Establishing the Patient-Acceptable Symptom State for the Numeric Rating Scale-Pain Score in a Postoperative Non-Shoulder Hand and Upper-Extremity Population.

Purpose: The patient-acceptable symptom state (PASS) is a threshold score on a patient-reported outcome measurement beyond which patients consider themselves "well." Our purpose was to establish the PASS for the numeric rating scale (NRS) for pain in a 1-year postoperative hand surgery population.

Methods: This retrospective study included adult patients undergoing non-shoulder upper-extremity surgery at a single, tertiary medical center identified over a 9-month period.

Universal Design in Education (UDE) Across the Life Course: Applying a Systems Framework to Create an Inclusive Experience for All.

The UN Convention on the Rights of Persons with Disabilities (UNCRPD) promotes the realisation of the right of persons with disabilities to education through Article 24 - Education. Universal Design in Education (UDE) fosters a whole systems approach so that the physical and digital environments, the educational services, and the teaching and learning can be easily accessed, understood and used, by the widest range of learners and by all key stakeholders, in a more inclusive environment. The whole systems approach incorporates the entire educational environment, as well as the recognition of the capacity for all learners (including persons with disabilities) to learn, and environments which are fully accessible and inclusive.

Double and Single True Knot of an Umbilical Cord: A Case Report.

The primary function of the umbilical cord is to transport blood to and from the fetus. It carries deoxygenated blood away from the fetus by two umbilical arteries, and oxygenated blood from the placenta toward the fetus by an umbilical vein. In some cases, the umbilical cord can form a true knot increasing the risk of asphyxia and fetal demise.

Establishing the Patient Acceptable Symptom State in a Nonshoulder Hand and Upper Extremity Population for the QuickDASH and PROMIS UE Computer Adaptive Tests.

Purpose: It is unclear what score thresholds on patient-reported outcomes instruments reflect an acceptable level of upper extremity (UE) function from the perspective of patients undergoing hand surgery. The purpose of this study was to calculate the patient acceptable symptom state (PASS) for the Disabilities of the Arm, Shoulder, and Hand (QuickDASH) and Patient-Reported Outcomes Measurement Information System (PROMIS) UE Computer Adaptive Test (CAT), version 2.0, in a population who underwent hand surgery.

Establishing the Minimal Clinically Important Difference and Substantial Clinical Benefit for the Pain Visual Analog Scale in a Postoperative Hand Surgery Population.

Purpose: Although the pain visual analog scale (VAS-pain) is a ubiquitous patient-reported outcome instrument, it remains unclear how to interpret changes or differences in scores. Therefore, our purpose was to calculate the minimal clinically important difference (MCID) and substantial clinical benefit (SCB) for the VAS-pain instrument in a nonshoulder hand and upper extremity postoperative population.

Methods: Adult postoperative patients treated by 1 of 5 fellowship-trained orthopedic hand surgeons at a single tertiary academic medical center were identified.

Establishing the Substantial Clinical Benefit in a Non-Shoulder Hand and Upper Extremity Population for the QuickDASH and PROMIS Upper Extremity and Physical Function Computer Adaptive Tests.

Purpose: It is unclear what score changes on the abbreviated Disabilities of the Arm, Hand, and Shoulder (QuickDASH), Patient-Reported Outcomes Measurement Information System (PROMIS) upper extremity (UE) computer adaptive test (CAT), and PROMIS physical function (PF) CAT represent a substantial improvement. We calculated the substantial clinical benefit (SCB) for these 3 instruments in a non-shoulder hand and upper extremity population.

Methods: Adult patients treated between March 2015 and September 2019 at a single academic tertiary institution were identified.

Recurrent Carpal Tunnel Syndrome Associated with Mycobacterium szulgai Infection: A Case Report.

Case: We present the case of an otherwise healthy 77-year-old male retired firefighter and recreational pheasant hunter who presented with recurrent symptoms of carpal tunnel syndrome and tenosynovitis because of Mycobacterium szulgai. He was initially treated unsuccessfully for a presumed seronegative rheumatologic flare, followed by surgical diagnosis and treatment including revision carpal tunnel release with tenosynovectomy, and a secondary debridement and wound closure. His symptoms resolved after several months of multidrug antibiotic therapy with only mild residual median nerve deficit.

The "Y" Double Spiral Cord: An Anatomic Variant of Dupuytren Disease: A Report of 2 Cases.

Case: We report 2 cases of a spiral nerve variant that has only 1 previously reported description in the literature. A pretendinous cord was found to branch into a "Y" configuration, extending distally on both the radial and ulnar sides of the same digit, with the radial and ulnar digital nerves spiraling around each limb of the "Y cord".

Conclusion: Rare spiral nerve variants exist which place the digital neurovascular bundles (NVBs) at risk.

Impinging exostoses of the proximal radius: a report of two cases with distinct clinical features.

Owing to the rotatory motion of proximal radius and the closely apposed anatomic structures, cortically based osseous lesions at the level of the proximal forearm may produce symptomatic impingement. While osseous impingement onto the adjacent proximal ulna may result in limited forearm rotation, impingement on the surrounding soft-tissue structures may produce symptoms as well. Here, we describe two cases of symptomatic proximal radius exostosis, each of which produced distinct clinical symptoms.

Regional differences between superficial and deep lumbar multifidus in patients with chronic lumbar spine pathology.

Background: Due to its unique arrangement, the deep and superficial fibers of the multifidus may have differential roles for maintaining spine stabilization and lumbar posture; the superficial multifidus is responsible for lumbar extension and the deep multifidus for intersegmental stability. In patients with chronic lumbar spine pathology, muscle activation patterns have been shown to be attenuated or delayed in the deep, but not superficial, multifidus. This has been interpreted as pain differentially influencing the deep region.

Corrigendum: Surgical Rates for Crohn's Disease Are Decreasing: A Population-Based Time Trend Analysis and Validation Study.

This corrects the article DOI: 10.1038/ajg.2017.

Surgical Rates for Crohn's Disease are Decreasing: A Population-Based Time Trend Analysis and Validation Study.

Objectives: Temporal changes for intestinal resections for Crohn's disease (CD) are controversial. We validated administrative database codes for CD diagnosis and surgery in hospitalized patients and then evaluated temporal trends in CD surgical resection rates.

Methods: First, we validated International Classification of Disease (ICD)-10-CM coding for CD diagnosis in hospitalized patients and Canadian Classification of Health Intervention coding for surgical resections.

Universal Design Across the Curriculum: Training for Students and Teachers.

Providing an inclusive educational setting for children with disabilities is essential if they are to truly benefit from mainstream education. Universal design (UD) provides a framework to develop our classrooms, materials and methods to accommodate diverse learners and students with special educational needs without the need to retrofit or remove the student from the classroom. This paper outlines the theory and the approach of two training courses on Universal Design developed for teachers and students.

Clinical Predictors of the Risk of Early Colectomy in Ulcerative Colitis: A Population-based Study.

Background: A subset of patients with ulcerative colitis (UC) will require colectomy within a few years of diagnosis. Thus, our aim was to determine the clinical predictors of early colectomy among patients with UC who are hospitalized with an acute flare.

Methods: Using population-based surveillance (1996-2009), all adults (≥18 years) hospitalized for UC within 3 years of diagnosis (n = 489) were identified.

Lumbar multifidus muscle degenerates in individuals with chronic degenerative lumbar spine pathology.

Histological and cell-level changes in the lumbar musculature in individuals with chronic lumbar spine degenerative conditions are not well characterized. Although prior literature supports evidence of changes in fiber type and size, little information exists describing the tissue quality and biology of pathological features of muscle in this population. The purpose of this study was to quantify multifidus tissue composition and structure, inflammation, vascularity, and degeneration in individuals with chronic degenerative lumbar spine pathology.

Clinical prediction rule to determine the need for repeat ERCP after endoscopic treatment of postsurgical bile leaks.

Background And Aims: In patients who have undergone ERCP with biliary stenting for postsurgical bile leaks, the optimal method (ERCP or gastroscopy) and timing of stent removal is controversial. We developed a clinical prediction rule to identify cases in which a repeat ERCP is unnecessary.

Methods: Population-based study of all patients who underwent ERCP for management of surgically induced bile leaks between 2000 and 2012.

Contribution of Lumbar Spine Pathology and Age to Paraspinal Muscle Size and Fatty Infiltration.

Study Design: Retrospective chart analysis of 199 individuals aged 18 to 80 years scheduled for lumbar spine surgery.

Objective: The purpose of this study was to quantify changes in muscle cross-sectional area (CSA) and fat signal fraction (FSF) with age in men and women with lumbar spine pathology and compare them to published normative data.

Summary Of Background Data: Pathological changes in lumbar paraspinal muscle are often confounded by age-related decline in muscle size (CSA) and quality (fatty infiltration).

Smoking Is Associated with an Increased Risk for Surgery in Diverticulitis: A Case Control Study.

Importance: Cigarette smoking increases the risk of surgery in Crohn's disease. However, the effect of smoking on the need for surgery for diverticulitis is unknown.

Objective: We evaluated whether smoking was a risk factor for surgery among patients admitted to hospital with acute diverticulitis.

Analytical model and stability analysis of the leading edge spar of a passively morphing ornithopter wing.

This paper presents the stability analysis of the leading edge spar of a flapping wing unmanned air vehicle with a compliant spine inserted in it. The compliant spine is a mechanism that was designed to be flexible during the upstroke and stiff during the downstroke. Inserting a variable stiffness mechanism into the leading edge spar affects its structural stability.

MRI Findings Associated with Recalled Modular Femoral Neck Rejuvenate and ABG Implants.

MARS-MRI is suggested for the diagnosis of adverse local tissue reactions (ALTR) in patients with recalled femoral stems with modular necks, but there has been no major study looking at MARS-MRI findings in this population. A retrospective review was performed on 312 patients who received a modular neck hip implant between October 2007 and February 2012. 62% of patients had intra-articular effusions, with 27% containing debris.

Ulcerative colitis-associated hospitalization costs: a population-based study.

Background: Hospitalization costs for ulcerative colitis (UC) following the introduction of infliximab have not been evaluated.

Objective: To study predictors of costs for UC patients who were hospitalized for a flare or colectomy.

Methods: Population-based surveillance identified adults (≥18 years of age) admitted to hospital for UC flare or colectomy between 2001 and 2009 in the Calgary Health Zone (Alberta).

Colectomy is a risk factor for venous thromboembolism in ulcerative colitis.

Aim: To compare venous thromboembolism (VTE) in hospitalized ulcerative colitis (UC) patients who respond to medical management to patients requiring colectomy.

Methods: Population-based surveillance from 1997 to 2009 was used to identify all adults admitted to hospital for a flare of UC and those patients who underwent colectomy. All medical charts were reviewed to confirm the diagnosis and extract clinically relevant information.