Improving prescribing learning in problem-based learning.

Background: Prescribing errors are known to occur in clinical practice. To ensure prescribing competence, foundation doctors in the United Kingdom now need to pass a national Prescribing Safety Assessment (PSA). Medical students are requesting more prescribing learning.

Serial Range of Motion and Grip Strength Measurements, Patient-Reported Outcomes, and Radiographic Thresholds Associated With Less Satisfactory Outcomes After Low-Energy Distal Radius Fracture in Women Aged 50 Years and Older.

Purpose: To document the change of clinical (wrist motion and grip strength) measurements and Patient-Rated Wrist Evaluation (PRWE) scores at 9 weeks and 3, 6, and 12 months after distal radius fracture (DRF) in women 50 years and older with exclusively isolated, displaced, and low-energy DRFs treated by either closed and/or open reduction and to relate these outcomes to their radiographic results.

Methods: In this retrospective single-institution cohort study, patients' post-DRF clinical measurements and PRWE scores were prospectively collected from December 2007 through September 2018 and stratified according to their final radiographic values of volar/dorsal tilt, ulnar variance, and radial inclination.

Results: Of the 1,319 women identified, 1,126 (85%) were treated nonsurgically, and 193 (15%) were treated operatively.

Does Addition of a Longer Acting Local Anesthetic Improve Postoperative Pain After Carpal Tunnel Release? A Randomized Controlled Trial.

Purpose: Carpal tunnel release (CTR) is a simple and effective treatment for carpal tunnel syndrome in patients who have failed nonsurgical management. This surgery is often performed in the ambulatory clinic under local anesthesia, with lidocaine, a short-acting agent. Few studies have investigated the use of longer acting agents, such as bupivacaine, for outpatient CTR.

Coronal translation of the forearm, proximal capitate, and ulnar styloid predict radial inclination in distal radius fractures in older female patients.

Aims: The aims of this study were to identify means to quantify coronal plane displacement associated with distal radius fractures (DRFs), and to understand their relationship to radial inclination (RI).

Methods: From posteroanterior digital radiographs of healed DRFs in 398 female patients aged 70 years or older, and 32 unfractured control wrists, the relationships of RI, quantifiably, to four linear measurements made perpendicular to reference distal radial shaft (DRS) and ulnar shaft (DUS) axes were analyzed: 1) DRS to radial aspect of ulnar head (DRS-U); 2) DUS to volar-ulnar corner of distal radius (DUS-R); 3) DRS to proximal capitate (DRS-PC); and 4) DRS to DUS (interaxis distance, IAD); and, qualitatively, to the distal ulnar fracture, and its intersection with the DUS axis.

Results: In the study (fracture) and control groups, respectively, the mean values were: RI, 17.

Empowering future pharmacists - Embedding prescribing in the United Kingdom pharmacy undergraduate degree.

Introduction: Pharmacy education within the United Kingdom (UK) is on the cusp of a major change with the integration of pharmacist independent prescribing into the undergraduate Master of Pharmacy (MPharm) degree and foundation year. This presents an opportunity for schools of pharmacy to completely review and redesign the MPharm degree in order to embed prescribing. This commentary details what needs to change within the MPharm degree and how these changes can be enacted.

Correlation between superior humeral head migration and proximal long head of biceps tendon pathology in patients with and without rotator cuff tears using magnetic resonance imaging and radiography.

Background: The biomechanical role of the proximal long head of the biceps tendon (PLHB) in glenohumeral joint stability remains controversial. This retrospective study aims to correlate between humeral head migration and PLHB pathology in patients with and without rotator cuff tendon tears using imaging.

Methods: Seventy-nine patients who underwent 3T magnetic resonance imaging of the shoulder were retrospectively reviewed.

Cannabis use patterns among patients with upper extremity conditions at the time of legalization in Canada.

Background: Recreational cannabis use was legalized in Canada in 2018. Cannabis use patterns and patient attitudes toward cannabis use, particularly in the context of these legal changes, are not well understood. Our aim was to evaluate baseline cannabis use patterns and attitudes at the time of legalization among patients with upper extremity conditions in Canada.

The Effects of Patient Resilience and Catastrophizing on Carpal Tunnel Surgical Outcomes.

Purpose: Outcomes following carpal tunnel release (CTR) are generally favorable. When patient satisfaction or symptom resolution is not as expected, understanding what factors contribute to that outcome could allow for strategies targeted at improving results. Our purpose was to determine if measurable mental health factors, specifically resilience and pain catastrophization, correlate with patients' postoperative outcomes following CTR.

Magnitude, Direction, Temporal Patterns, and Frequency of Loss of Distal Radius Fracture Reduction in Women 50 Years and Older.

Purpose: To determine the magnitude, direction, temporal patterns, and frequency of reduction loss following nonsurgical, closed treatment of distal radius fractures in women 50 years and older and correlate these observations with bone mineral density and age.

Methods: We reviewed registry data on 1,148 patients 50 years and older with distal radius fractures managed by closed reduction and cast immobilization. Radial inclination (RI), ulnar variance (UV), and radial tilt (RT) were measured immediately and at 1, 2, 3, 6, 9, and 12 weeks after reduction.

Coracoclavicular bursal changes on MRI: a diagnostic consideration in patients with shoulder pain and reduced coracoclavicular distance.

Objective: To describe MRI changes of the coracoclavicular bursa in patients presenting with shoulder pain and examine whether there is an association with coracoclavicular distance measurements.

Methods: Retrospective analysis of 198 shoulder 3T MRI scans for patients with shoulder pain was performed. Two musculoskeletal trained radiologists read all MRI scans.

Upper Extremity Injuries in Rock Climbers: Diagnosis and Management.

Rock climbing places substantial stress on the upper extremities and can lead to unique injuries not common to other sports. With increasing popularity of the sport, hand surgeons are expected to see more patients with these pathologies. An understanding of the sport, accurate diagnoses, and appropriate treatment protocols are critical to maintain climbers' competitive abilities.

The Unsalvageable Radial Head in Patients Aged 30 Years and Younger.

Purpose: Concern exists regarding the use of radial head arthroplasty (RHA) in younger patients. This study assessed clinical, functional, and radiographic outcomes of RHA in patients aged 30 years and younger.

Methods: A retrospective review identified 26 elbows that underwent a smooth stem modular RHA in patients aged 30 years and younger at a median follow-up of 3.

Four-Corner Arthrodesis With Differing Methods of Osteosynthesis: A Systematic Review.

Purpose: The purpose of this study was to compare the union rates and clinical outcomes of 4-corner arthrodesis with different methods of osteosynthesis.

Methods: A systematic review of studies published in Ovid, Medline, Embase, and PubMed was conducted. Primary studies that reported clinical and radiographic results following 4-corner arthrodesis for scapholunate advanced collapse (SLAC), scaphoid nonunion advanced collapse (SNAC), or other types of wrist arthritis in human subjects were eligible.

The Effect of Personalized Patient Videos on Patient Satisfaction After Arthroscopic Shoulder Surgery.

Dissatisfaction after shoulder arthroscopy may be influenced by the information that patients receive. Multimedia is an emerging modality of information delivery. The goal of this study was to evaluate whether providing patients with a personalized video of their arthroscopic shoulder surgery improved satisfaction through a multisurgeon randomized controlled study.

Outcomes of nonoperative management of displaced olecranon fractures in medically unwell patients.

Background: Surgical treatment of displaced olecranon fractures in the elderly has a high rate of complications, including wound breakdown and fixation failure. The purpose of this study was to assess the clinical, radiographic, and functional outcomes of nonsurgical management of displaced olecranon fractures in low-demand elderly and medically unwell patients.

Methods: A retrospective review of 28 patients with displaced closed olecranon fractures was performed with an average follow-up of 11 months.

Citizen Science Uncovers as a Threat to Several Rare or Endangered California Manzanita Species.

The Sudden Oak Death (SOD) Blitzes consist of yearly surveys led by citizen scientists designed to map the distribution of , cause of the forest disease called SOD, across northern California. During the 2017 Santa Cruz County SOD Blitz, six rare or endangered (manzanita) species were found to be possibly symptomatic for the first time. Symptoms included branch cankers and associated canopy mortality, and affected multiple individuals per species.

Genetic and phenotypic variation of Phytophthora crassamura isolates from California nurseries and restoration sites.

Phenotypic and sequence data were used to characterize 28 isolates resembling Phytophthora megasperma from 14 host species in 2 plant production facilities and 10 restoration sites across the San Francisco Bay Area (California; USA). Size of the oogonia and DNA sequences (nuclear internal transcribed spacer (ITS) and mitochondrial cytochrome c oxidase subunit 1 (COX 1)) were compared, and sensitivity to mefenoxam and pathogenicity were measured. Based on ITS 61 % of isolates matched ex-type sequences of Phytophthora crassamura from Italy, and the remainder matched or were close to the P.

Why do GPs leave direct patient care and what might help to retain them? A qualitative study of GPs in South West England.

Objective: To identify factors influencing general practitioners' (GPs') decisions about whether or not to remain in direct patient care in general practice and what might help to retain them in that role.

Design: Qualitative, in-depth, individual interviews exploring factors related to GPs leaving, remaining in and returning to direct patient care.

Setting: South West England, UK.

Pharmacists' perceptions of their emerging general practice roles in UK primary care: a qualitative interview study.

Background: UK general practice is experiencing a workload crisis. Pharmacists are the third largest healthcare profession in the UK; however, their skills are a currently underutilised and potentially highly valuable resource for primary health care. This study forms part of the evaluation of an innovative training programme for pharmacists who are interested in extended roles in primary care, advocated by a UK collaborative '10-point GP workforce action plan'.

Intraoperative culture positive allograft bone and subsequent postoperative infections: a retrospective review.

Background: Obtaining intraoperative cultures of allograft bone just before use in orthopedic procedures is standard practice in many centres; however, the association between positive cultures and subsequent surgical infections is unknown. Our study had 3 goals: to determine the prevalence of positive intraoperative allograft culture and subsequent infection; to determine if, in cases of subsequent infection, organisms isolated at reoperation were the same as those cultured from the allograft at the time of the index procedure; and to assess the costs associated with performing intraoperative allograft cultures.

Methods: In this retrospective case series, we obtained data on patients receiving allograft bone between 2009 and 2012.

Variability in Outcome Reporting for Operatively Managed Anterior Glenohumeral Instability: A Systematic Review.

Purpose: The purpose of this study was to quantify the degree of variability in outcomes assessed after surgery for anterior shoulder instability in recent high-impact literature.

Methods: Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, an extensive review of the literature during a 5-year period from January 2011 through December 2015 was performed across 6 orthopaedic journals with high impact factors to identify all studies investigating outcomes after anterior shoulder instability. Studies reporting clinical outcomes for patients with anterior glenohumeral instability after surgical treatment with at least 1-year follow-up were included.