Outcome assessment following distal radius fractures

Main Theme: Hip and Knee Reconstruction - Challenges & Controversie

Dynamic hip screw blade fixation for intertrochanteric hip fractures

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Screw length in volar locking plate fixation for distal radial fractures

Purpose. To develop a reference for the distal screw length in volar locking plate fixation for distal radial fractures in an East Asian population. Methods. 12 pairs of forearm specimens from 11 male and one female East Asian cadavers were scanned using computed tomography. On sagittal images of the distal radius, the mean cortex-to-cortex distance of 8 quadrants was measured as a reference for the distal screw length. In addition, intra-operative 3-dimensional fluoroscopy of 10 male and 10 female patients who underwent volar locking plate fixation for distal radial fractures was used to validate the distal screw length in the cadaveric reference. 76 distal locking screws were applied in the 8 quadrants; their cortex-to-cortex distances were measured. Results. The mean cortex-to-cortex distances at quadrants A, B, C, D, E, F, G, and H were 15.4 mm, 19.6 mm, 20.8 mm, 20.0 mm, 13.3 mm, 18.0 mm, 18.8 mm, and 17.4 mm, respectively. In 45% of the specimens, the 2 screws inserted at quadrants C and D were longest. Distal screws (quadrants A to D) were significantly longer than proximal screws (quadrants E to H) [p=0.02]. In intra-operative 3-dimensional fluoroscopic images, 2 of the 76 distal locking screws penetrated the dorsal cortex (one in quadrant A and one in quadrant F). The mean screw length was 88.0% of the cortex-to-cortex distance. When referenced to the cadaveric data, 88.2% of the screws could be safely inserted without penetrating the dorsal cortex, and the remaining 11.8% of screws (5 at quadrant D, one at quadrant B, and 3 at quadrant C; all in female patients) could potentially cause dorsal cortex penetration of 2 to 4 mm. In male patients, the mean screw length was 76.1% of the cortex-to-cortex distance based on the cadaveric reference. In female patients, when the screw length was 4 mm less than the cadaveric reference, the mean screw length would be 72.0% of the referenced cortex-to-cortex distance, with no dorsal cortex penetration. Conclusion. In female patients, the screw length should be 4 mm less than the cadaveric reference to avoid dorsal cortex penetration.link_to_OA_fulltex

Differential regulation of FOXM1 isoforms by RAF/MEK/ERK signaling

Conference Theme: Phosphosignalin

Speak-up culture in an intensive care unit in Hong Kong: A cross-sectional survey exploring the communication openness perceptions of Chinese doctors and nurses

© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted. Objectives Despite growing recognition of the importance of speaking up to protect patient safety in critical care, little research has been performed in this area in an intensive care unit (ICU) context. This study explored the communication openness perceptions of Chinese doctors and nurses and identified their perceptions of issues in ICU communication, their reasons for speaking up and the possible factors and strategies involved in promoting the practice of speaking up. Design A mixed-methods design with quantitative and sequential qualitative components was used. Setting and participants Eighty ICU staff members from a large public hospital in Hong Kong completed a questionnaire regarding their perceptions of communication openness. Ten clinicians whose survey responses indicated support for open communication were then interviewed about their speak-up practices. Results The participating ICU staff members had similar perceptions of their openness to communication. However, the doctors responded more positively than the nurses to many aspects of communication openness. The two groups also had different perceptions of speaking up. The interviewed ICU staff members who indicated a high level of communication openness reported that their primary reasons for speaking up were to seek and clarify information, which was achieved by asking questions. Other factors perceived to influence the motivation to speak up included seniority, relationships and familiarity with patient cases. Conclusions Creating an atmosphere of safety and equality in which team members feel confident in expressing their personal views without fear of reprisal or embarrassment is necessary to encourage ICU staff members, regardless of their position, to speak up. Because harmony and saving face is valued in Chinese culture, training nurses and doctors to speak up by focusing on human factors and values rather than simply addressing conflict management is desirable in this context