Breaking the cycle of stigmatization: managing the stigma of incontinence in social interactions.

Incontinence is a highly stigmatizing condition. This article explores the dynamics of stigmatization in interpersonal interactions from the perspective of both individuals who are stigmatized and individuals who are not stigmatized. When people who are stigmatized and nonstigmatized interact with each other, both experience threats to self-esteem, but for different reasons. Individuals who are stigmatized may experience self-esteem decrements because they feel that their group is devalued in the eyes of others. Those who are nonstigmatized may fear that their actions will be perceived as biased, thereby threatening their self-image as an unprejudiced person. Individuals who are stigmatized and nonstigmatized act in ways that make their worst fears more than likely come true. Ways that nurses can facilitate ending this cycle with patients who are incontinent are discussed.     

Hand therapy for dysfunction of the intrinsic muscles

Intrinsic muscle dysfunction can be devastating. Patients often have difficulty using the affected hand for most daily activities. Physicians, occupational therapists, and patients have to work together to enable the patient to regain functional use of the hand to perform activities that are a part of their life roles. Occupational therapists play an important role in the rehabilitation process to regain motion, strength, and dexterity so that patients can use the hand more functionally. Patient education and active participation in their therapy is also essential in the functional recovery of the hand.     

Cultural Considerations of Hand Use

Although each of us has the same capacity for hand use based on musculoskeletal structure and physiology, the choice and meaning of hand usage and activity are unique to the individual and influenced by sociocultural values, beliefs, and expectations. Effective therapists provide culturally competent care. For the hand therapist, this involves understanding how patients use their hands and the meaning clients ascribe to that use. This article will provide a review of cross-cultural variations in hand use in activities of daily living, communication, and decoration.     

A systematic review of the psychometric properties of self‐reported scales assessing burn contractures reveals the need for a new tool to measure contracture outcomes

Approximately 40% of burn patients develop scar contractures. It is unknown which scar contracture therapy best optimizes activities of daily living (ADL).The appropriateness of self‐reported outcome tools in measuring anti‐scar contracture therapies has not been assessed. We conducted a systematic review to determine the quality of existing self‐reported scales in measuring ADL among burn patients by analyzing and comparing psychometric properties—factor analysis, validity, reliability, and responsiveness. EMBASE, LILACS, American Psychological Association PsycNET databases were searched for relevant articles. Forty‐one articles discussing 10 burn and non‐burn–specific scales met eligibility criteria of ADL assessment, and available psychometric analyses. A common strength in most scales was good overall reliability. Common weaknesses were insufficient data on factor analyses, content validity specific to ADL assessment, and responsiveness. The psychometric analyses studies on these scales had poor sample variability. There is insufficient data on the dimensionality and responsiveness of existing scales to support their use for measuring ADL in burn patients. Existing scales do not comprehensively measure ADLs as an isolated parameter. A psychometrically valid, comprehensive self‐reported burn contracture scale that measures ADLs among a diverse group of burn patients needs to be developed to optimize burn contracture treatments and develop new therapies.     

Hand and wrist research productivity in journals with high impact factors: a 20 year analysis

Bibliometric analyses, which study trends in research productivity, have not previously been applied to hand and wrist research. This study analyses temporal and geographic trends in hand and wrist research from 1988 to 2007. Original research articles were collected from seven English language journals selected on the basis of impact factor. Research production and quality (level of evidence) were determined by country and global region. Linear regression analysis was used to investigate trends. No significant increase in research volume was observed, but journal impact factors have risen significantly since 1988. Western Europe contributed significantly more high-quality (Level I and II) studies than the United States. Research contributions show a geographical distribution concentrated in the US and Western Europe, but considerable changes in this distribution have occurred. From 1988 to 2007, there was a relative increase in research production from Europe, Latin America and Asia, and a relative decline from the US.     

《中华手外科杂志》2005-2009年引文分析

目的 研究<中华手外科杂志>参考文献的引用规律,了解我国手外科领域论文引文的一般规律和科研人员吸收利用科技文献的情况.方法 采用文献计量学方法 ,对该刊2005至2009年共30期942篇文章的引文进行逐篇统计,记录分析,计算引文量、引文率、引文语种、引文类型、引文年代和普赖斯指数.结果 该刊共刊载文献942篇,引文率为87.37%引文量5 390条,平均为6.55条.主要引文类型为期刊(90.71%)和图书(9.29%),普赖斯指数44.9r7%,自引率31.61%,被引用频次前18位的中外文期刊的文献引用量占期刊引文总量的66.21%.结论 <中华手外科杂志>是手外科领域高质量的专业核心期刊,引文的外文语种较为单一,引文内容较新颖.     

《中华手外科杂志》2005-2009年引文分析

目的 研究<中华手外科杂志>参考文献的引用规律,了解我国手外科领域论文引文的一般规律和科研人员吸收利用科技文献的情况.方法 采用文献计量学方法 ,对该刊2005至2009年共30期942篇文章的引文进行逐篇统计,记录分析,计算引文量、引文率、引文语种、引文类型、引文年代和普赖斯指数.结果 该刊共刊载文献942篇,引文率为87.37%引文量5 390条,平均为6.55条.主要引文类型为期刊(90.71%)和图书(9.29%),普赖斯指数44.9r7%,自引率31.61%,被引用频次前18位的中外文期刊的文献引用量占期刊引文总量的66.21%.结论 <中华手外科杂志>是手外科领域高质量的专业核心期刊,引文的外文语种较为单一,引文内容较新颖.     

《中华手外科杂志》2005-2009年引文分析

目的 研究<中华手外科杂志>参考文献的引用规律,了解我国手外科领域论文引文的一般规律和科研人员吸收利用科技文献的情况.方法 采用文献计量学方法 ,对该刊2005至2009年共30期942篇文章的引文进行逐篇统计,记录分析,计算引文量、引文率、引文语种、引文类型、引文年代和普赖斯指数.结果 该刊共刊载文献942篇,引文率为87.37%引文量5 390条,平均为6.55条.主要引文类型为期刊(90.71%)和图书(9.29%),普赖斯指数44.9r7%,自引率31.61%,被引用频次前18位的中外文期刊的文献引用量占期刊引文总量的66.21%.结论 <中华手外科杂志>是手外科领域高质量的专业核心期刊,引文的外文语种较为单一,引文内容较新颖.     

Hand injuries in agricultural accidents.

The aim of this study was to investigate the incidence of hand injuries due to farming accidents in a defined population with a representative mixture of agricultural activities. During a 12-month period all agricultural accidents treated at the five hospitals in the County of Ringk?bing, Denmark were prospectively registered. Follow-up was done by telephone interview 4 months after the accident. Of the 260 persons injured in agricultural accidents, 117 (45%) had lesions of the upper extremity and 73 persons (28%) had hand injuries. The most common injuries were lacerations and amputations (45%) followed by fractures (36%). Mean sick leave was 25 days, and mean work impairment was 31 days in patients with hand injuries.     

Hand surgery and quality of life.

The outcome in patients having surgery to the hand was assessed subjectively using a questionnaire that covered activities of daily living (ADL), hand pain and psychological well-being. The questionnaires were completed on average 6.9 months preoperatively and 20.6 months postoperatively by 15 patients with osteoarthritis undergoing trapeziectomy and 25 patients with rheumatoid arthritis undergoing Swanson arthroplasties of the metacarpophalangeal joints. Surgery resulted in significant improvements in reported ADL and hand pain, in both groups. Improvement in perception of hand function and health was only seen in the osteoarthritic group. There was no improvement in arthritis activity, mood or quality of life in either group. These results confirm that surgery for arthritis of the hand relieves pain and improves ADL. However, it has a greater effect in patients with localized osteoarthritis than in those with rheumatoid arthritis.     

An evaluation of low back-pain-related content in Canadian newspaper media

STUDY DESIGN: Review of newspaper articles. OBJECTIVE: To assess the content of newspaper articles in 2 provinces in Canada to determine if rest or avoidance of activity is being recommended for back pain. SUMMARY OF BACKGROUND DATA: Inaccurate back pain beliefs in the general public may arise due to messages in the mass media. One persisting belief in Canada is that rest or activity avoidance is needed until back pain resolves. METHODS: We searched newspapers in 2 Canadian provinces via an electronic database for articles discussing back pain. Two trained raters used an article review template to indicate whether the article's main recommendation was to stay active, rest, was neutral (indicating a balance between rest and activity), or did not provide advice on level of activity during an episode of back pain. RESULTS: One hundred 29 articles were identified. The primary advice provided related to level of activity during an episode of back pain was stay active in 24% of articles, whereas no articles primarily recommended rest or avoidance of activity. Sixteen percent of articles were rated as neutral, indicating the authors suggested a balance between rest and activity. CONCLUSIONS: Back-pain-related newspaper articles do not carry messages that advocate rest or avoidance of activity, but rather highlight the importance of staying active during an episode or participating in exercise.     

The quality and strength of evidence for etiology: example of carpal tunnel syndrome

PURPOSE: The purpose of this investigation was to evaluate the quality and strength of scientific evidence supporting an etiologic relationship between a disease and a proposed risk factor using a scoring system based on the Bradford Hill criteria for causal association. METHODS: A quantitative score based on the Bradford Hill criteria (qBHs) was used to evaluate 117 articles presenting original data regarding the etiology of carpal tunnel syndrome: 33 (28%) that evaluated biological (structural or genetic) risk factors, 51 (44%) that evaluated occupational (environment or activity-related) risk factors, and 33 (28%) that evaluated both types of risk factors. RESULTS: The quantitative Bradford Hill scores of 2 independent observers showed very good agreement, supporting the reliability of the instrument. The average qBHs was 12.2 points (moderate association) among biological risk factors compared with 5.2 points (poor association) for occupational risk factors. The highest average qBHs was observed for genetic factors (14.2), race (11.7), and anthropometric measures of the wrist (11.3 points) with all studies finding a moderate causal association. The highest average qBHs among occupational risk factors was observed for activities requiring repetitive hand use (6.5 points among the 30 of 45 articles that reported a causal association), substantial exposure to vibration (6.3 points; 14 of 20 articles), and type of occupation (5.6 points; 38 of 53 articles), with the findings being much less consistent. CONCLUSIONS: According to a quantitative analysis of published scientific evidence, the etiology of carpal tunnel syndrome is largely structural, genetic, and biological, with environmental and occupational factors such as repetitive hand use playing a minor and more debatable role. Speculative causal theories should be analyzed through a rigorous approach prior to wide adoption.     

The Pathophysiology of Focal Hand Dystonia

Narrative ReviewFocal hand dystonia is a disabling movement disorder, often task specific, that leads to impaired hand use. In addition to a genetic predisposition, environmental risk factors including repetitive use and musculoskeletal constraints are contributory. Although the underlying cause is unknown, recent studies have identified several key mechanisms that may play a part in its genesis. Failure of inhibition, abnormal sensorimotor integration, and maladaptive plasticity seem to be important. Understanding the underlying physiology may lead to the design of novel therapies.Level of Evidence5.     

Combined thenar and hypothenar hammer syndromes: case report and review of the literature

Patients who use the palms of their hands as a hammer may cause irreversible damage to the radial or ulnar arteries. Damage to the intima may lead to arterial thrombosis, whereas damage to the media may cause aneurysm formation with embolization to the digital arteries, causing symptoms of ischemia. These patients may have symptoms of Raynaud syndrome, or they may have ischemic ulcerations of their fingers. Hypothenar hammer syndrome with involvement of the ulnar artery is much more frequently encountered than thenar hammer syndrome, which is caused by damage to the radial artery. We report a patient with symptomatic occlusion of both the radial and ulnar arteries secondary to repetitive trauma to the palm of his hand. In our review of the literature, we found two reports involving a total of four patients with similar findings. Both conservative and surgical treatments have been used successfully. Avoidance of the precipitating activities is important in long-term management of these patients.     

Hand function of C6 and C7 tetraplegics 1 - 16 years following injury

STUDY DESIGN: Retrospective cohort study. OBJECTIVE: To quantify the hand function of C6 and C7 tetraplegics 1 - 16 years after injury. SETTING: Patients were assessed in their homes. METHODS: Medical records of patients admitted to the Prince Henry Hospital Spinal Injuries Unit between 1984 and 1999 were used to identify all patients with C6 or C7 tetraplegia at 3 months post injury. Sixty-five patients (107 hands) were identified in this way. Forty-seven patients (81 hands) were located and agreed to partake in the study, and seven (nine hands) had died. Thus 81% of patients (83% of hands) still alive at follow-up were assessed. MAIN OUTCOME MEASURES: Unilateral hand function was assessed with the Grasp and Release Test (GRT) and a 10 item Activities of Daily Living (ADL) Test. Prevalance and severity of contractures, lateral grasp (key grip) strength and extensibility of the extrinsic finger flexor muscles were also determined. RESULTS: All hands except one had been managed without surgical intervention. The median number of ADL tasks successfully completed was 9/10 (interquartile range=8 - 10) and the median number of objects successfully manipulated in the GRT was 3/6 (IQ range=3 - 5). Lateral grasp was poor (74% and 75% of hands could not use a lateral grasp to move the paperweight or depress the fork in the GRT, respectively), and the prevalence of contractures was low (53% of hands had full passive range of motion). CONCLUSION: In the long term, most C6 and C7 tetraplegics attain a high level of hand function despite poor lateral grasps.     

《中华手外科杂志》引文变迁分析

目的 了解我国手外科学领域论文引文的一般规律和著者吸收利用科技文献的实际情况。方法 利用文献计量方法和引文分析法,对《中华手外科杂志》5年（1995年－1999年）的论文引文的平均值、引文的类型等进行统计学分析。结果 论文平均引文量为5．4条,中外文的比例为1：1．3,期刊总引文量的87．1％,引文自引率为11．0％。被引文献峰值（9．8％）是在发表后的第4年,文献半衰期为6－7年。结论 期刊是手外科学论文的主要引文源,按照布拉德福的文献主散规律,找出8种核心期刊而《中华手外科杂志》在其中占首位。     

How informative is the print media coverage of colorectal cancer?

Aim  To date there has been no assessment of the educational content of colorectal newspaper articles. We aimed to analyse articles in the print media concerning colorectal cancer for their public health content. Method  Articles mentioning colorectal cancer in the top 10 UK newspapers were analysed over a 1‐year period for their educational content. The number of articles mentioning ‘red flag’ symptoms, celebrity connections or specific cancer charities was recorded. Results  Of the 349 articles identified, 146 were not relevant. Of the remaining 203 articles, 62 (30%) were concerned with celebrities with colon cancer, 13 (6.4%) made reference to red flag symptoms and 14 (6.9%) mentioned cancer charities by name. Conclusion  About 13% of newspaper articles have any educational content. If this increased, the general public might benefit.     

Have the media influenced the use of hip resurfacing arthroplasty? A review of UK print media

INTRODUCTION

The aim of this study was to look at the different claims made about hip resurfacing arthroplasty in the popular UK print media and how this relates to findings in the scientific literature.

METHODS

A review of UK popular print media from January 1992 to June 2011 was performed using the Lexis® Library online news database. Only articles discussing the clinical results of hip resurfacing arthroplasty were included. After excluding duplicates, 49 newspaper articles were found suitable for this study. The main outcome measure was the claims made in popular UK print media about hip resurfacing. These were compared with the scientific publication. We reviewed the trend of use of hip resurfacing prostheses during the same period as reported in the National Joint Registry.

RESULTS

A disparity was found between the claims in the newspapers and published scientific literature. The initial newspaper articles highlighted only the positive aspects of hip resurfacing arthroplasty, without definitive contemporary evidence backing the claims. Most of these claims were refuted by future scientific publications. The initial positive media reports coincided with an increase in the use of hip resurfacing but the decline coincided with negative reports in the scientific literature.

CONCLUSIONS

The trend of the newspaper articles and that of the number of hip resurfacing prostheses implanted suggests that the media may have been partly responsible for the increased use of this prosthesis. The subsequent decrease was initiated by the scientific literature.     

The Value of Ultrasonography in Hand Surgery

The quality of ultrasound imaging to examine anatomical structures in the wrist and hand has improved highly over the last years. The value of ultrasonography (US) performed by hand surgeons on treatment decisions was investigated in this study. One hundred and ninety-five patients with an unclear clinical hand problem were evaluated by high-definition ultrasonography from January 2005 until June 2007. In 21% of cases, the procedure and therapy were influenced by the ultrasonographic findings. In 26 patients examined by ultrasound, surgery was avoided, while 14 patients had unexpected ultrasound results that led to surgery. In 22 of the 84 performed operations, ultrasound had a direct impact on the surgical procedure itself. The agreement of the ultrasonographic diagnosis and the post-operative diagnosis (n = 80) was better, though not statistically significant compared to the agreement between clinical diagnosis and diagnosis after operation (n = 84). Ultrasound imaging performed by the hand surgeon improves quality in the evaluation of hand problems. Ultrasonography is a cost-effective high-resolution investigation with the possibility of dynamic imaging.