A Prospective, Double-Blind Evaluation of Anterior Cruciate Ligament Reconstruction With Tibialis Tendon Allograft: Donor Age Does Not Alter Outcomes.

Purpose: To evaluate the effect of graft donor age on outcomes of anterior cruciate ligament (ACL) reconstruction with nonirradiated, fresh-frozen tibialis tendon allografts. Methods: This prospective, randomized, double-blind, single surgeon, 2-year follow-up study enrolled 40 patients (28 female, 12 male who underwent ACL reconstruction with tibialis tendon allografts. Results were compared with historical outcomes for allografts from donors aged 18 to 70 years. Analysis was determined by Group A (<50 years) and Group B (>50 years). Objective and subjective International Knee Documentation Committee (IKDC) forms, KT-1000 testing, and Lysholm scores were used for the evaluation. Results: Follow-up on average of 24 months was completed in 37 patients (92.5%; Group A = 17, Group B = 20). Average patient age at surgery for Group A was 42.1 years (range 27-54) and Group B was 41.7 years (range 24-56). None of the patients required additional surgery during the initial 2-year follow-up. At 2-year follow-up, there were no significant differences in subjective outcomes. IKDC objective ratings for Group A were A-15 and B-2, and Group B were A-19 and B-1 (P = .45). Average IKDC subjective scores for Group A were 86.1 (± 16.2) and Group B were 84.1 (± 15.6) (P = .70). KT-1000 side to side differences for Group A were 0-4, 1-10, and 2-2, and Group B were 0-2, 1-10, 2-6 (P = .28). Average Lysholm scores for Group A were 91.4 (± 16.7) and Group B were 88.1 (± 12.3) (P = .49). Conclusions: Donor age was not associated with clinical outcomes after ACL reconstruction using nonirradiated, fresh-frozen tibialis tendon allografts. Level of Evidence: II, prospective prognostic trial.

Cross-sectional study to examine evidence-based practice skills and behaviors of physical therapy graduates: is there a knowledge-to-practice gap?

BACKGROUND: Curricula changes in physical therapist education programs in Canada emphasize evidence-based practice skills, including literature retrieval and evaluation. Do graduates use these skills in practice? OBJECTIVES: The aim of this study was to evaluate the use of research information in the clinical decision making of therapists with different years of experience and evidence-based practice preparation. Perceptions about evidence-based practice were explored qualitatively. DESIGN: A cross-sectional study with 4 graduating cohorts was conducted. METHODS: Eighty physical therapists representing 4 different graduating cohorts participated in interviews focused on 2 clinical scenarios. Participants had varying years of clinical experience (range=1-15 years) and academic knowledge of evidence-based practice skills. Therapists discussed the effectiveness of interventions related to the scenarios and identified the sources of information used to reach decisions. Participants also answered general questions related to evidence-based practice knowledge. RESULTS: Recent graduates demonstrated better knowledge of evidence-based practice skills compared with therapists with 6 to 15 years of clinical experience. However, all groups used clinical experience most frequently as their source of information for clinical decisions. Research evidence was infrequently included in decision making. LIMITATIONS: This study used a convenience sample of therapists who agreed to volunteer for the study. CONCLUSIONS: The results suggest a knowledge-to-practice gap; graduates are not using the new skills to inform their practice. Tailoring academic evidence-based activities more to the time constraints of clinical practice may help students to be more successful in applying evidence in practice. Academic programs need to do more to create and nurture environments in both academic and clinical settings to ensure students practice using evidence-based practice skills across settings.

Improved detection of developmental delays among young children in foster care.

OBJECTIVE: Our goal was to determine if systematic use of a validated developmental screening instrument is feasible and improves the detection of developmental delay (DD) in a pediatric medical home for children in foster care. DESIGN AND METHODS: This study had a pre-post study design, following a practice intervention to screen all children in foster care for DD by using the Ages and Stages Questionnaire (ASQ). The baseline detection rate was determined by medical chart review for all children aged 4 to 61 months who were new to foster care (NFC) during a 2-year period. After implementation of systematic screening, caregivers of young children who were NFC or already in foster care (IFC) completed the ASQ at preventive health care visits. We assessed the feasibility of systematic screening (the percentage of ASQs completed among the NFC and IFC groups). We compared the detection of DD among the baseline NFC group and the screening-NFC group by using bivariate and multivariable logistic regression. RESULTS: Of 261 visits that occurred after initiation of screening, 251 (96%) visits had a completed ASQ form in the medical chart, demonstrating high feasibility. Among children who were NFC, the detection of DD was higher in the screening than baseline period for the entire population (58% vs 29%; P < .001), for each age group (infants: 37% vs 14%; toddlers: 89% vs 42%; preschool: 82% vs 44%; all P < or = .01), and for all developmental domains. On adjusted analyses, the detection of potential DD in toddler and preschool children was higher among the NFC screening group than the NFC baseline group. CONCLUSION: Systematic screening for DD using the ASQ was feasible and seemed to double the detection of DDs.

Tacrolimus ointment: utilization patterns in children under age 2 years.

Atopic dermatitis (AD) is a common eczematous skin condition; as many as 10-17 percent of all children are affected, and 35-60 percent of affected patients manifest symptoms manifest during the first year of life. Treatment principles for AD in young children involve conservative measures such as avoidance of hot water and environmental irritants, combined with liberal use of emollients after bathing. Low potency topical corticosteroids (TCS) are the current standard of therapy for AD in young children, reserving mid- and high-potency TCS for severe disease. However, complications of long-term use of TCS include skin atrophy, stria formation, telangiectasia, hypopigmentation, secondary infections, steroid acne, allergic contact dermatitis, and miliaria. The pediatric population is also at increased risk for systemic absorption because of their high ratio of skin surface to body mass. Systemic absorption may result in hypothalamic-pituitary-adrenal axis suppression and ultimately growth retardation. Although most topical and systemic corticosteroids are not approved by the Food and Drug Administration for use in children less than 2 years of age, conservative treatment often fails in this age group and frequently patients are treated with TCS, antibiotics, and antihistamines.

Keratosis pilaris in pregnancy: an unrecognized dematosis of pregnancy?

Keratosis pilaris (KP) is a common hyperkeratotic condition that most commonly presents as skin-colored follicular papules surrounded by erythema. These lesions often appear grouped together on the lateral aspect of the arms, thighs, and buttocks. Although the etiology of KP is uncertain, it is thought to be the result of the formation of an orthokeratotic plug, which blocks and dilates the orifice and upper portion of the follicular infundibulum (Figure 1). Histologically, mild perivascular mononuclear cell infiltrates are usually present in the adjacent dermis. Studies have indicated a role for hormonal influences in the development of KP. The five cases presented in this study demonstrate keratosis pilaris as a condition in which the onset or severity of the dermatosis may be linked to the hormonal changes of pregnancy.