A population-based nationwide study of cruciate ligament injury in Sweden, 2001-2009: Incidence, treatment, and sex differences

Background: A few national cruciate ligament (CL) registers have been initiated with operative surveillance and outcome monitoring. No nationwide study describing CL injury has ever been done. Purpose: To study the incidence and characteristics of patients diagnosed with cruciate ligament injury in Sweden. Study Design: Descriptive epidemiology study. Methods: Data for all patients with a diagnosed CL injury between 2001 and 2009 were identified from the National Swedish Patient Register. Risk analysis and specific incidences were calculated according to age, sex, geographic region, and surgery. Results: A total number of 56,659 patients with CL injury were included in the study, and the overall incidence of CL injury in Sweden was 78 per 100,000 persons. Sixty percent of the patients were male. The mean age was 32 years (range, 1-98 years), and 50% of the cohort was younger than 30 years. There was an increased rate of injury among female patients younger than 20 years as compared with male patients in that age group. Among patients with CL injury, 36% underwent reconstructive surgery, with one-third of these performed within 1 year after injury. Among patients who underwent surgery, 59% were male; the mean age was 27 years (range, 5-89 years). Conclusion: This study defines the incidence of CL injury and also demonstrates sex differences in which men were more likely to sustain a CL injury, although female patients were injured at an earlier age. The findings in this study corroborate the results from recent surgical registers. Clinical Relevance: No data have hitherto been published including all patients with CL injury, treated both surgically and nonsurgically. Such baseline epidemiologic data are crucial to be able to validate and judge the generalizability of results from procedure registers and clinical studies. © 2012 The Author(s)

Personal protection equipment for orthopaedic and trauma surgery during the COVID-19 pandemic:The results of an EFORT survey initiative

• Orthopaedic and trauma surgeons performing surgery in the COVID-19 pandemic environment faced problems with availability, use, rationing, modification, compliance and recycling of personal protection equipment (PPE). • Orthopaedic and trauma surgeons were not well informed concerning the use of PPE for aerosol-generating orthopaedic and trauma procedures. • Scientific bodies, health authorities and management have provided insufficient guidelines for the use of PPE in aerosol-generating orthopaedic and trauma procedures. • The availability of specific PPE for orthopaedic and trauma operating theatres is low. • Hospital management and surgeons failed to address the quality of operating theatre ventilation or to conform to recommendations and guidelines. • Operating theatre PPE negatively affected surgical performance by means of impaired vision, impaired communication, discomfort and fatigue. • Existing PPE is not adequately designed for orthopaedic and trauma surgery, and therefore, novel or modified and improved devices are needed © 2022. The author

Stress fractures of the tibia: can personality traits help us detect the injury-prone athlete?

One of the few serious drawbacks associated with running is overuse injuries such as stress fractures of the tibia, which cause local pain and swelling, often resulting in a temporary cessation of training. Whereas some runners rarely become injured, others experience recurrent injuries even during fairly short periods of time. The aim of the present study was to compare selected personality traits in a group of runners who had sustained a previous tibial stress fracture (n½17), with a matched group of runners (n½17) who had never experienced stress fractures. The results indicated that the injured runners, especially the women, scored higher than the non-injured runners did on inventories measuring both the Type A behavior pattern and exercise dependency. Since motivation, ambitiousness, and competitiveness are integral parts of these inventories, high scoring individuals might be part of a high-risk population for running injuries, the more so if the individual also feels dependent on regular running for managing stress related mood states, which was the case particularly for the injured women in the present study. However, the somewhat limited number of runners who had had a confirmatory scintigram, which was a criterion for inclusion in the study, warrants a cautious interpretation of the results. The findings nevertheless suggest that in order to prevent recurrent injuries, health education professionals and clinicians ought to focus on conveying the importance of detecting precursors of injury, and the subsequent steps which should be taken to avoid developing a serious injury

Exploring Virtual Worlds for Scenario-Based Repeated Team Training of Cardiopulmonary Resuscitation in Medical Students

In medicine, education and recurrent training is fundamental for efficient and safe care. In emergency situations one has to rely on robust protocols that reduce the risk for errors. However, today there is plenty of evidence that the professional level of knowledge, manual, cognitive and teamwork skills as well as suitable attitudes needs to be raised. By using new and promising educational technology it has been proposed that one can address several problems in today’s education and training. So far, in medicine there haven’t been many results on whether gaming technology supports learning although findings from several authors are encouraging. One area of particular interest is that of cardiopulmonary resuscitation (CPR), since all health care professionals are assumed to possess competence in this field. To disseminate the knowledge and skills, with the goal of reaching better outcome after out-of-hospital sudden cardiac arrests, CPR is also trained at schools. With the rapid development in information and communications technology (ICT) and the increase in computer access and skills in a digital native generation, the stage is set for “serious games”. By using cardiopulmonary resuscitation as a model, the aim of this thesis project has been to understand if a virtual world is suitable for training medical and high school students to assist in emergency medical situations. A virtual world with capabilities to train teamwork CPR was developed. Short scenario based training sessions using a virtual school environment was carried out in teams. In study I and II user experiences and reactions were assessed from a social cognitive and games research perspective. The findings in terms of strengthened self-efficacy beliefs and positive ratings on dimensions of “flow” experience indicated that this tool could engage the subjects and carried properties important for learning and execution. Results from Swedish and US high schools were comparable. Study III was a transfer study in which virtual world pre-trained groups were assessed and compared to control subjects in a full-scale high fidelity patient simulator, 6 and 18 months after virtual world CPR team training. Main findings in this study indicated that subjects trained 6 months before simulator assessment delivered higher quality CPR in terms of chest compressions, and followed the CPR protocol better than the other groups. In study IV the aim was to get a more complete picture of how the virtual world CPR team training was perceived by the participants and compare the findings with theories on learning and serious games. Using a qualitative approach, four categories evolved as end result. The findings support many of the proposed benefits of serious games, such as high levels of enjoyment and engagement. Further, learning in teams is beneficial for several reasons. However, there are areas that call for some caution. It can be questioned if a sense of mastery created in a virtual world easily transfers to the real world. Also, not all students are enchanted by computers and computer games – when establishing training in virtual worlds one has to consider the level of computer interest among the users. To evoke the proposed positive effects of virtual world training, one has to meet the demands this game derived method poses in terms of high levels of challenge, proximal goal-setting, affective involvement and rich feed-back. Although being exploratory to its nature, the results from this project demonstrate possibilities within virtual worlds for training in teams. Being accessible, relatively inexpensive to run and rich in variations, virtual worlds based training can be motivated in a variety of settings within medicine