Anatomic and Biomechanical Study of Thumb Carpometacarpal Dislocations: A Laboratory Study.

BACKGROUND: No previous study recreating an isolated thumb carpometacarpal (CMC) dislocation with or without suture augmentation has been performed in the laboratory. This investigation aimed to evaluate the mechanism and ligamentous complex of isolated thumb CMC dislocations. METHODS: Biomechanical analysis was performed in 10 cadaveric specimens. A posteriorly directed force or axial loading with hyperflexion through the CMC joint was applied. Load was applied at a rate of 1 mm/s until posterior CMC dislocation was achieved. Maximum load, displacement under nominal loading, stiffness, and mode of failure were recorded. The native ligament was repaired, augmented with high-tensile suture, and testing was repeated. RESULTS: Posteriorly directed force produced posterior CMC dislocations, while axial loading and hyperflexion through the CMC joint caused fractures. Load-to-failure of the native CMC joint was 217.76 N (SD = 66.03). Stiffness of the ligamentous complex on average was 18.86 N/mm (SD = 8.83). Mean load-to-failure after repair with suture augmentation was 94.62 N (SD = 39.77), with average stiffness of 8.21 N/mm (SD = 3.06). The native ligament was noted to have greater stiffness (P = .002) and greater load-to-failure (P = .0001) than repair with suture augmentation. Maximum displacement-to-failure of the native ligament was 14.5 mm compared with repair with suture augmentation 11.9 mm (P = .068). CONCLUSION: Isolated CMC dislocation was achieved with a posteriorly directed force rather than hyperflexion of the joint. Ultimate failure load of the repaired ligaments with suture augmentation was about half of that of the native ligaments. Further research into this technique is warranted.

Implementing SAFER Responses to Misconduct and Responding to Biased Patient Requests ASAP.

Background: In response to encounters involving misconduct, discrimination, and harassment toward healthcare workers, the Experience Training, Education, and Coaching (XTEC) team was tasked with empowering staff members to respond to biased requests and misconduct appropriately and consistently. The aim of this article is to discuss communication strategies for how to respond to patient bias and misconduct. Methods: XTEC developed a training program with two focused communication strategies: (1) SAFER, a stepped approach to respond to patient and visitor misconduct and (2) ASAP, an approach for responding to patient bias which we describe as requests related to race, religion, ethnicity, gender, and other personal attributes of staff. Intervention: SAFER ASAP workshops were delivered to 2154 health care professionals through 109 face-to-face training over a 15-month period between January 2019 and March 2020. All trainings were discussion- and scenario-based, ranging in duration from 60 to 90 min. Participants were given pre- and post-training test case scenarios, in which respondents wrote responses to a challenging behavior to assess skill attainment post-training. Results:Seventy-one percent demonstrated higher levels of response ability post-training, and 92% of respondents indicated they would likely recommend this training to others. Conclusions: SAFER ASAP is an effective communication training program for responding to patient and visitor bias and misconduct.

Speaking to the Heart of Our Patients: An Empathic Communication Education Initiative.

Communicating with empathy is a critical skill within the nurse-patient relationship and a driver of a positive patient experience. Staff at a large midwestern medical organization identified an education-based communication improvement strategy to address a gap within its patient experience data. An evidence-based empathic communication education framework was developed and delivered to more than 8,400 nurses and allied health staff. Posteducation sustainment strategies were included within the framework to support ongoing concept mastery and practical application. A multilevel evaluation strategy was used to measure the education's impact from both a learner and patient perspective. Evaluations demonstrated the chain of impact from reaction, learning, behavior, and results, indicating the education improved staff members' ability to communicate empathically, contributing to an increase from baseline in communication-related patient experience data. [J Contin Educ Nurs. 2021;52(7):319-325.].

Stress, inflammation, and yoga practice.

OBJECTIVE: To address the mechanisms underlying hatha yoga's potential stress-reduction benefits, we compared inflammatory and endocrine responses of novice and expert yoga practitioners before, during, and after a restorative hatha yoga session, as well as in two control conditions. Stressors before each of the three conditions provided data on the extent to which yoga speeded an individual's physiological recovery. METHODS: A total of 50 healthy women (mean age, 41.32 years; range, 30-65 years), 25 novices and 25 experts, were exposed to each of the conditions (yoga, movement control, and passive-video control) during three separate visits. RESULTS: The yoga session boosted participants' positive affect compared with the control conditions, but no overall differences in inflammatory or endocrine responses were unique to the yoga session. Importantly, even though novices and experts did not differ on key dimensions, including age, abdominal adiposity, and cardiorespiratory fitness, novices' serum interleukin (IL)-6 levels were 41% higher than those of experts across sessions, and the odds of a novice having detectable C-reactive protein (CRP) were 4.75 times as high as that of an expert. Differences in stress responses between experts and novices provided one plausible mechanism for their divergent serum IL-6 data; experts produced less lipopolysaccharide-stimulated IL-6 in response to the stressor than novices, and IL-6 promotes CRP production. CONCLUSION: The ability to minimize inflammatory responses to stressful encounters influences the burden that stressors place on an individual. If yoga dampens or limits stress-related changes, then regular practice could have substantial health benefits.

Diagnosis and Management Strategies for Distal Biceps Rupture.

Rupture of the distal biceps tendon most commonly is secondary to mechanical overload during eccentric muscle contraction. Due to deficits of strength and endurance, surgical repair usually is recommended. Although both single- and double-incision approaches have been described, double-incision techniques have been shown to better re-create the native anatomic insertion. However, excellent and comparable clinical outcomes have been demonstrated with both techniques. Fixation with a cortical button and interference screw has been shown to be the strongest construct biomechanically; however, several modern constructs provide adequate strength. Surgical technique should focus on restoration of anatomy, early range of motion, and prevention of complications. [Orthopedics. 2019; 42(6):e492-e501.].

Improving Resiliency in Healthcare Employees.

OBJECTIVES: The high prevalence of stress at the workplace has been well documented; however, few studies have investigated the efficacy of worksite resiliency programs. Therefore, the objec- tive of this project was to examine the impact of a worksite resilience training program on improving resiliency and health behaviors in healthcare employees. METHODS: Between 2012 and 2016, 137 adult wellness center members of a healthcare institution participating in a single-arm cohort study of a 12-week resiliency training program were assessed at baseline, end of intervention, and at 3-month follow-up. RESULTS: Statistically significant (p ≤ .01) improvements were seen at the end of the intervention and extending to 3 months follow-up for resiliency, perceived stress, anxiety level, quality of life, and health behaviors. CONCLUSIONS: These results support the premise that worksite programs designed to improve resiliency in healthcare employees have efficacy in improving resiliency, quality of life and health behaviors. Given the importance of stress and burnout in healthcare employees, future randomized studies are warranted to determine more clearly the impacts of this type of resiliency intervention for improving the wellness of healthcare workers.

Improvements in Health Behaviors, Eating Self-Efficacy, and Goal-Setting Skills Following Participation in Wellness Coaching.

Purpose . This project examined potential changes in health behaviors following wellness coaching. Design . In a single cohort study design, wellness coaching participants were recruited in 2011, data were collected through July 2012, and were analyzed through December 2013. Items in the study questionnaire used requested information about 11 health behaviors, self-efficacy for eating, and goal-setting skills. Setting . Worksite wellness center. Participants . One-hundred employee wellness center members with an average age of 42 years; 90% were female and most were overweight or obese. Intervention . Twelve weeks of in-person, one-on-one wellness coaching. Method . Participants completed study questionnaires when they started wellness coaching (baseline), after 12 weeks of wellness coaching, and at a 3-month follow-up. Results . From baseline to week 12, these 100 wellness coaching participants improved their self-reported health behaviors (11 domains, 0- to 10-point scale) from an average of 6.4 to 7.7 (p < .001), eating self-efficacy from an average of 112 to 142 (on a 0- to 180-point scale; p < .001), and goal-setting skills from an average of 49 to 55 (on a 16- to 80-point scale; p < .001). Conclusion . These results suggest that participants improved their current health behaviors and learned skills for continued healthy living. Future studies that use randomized controlled trials are needed to establish causality for wellness coaching.

Motivational improvements for health behavior change from wellness coaching.

OBJECTIVES: To identify client priorities prior to wellness coaching, and examine motivational improvements for health behaviors on follow-up. METHODS: Clients completed a wellness questionnaire at baseline (before coaching) and at a 3-month follow-up. Overall, 177 participants (92% female, average age 42.9 (SD 11.2) years) were included in the analysis. Clients indicated priorities for coaching, and levels of importance, confidence, and readiness to change within each domain were compared between baseline and follow-up. RESULTS: Participants identified weight management as their top priority and successfully reduced their BMI. Participants also demonstrated significant improvements in motivation and confidence in most health behavior domains. CONCLUSIONS: These results provide further support for the effectiveness of wellness coaching for weight management and for improving motivational readiness for behavior change.

The effectiveness of wellness coaching for improving quality of life.

OBJECTIVE: To learn more about the potential psychosocial benefits of wellness coaching. Although wellness coaching is increasing in popularity, there are few published outcome studies. PATIENTS AND METHODS: In a single-cohort study design, 100 employees who completed the 12-week wellness coaching program were of a mean age of 42 years, 90% were women, and most were overweight or obese. Three areas of psychosocial functioning were assessed: quality of life (QOL; 5 domains and overall), depressive symptoms (Patient Health Questionnaire-9), and perceived stress level (Perceived Stress Scale-10). Participants were recruited from January 1, 2011, through December 31, 2011; data were collected up to July 31, 2012, and were analyzed from August 1, 2012, through October 31, 2013. RESULTS: These 100 wellness coaching completers exhibited significant improvements in all 5 domains of QOL and overall QOL (P<.0001), reduced their level of depressive symptoms (P<.0001), and reduced their perceived stress level (P<.001) after 12 weeks of in-person wellness coaching, and they maintained these improvements at the 24-week follow-up. CONCLUSION: In this single-arm cohort study (level 2b evidence), participating in wellness coaching was associated with improvement in 3 key areas of psychosocial functioning: QOL, mood, and perceived stress level. The results from this single prospective cohort study suggest that these areas of functioning improve after participating in wellness coaching; however, randomized clinical trials involving large samples of diverse individuals are needed to establish level 1 evidence for wellness coaching.