Feasibility pilot of a novel coaching intervention to optimize cannabis use for chronic pain management among Veterans.

Introduction: Chronic pain is common among Veterans, some of whom use cannabis for pain. We conducted a feasibility pilot study of a novel coaching intervention to help Veterans optimize use of medical cannabis products for pain management (NCT06320470).

Methods: The intervention drew from scientific literature, consultation with cannabis experts, Veteran input via a Community Advisory Board, and tenets of motivational interviewing.

Developing plant functional groups to identify changes in functional composition and diversity in a dryland river experiencing artificially sustained flows.

Land use and climate changes are driving significant shifts in the magnitude and persistence of dryland stream surface flows. The impact of these shifts on ecological functioning is largely unknown, particularly where streams have become wetter rather than drier. This study investigated relationships between hydrologic regime (including surface water persistence, differences in groundwater depth and altered flooding dynamics) with plant traits and riverine vegetation functional composition.

Surgery for cerebral palsy part 3: classification and operative procedures for thumb deformity.

Spastic thumb deformity is the result of imbalance between intrinsic and extrinsic forces acting across unstable joints. This paper presents a classification of spastic thumb deformity based on the accurate assessment of the deforming forces, outlines methods for their correction and reviews the results of our surgery. Thumb reconstruction procedures were performed in 32 patients with 33 spastic thumb deformities.

The surgical treatment of brachial plexus injuries.

Background: Brachial plexus injuries cause a devastating loss of function in the arm. The aim of this study was to review the results of surgical treatment of patients with brachial plexus injuries.

Methods: Forty-seven patients were reviewed.

Unrecognised arterial injury of the forearm: a secondary bleed presenting as acute compartment syndrome.

This case describes an arterial injury that remained unrecognised for 3 days, when a sudden secondary bleed caused acute compartment syndrome of the forearm. We have been unable to find another case of compartment syndrome presenting in this manner. The importance of thorough wound exploration is highlighted and the diagnosis and treatment of the syndrome discussed.

Glove punctures in an orthopaedic trauma unit.

A series of 421 operations in an orthopaedic trauma unit have been studied for glove punctures; 37.5 per cent of operations had a puncture demonstrated in the surgeon's gloves. The procedures at a high risk of glove punctures were hip operations (57 per cent) and internal fixation (54 per cent).

Prospective scenarios: a method of evaluating new decision tools.

Prospective randomized controlled trials are rarely suitable for the evaluation of new decision making techniques. An approach is described in which a cohort of patients is taken down the usual study pathway to the point at which the new technique would be used. Conventional decision rules are then applied and the results recorded.

Laparoscopy as an adjunct to decision making in the 'acute abdomen'.

When patients are admitted to hospital with acute abdominal pain, clinicians, irrespective of a specific diagnosis, intuitively select three diagnostic classes: operation definitely required (Group A); operation definitely not required (Group B); need for operation uncertain (Group C). The last is followed either by a precautionary laparotomy or a variable period of observation/investigation. We have studied prospectively the influence of laparoscopy on the distribution between these classes and particularly on outcome in group C.