and 6 because of insufficient tensioning of the tension band. Failure due to migration, only occurred in the group with the proximally bend only K-wire technique. CONCLUSION: Our recommendation is to distally bend the K-wires as well as proximally to prevent migration of K-wires.