Femoral head measurement in hemiarthroplasty: assessment of interobserver error using 3 measuring systems

We have assessed the consistency of measurement of femoral head circumference using 3 standard measuring instruments used in hemiarthroplasty of the hip. Fifty femoral heads were independently sized by ten independent observers using a caliper, a half circular measuring template, each allowing measurement to the nearest millimeter.We found significantly greater variance of the results using the half-circular templates (p=0.001) and the calipers (p=0. 011) compared with the full circular measuring templates. Measurement with calipers underestimated femoral head size by 0.72 mm compared with full circular measuring templates (p=0.02). Insertion of an undersized hemiarthroplasty head is a cause of increased point loading of the acetabulum and may result in increased rates of acetabular erosion. The use of full circular measurement templates is recommended as the most consistent method for head sizing in hemiarthroplasty of the hip.     

Atypical Bennett’s fracture-dislocation

We herein report an unusual case of a fracture-dislocation of the thumb metacarpal base. The injury consisted of features typical of Bennett’s fracture-dislocation of the thumb trapeziometacarpal joint, with additional rotation of the proximal fragment, signifying a greater ligamentous injury. Radiographic features of this injury are discussed together with its pathomechanics. Surgical management was undertaken due to the inherent instability of this injury.     

Managing the ‘picky eater’ dilemma

Picky eating is a common cause of concern for parents of young children. Paediatricians and family physicians are in a key position to help parents learn ways to feed their children effectively. Despite the high prevalence of picky eating, the growth of the majority of picky eaters does not suffer adversely. In the absence of worrying signs and symptoms, reassurance of the child’s normal growth would help allay parental anxieties. Reinforcement of basic feeding principles and providing healthy dietary advice are important strategies to help parents manage children who are picky eaters.     

Hearing impairment and hearing aid usage in Singapore

Objective: To examine the epidemiological and audiological profile, pattern of hearing aid (HA) fitting and usage among HA users in Singapore. Design: Retrospective cross-sectional study. Study sample: Cohort of 1068 subjects issued with HAs at a tertiary hospital between 2001 and 2013. Results: Mean age was 70?years with 50.8% male. Mean hearing loss (HL) was 63.1?dB and 69.5% had at least moderate-severe HL. Sensorineural HL was present in 66.4% and 69.8% had symmetrical HL. “Behind-the-Ear” HAs were cheaper than “In-Ear” HAs. Standard “Behind-The-Ear” HAs were also cheaper than “Receiver-in-Canal” HAs. Among In-Ear HAs, “In-the-Canal” and “Completely-in-Canal” were more popular than “In-the-Ear” HAs despite costing more. HA was used ≥4?days/week by 85.6% but >7?h per day by only 35.7%. Only 18% received bilateral first HA fitting. In multivariate analysis, younger age and symmetrical HL were predictors of bilateral HA uptake while better Pure-Tone-Audiometry of aided ear and >7?h of daily HA usage were predictors of successive HA fitting. Conclusions: HA users in Singapore were elderly and presented with advanced HL. Bilateral HA adoption and average daily use were low compared to other developed countries. Future research on understanding the suboptimal HA usage should explore patients' motivation, hearing disability, and HA effectiveness.     

Perceptions of general practitioners towards the use of a new system for treating back pain: a qualitative interview study

Background  

Changing clinicians' behaviour is recognised as a major challenge. It is clear that behaviour change not only depends on demonstrating the proven effectiveness of clinical interventions; contextual and occupational factors, such as 'change readiness', may be central to their implementation. This paper highlights the context of behaviour change in relation to a healthcare innovation introduced within primary care, highlighting the importance of organisational and interpersonal factors that may help explain the dynamics of implementation.     

Increasing body image flexibility in a residential eating disorder facility: Correlates with symptom improvement

Objective: The purpose of this study was to examine the effects of changes in body image psychological flexibility over the course of treatment on various outcome variables. Method: Participants included 103 female, residential patients diagnosed with an eating disorder. Pretreatment and posttreatment data were collected that examined body image psychological flexibility, general psychological flexibility, symptom severity, and other outcome variables. Results: Changes in body image psychological flexibility significantly predicted changes in all outcome measures except for obsessive-compulsive symptoms after controlling for body mass index, depression, and anxiety. Additionally, these results were maintained after controlling for general psychological flexibility, contributing to the incremental validity of the BI-AAQ. Discussion: This study suggests that changes in body image psychological flexibility meaningfully predict changes in various treatment outcomes of interest, including eating disorder risk, quality of life, and general mental health. Findings indicate that body image psychological flexibility might be a viable target for eating disorder treatment.