Failure to Compensate: Patients With Nerve Injury Use Their Injured Dominant Hand,Even When Their Nondominant Is More Dexterous

ObjectiveTo identify how individuals respond to unilateral upper extremity peripheral nerve injury via compensation (increased use of the nondominant hand). We hypothesized that injury to the dominant hand would have a greater effect on hand use (left vs right choices). We also hypothesized that compensation would not depend on current (postinjury) nondominant hand performance because many patients undergo rehabilitation that is not designed to alter hand use.DesignObservational survey, single-arm.SettingsAcademic research institution and referral center.ParticipantsA total of 48 adults (N=48) with unilateral upper extremity peripheral nerve injury. Another 14 declined participation. Referred sample, including all eligible patients from 16 months at 1 nerve injury clinic and 1 hand therapy clinic.InterventionsNot applicable.Main Outcome MeasuresHand use (% of actions with each hand) via Block Building Task. Dexterity via Jebsen-Taylor Hand Function.ResultsParticipants preferred their dominant hand regardless of whether it was injured: hand usage (dominant/nondominant) did not differ from typical adults, regardless of injured side (P>.07), even though most participants (77%) were more dexterous with their uninjured nondominant hand (mean asymmetry index, ?0.16±0.25). The Block Building Task was sensitive to hand dominance (P=2 × 10^?4) and moderately correlated with Motor Activity Log amount scores (r²=0.33, P<.0001). Compensation was associated only with dominant hand dexterity (P=3.9 × 10^?3), not on nondominant hand dexterity, rehabilitation, or other patient and/or injury factors (P>.1).ConclusionsPatients with peripheral nerve injury with dominant hand injury do not compensate with their unaffected nondominant hand, even if it is more dexterous. For the subset of patients unlikely to recover function with the injured hand, they could benefit from rehabilitation that encourages compensation with the nondominant hand.     

Various classes of removable partial dentures: A study of prevalence among patients attending a dental and educational institute in Riyadh,Saudi Arabia

PurposeKnowledge about the most prevalent types of Kennedy classifications is of great value and will enlighten dental students, dental technicians, and practitioners regarding the treatment needs of their patients, ultimately leading to better treatment outcomes. The aim was to determine the prevalence of various Kennedy classifications among patients attending clinics at the College of Dentistry at King Saud bin Abdulaziz University for Health Sciences and King Abdulaziz Dental Center, National Guard Health Affairs, who were seeking treatment for partial edentulism.MethodsAn observational cross-sectional study was conducted by visualizing cast models for partially edentulous patients. Kennedy classification, age, gender, and treatment design were recorded from the lab request sheets that were attached to the casts in the labs at both the College of Dentistry at King Saud bin Abdulaziz University for Health Sciences and King Abdulaziz Dental Center, National Guard Health Affairs. The statistical analyses were performed with SPSS version 20.0 utilizing frequency and Pearson’s and Spearman’s correlation tests.ResultsKennedy Class I (45.0%) was the most prevalent pattern in both dental arches, followed by Class III (26.2%). Next was Class II (23.3%), while Class IV was the least prevalent (5.4%).ConclusionKennedy Class I was the most noted classification in our patient population. As age increases, there is an increased tendency toward Class I and II.     

Normative values for the Sensory Organization Test in an active duty military cohort

BackgroundComputerized dynamic posturography is commonly used to assess balance in service members, but normative values for the military population have not been established.Research questionWhat are the normative values for the Motor Control Test (MCT), Sensory Organization Test (SOT) and the enhanced SOT (eSOT) within the military population and at which point do they differ?MethodsCross-sectional study. 237 active duty service members (78 % male) completed the MCT, SOT and the eSOT with the sway manipulated at a gain of 1.2, 1.4, 1.6, 1.8, or 2.0. A Mann-Whitney U test was used to compare the means of men and women for the SOT and MCT composite scores. A Kruskal-Wallis H test was used to compare the means of age groups for the SOT composite score. An independent t-test was used to compare the SOT composite scores from our military population to the manufacturer’s normative (civilian) data. The means and standard deviations for the eSOT scores were reported for each gain. Paired-samples t-tests were performed to compare the SOT composite score with the eSOT composite score for each level of gain.ResultsThere was no difference between SOT composite scores for men and women (Mann-Whitney U = 4363.50, p = 0.19) or among age groups (Kruskal-Wallis = 2.77, p = 0.25). The mean SOT composite scores were not different from the manufacturer’s normative values (p = 0.155). SOT composite scores were significantly higher than eSOT composite scores for gains of 1.4 (t = 3.16, p = 0.003), 1.6 (t = 5.73, p < 0.001), 1.8 (t = 5.26, p < 0.001) and 2.0 (t = 5.89, p < 0.001). MCT composite scores were lower in the 18−26 year old than the 36−45 year old age group (p = 0.013).SignificanceThis study establishes normative values for the MCT, SOT and eSOT in active duty military service members. The results suggest that the manufacturer’s normal values are appropriate for making judgments about the postural stability of service members.     

微信小程序合并时间管理器在眼科患儿监护人出院宣教中的应用效果

目的 探讨微信小程序合并时间管理器在眼科患儿出院宣教中的应用效果,为眼科护士出院宣教干预提供借鉴。方法 采用便利抽样法,选取98例眼科患儿监护人作为研究对象,将2021年2月-5月住院的49例患儿的监护人作为对照组,进行眼科常规出院宣教,将2021年6月-9月住院的49例患儿的监护人作为观察组,使用微信小程序合并时间管理器进行出院宣教干预。比较2组患儿监护人对疾病相关知识知晓情况、满意度及按时复诊人数。结果 干预1个月后,观察组疾病相关知识问卷得分、满意度得分及按时复诊率均高于对照组(t=-5.223,P=0.001;t=-5.419,P=0.001;χ²=6.874,P=0.009)。结论 使用微信小程序合并时间管理器在眼科病房进行出院宣教,能有效提高患儿监护人出院后疾病相关知识水平、按时就诊率及监护人满意度,提升护理服务质量。     

Preventing Adverse Drug Reactions After Hospital Discharge (PADR-AD): Protocol for a randomised-controlled trial in older people

BackgroundAdverse drug reactions (ADRs) and adverse drug events (ADEs) in older people contribute to a significant proportion of hospital admissions and are common following discharge. Effective interventions are therefore required to combat the growing burden of preventable ADRs. The Prediction of Hospitalisation due to Adverse Drug Reactions in Elderly Community Dwelling Patients (PADR-EC) score is a validated risk score developed to assess the risk of ADRs in people aged 65 years and older and has the potential to be utilised as part of an intervention to reduce ADRs.ObjectivesThis trial was designed to investigate the effectiveness of an intervention to reduce ADR incidence in older people and to obtain further information about ADRs and ADEs in the 12–24 months following hospital discharge.MethodsThe study is an open-label randomised-controlled trial to be conducted at the Royal Hobart Hospital, a 500-bed public hospital in Tasmania, Australia. Community-dwelling patients aged 65 years and older with an unplanned overnight admission to a general medical ward will be recruited. Following admission, the PADR-EC ADR score will be calculated by a research pharmacist, with the risk communicated to clinicians and discussed with participants. Following discharge, nominated general practitioners and community pharmacists will receive the risk score and related medication management advice to guide their ongoing care of the patient. Follow-up with participants will occur at 3 and 12 and 18 and 24 months to identify ADRs and ADEs. The primary outcome is moderate-severe ADRs at 12 months post-discharge, and will be analysed using the cumulative incidence proportion, survival analysis and Poisson regression.SummaryIt is hypothesised that the trial will reduce ADRs and ADEs in the intervention population. The study will also provide valuable data on post-discharge ADRs and ADEs up to 24 months post-discharge.     

Enhancing adherence and management in patients with hypertension: Impact of form and frequency of knowledge intervention

BackgroundThe alarming rise in prevalence of hypertension warrants psychosocial methods supplementing pharmacotherapy for better management and prevention of cardiac emergencies. The objective of the study was to assess the differential impact of the form and frequency of knowledge intervention on management of primary hypertension.Materials and methodThe study was conducted on 256 hypertensive patients recruited through purposive sampling at health centers in Hyderabad, India. Pretest post-test control group quasi-experimental design was adopted for the study. There were two forms of the knowledge intervention, namely ‘Direct Interaction’ and ‘Audio-Visual’. Each form was presented in two frequencies namely ‘single exposure’ and ‘double exposure’. The four groups were labelled as Direct Intervention Single (DIS), Direct Intervention Double (DID), Audio-Visual Single (AVS) and Audio-Visual Double (AVD). Adherence and management of hypertension were assessed at baseline and six weeks post experiment. Analysis of Covariance (ANCOVA) was applied using IBM SPSS Statistics version 20.ResultsANCOVA followed by Bonferroni Multiple Group Comparison Test revealed significant differences between the four intervention groups and control group on adherence (p< .001). In case of hypertension management significant differences were observed between Control group and DIS, DID (p < .001), Control and AVS (p < .01). Control group did not differ from AVD.ConclusionThere was a positive impact of Knowledge Intervention on adherence and management of hypertension. Double exposure in audio visual form was counterproductive in hypertension management.     

Low percentage of patients passed the ‘Back in Action’ test battery 9 months after bone-patellar tendon-bone anterior cruciate ligament reconstruction

BackgroundAnterior cruciate ligament (ACL) reconstruction is recommended in patients who intend to return to high-level sports. However, there is only a 55–80% return to pre-injury level of sports after ACL reconstruction, with a re-injury rate up to 20%. The aim of this study was to determine the percentage of patients passing the Back in Action (BIA) test 9 months after primary bone-patellar-tendon-bone (BPTB) ACL reconstruction, and evaluate the association between passing the BIA test and patient reported outcome measurements (PROMs).MethodsPatients underwent the BIA test 9 months after BPTB ACL reconstruction. In total 103 patients were included. Passing the BIA test (PASSED-group) was defined as a normal or higher score at all sub-tests with limb symmetry index (LSI) ≥90% for the dominant leg and LSI >80% for the non-dominant leg. Patients who did not meet these criteria were defined as the FAILED-group. PROMs included the International Knee Documentation Committee, Knee injury Osteoarthritis Outcome Score and Anterior Cruciate Ligament-Return to Sport after Injury.ResultsEighteen patients (17.5%) passed the BIA test 9 months after BPTB ACL reconstruction. PROMs were not statistically significant different between the PASSED- and FAILED-group.ConclusionLow percentage of patients passed the BIA test 9 months after BPTB ACL reconstruction. Although current PROMs cut-off values were met, the BIA test results show persistent functional deficits. Therefore, the BIA test could be of additional value in the decision-making process regarding return to sport (RTS). This study highlights the need for additional rehabilitation as RTS in a condition of incomplete recovery may increase the risk of re-injury.Level of evidenceII.     

Role of Elective Nodal Irradiation in Patients With ypN0 After Neoadjuvant Chemotherapy Followed by Breast-Conserving Surgery (KROG 16-16)

Background

Given the lack of established indications for elective nodal irradiation (ENI) in ypN0 patients after neoadjuvant chemotherapy (NAC) and breast-conserving surgery (BCS), we set out to investigate the role of ENI in ypN0 patients according to subtype and pathologic complete remission (pCR) status.