Application of eye and hand interventions in brain magnetic resonance imaging of young children.

Objective: To explore the feasibility of eye and hand interventions in young children during brain magnetic resonance imaging (MRI). Methods: A total of 414 4- to 6-year-old children who underwent brain MRI at our hospital were randomly divided into 4 groups: the routine posture group (n = 105), eye mask group (n = 102), fixed hand apron group (n = 108), and eye mask and fixed hand apron group (n = 99). All the children underwent brain MRI when they were awake (without using sedatives). The success rate of brain MRI and the quality of brain MR images were compared among the four groups. Results: The success rate of brain MRI was the highest in the eye mask and fixed hand apron group (94.9 %), followed by the eye mask group (85.3 %) (P < 0.05). The brain MR image quality was the best for children wearing eye masks and fixed hand aprons (5 points, 69 patients), followed by those wearing eye masks (5 points, 53 patients) (P < 0.05). Conclusion: When children undergo brain MRI, simultaneous eye and hand interventions can greatly improve the success rate of the examination and the quality of MR images. This study protocol was registered at the Chinese clinical trial registry (ChiCTR2100050248).

Hand preference trajectories as predictors of language outcomes above and beyond SES: Infant patterns explain more variance than toddler patterns at 5 years of age.

Prior studies found hand preference trajectories predict preschool language outcomes. However, this approach has been limited to examining bimanual manipulation in toddlers. It is not known whether hand preference during infancy for acquiring objects (i.e., reach-to-grasp) similarly predicts childhood language ability. The current study explored this motor-language developmental cascade in 90 children. Hand preference for acquiring objects was assessed monthly from 6 to 14 months and language skill was assessed at 5 years. Latent class growth analysis identified three infant hand preference classes: left, early right, and late right. Infant hand preference classes predicted 5-year language skills. Children in the left and early right classes, who were categorized as having a consistent hand preference, had higher expressive and receptive language scores relative to children in the inconsistent late right class. Consistent classes did not differ from each other on language outcomes. Infant hand preference patterns explained more variance for expressive and receptive language relative to previously reported toddler hand preference patterns, above and beyond socioeconomic status (SES). Results suggest that hand preference, measured at different time points across development using a trajectory approach, is reliably linked to later language.

RSTN COVID-19 Hand Recovery: Two years on, where are we now?

Hand surgery services were required to rapidly adapt to the coronavirus disease 2019 (COVID-19). Two years following the initial wave, hand surgery units continue to adapt and recover from the pandemic. The aim of the RSTN COVID-19 Hand Recovery survey was to evaluate what adaptions made to hand surgery services during COVID-19 have been maintained in the COVID recovery phase. A survey was distributed to hand surgery units, across the UK and Ireland. The survey was completed by consultant hand surgeons across 39 hospitals. Most practices returned to pre-pandemic standards. The main changes that endured were the increase in consultant-led triaging for referrals and utilisation of video conferencing platforms for teaching and meetings. Changes made during the pandemic, such as increased use of WALANT, out of theatre operating and use of telemedicine were not sustained during the recovery period. The COVID-19 pandemic allowed the opportunity for hand surgery services to adapt their services. Several changes that were implemented have since been proven to be more efficient and equally effective for patients. However, these changes have not been sustained and the barriers preventing permanent implementation should be scrutinised. We call on hand surgery units to evaluate their current practice to ensure that patients are provided a streamlined and sustainable service.

Innovative healthcare solutions: robust hand gesture recognition of daily life routines using 1D CNN.

Introduction: Hand gestures are an effective communication tool that may convey a wealth of information in a variety of sectors, including medical and education. E-learning has grown significantly in the last several years and is now an essential resource for many businesses. Still, there has not been much research conducted on the use of hand gestures in e-learning. Similar to this, gestures are frequently used by medical professionals to help with diagnosis and treatment. Method: We aim to improve the way instructors, students, and medical professionals receive information by introducing a dynamic method for hand gesture monitoring and recognition. Six modules make up our approach: video-to-frame conversion, preprocessing for quality enhancement, hand skeleton mapping with single shot multibox detector (SSMD) tracking, hand detection using background modeling and convolutional neural network (CNN) bounding box technique, feature extraction using point-based and full-hand coverage techniques, and optimization using a population-based incremental learning algorithm. Next, a 1D CNN classifier is used to identify hand motions. Results: After a lot of trial and error, we were able to obtain a hand tracking accuracy of 83.71% and 85.71% over the Indian Sign Language and WLASL datasets, respectively. Our findings show how well our method works to recognize hand motions. Discussion: Teachers, students, and medical professionals can all efficiently transmit and comprehend information by utilizing our suggested system. The obtained accuracy rates highlight how our method might improve communication and make information exchange easier in various domains.

Plasma-activated water: Candidate hand disinfectant for SARS-CoV-2 transmission disruption.

The global epidemic caused by SARS-CoV-2 has brought about worldwide burden and a sense of danger for more than two years, leading to a wide range of social, public health, economic and environmental issues. Self-inoculation through hands has been the primary way for environmental transmission of SARS-CoV-2. Plasma-activated water (PAW) has been reported as an effective, safe and environmentally friendly disinfectant against SARS-CoV-2. However, the inactivating effect of PAW on SARS-CoV-2 located on skin surface and its underlying mechanism of action have not been elucidated. In this study, PAW was prepared using an air-pressure plasma jet device. The antiviral efficiency of PAW1, PAW3, and PAW5 on the SARS-CoV-2 pseudovirus was 8.20 % (±2.88 %), 46.24 % (±1.79 %), and 91.71 % (±0.47 %), respectively. Additionally, determination of PAW's physicochemical properties, identification of major sterile effector in PAW, transmission electron microscopy analysis, malondialdehyde (MDA) assessment, SDS-PAGE, ELISA, and qPCR were conducted to reveal the virucidal mechanism of PAW. Our experimental results suggested that peroxynitrite, which was generated by the synergism of acidic environment and reactive species, was the major sterile effector of PAW. Furthermore, we found that PAW treatment significantly inactivated SARS-CoV-2 pseudovirus through the destruction of its structure of and the degradation of the viral RNA. Therefore, the possible mechanism for the structural destruction of SARS-COV-2 by PAW is through the action of peroxynitrite generated by the synergism of acidic environment and reactive species, which might react with and destroy the lipid envelope of SARS-CoV-2 pseudovirus. Nevertheless, further studies are required to shed light on the interaction mechanism of PAW-inherent RONS and viral components, and to confirm the determinant factors for virus inactivation of SARS-COV-2 by PAW. Therefore, PAW may be a candidate hand disinfectant used to disrupt the transmission of SARS-CoV-2.

Time-independent relationship between digits closure velocity and hand transport acceleration during reach-to-grasp movements.

Prehension movements in primates have been extensively studied for decades, and hand transport and hand grip adjustment are usually considered as the main components of any object reach-to-grasp action. Evident temporal patterns were found for the velocity of the hand during the transport phase and for the digits kinematics during pre-shaping and enclosing phases. However, such kinematics were always analysed separately in regard to time, and never studied in terms of dependence one from another. Nevertheless, if a reliable one-to-one relationship is proven, it would allow reconstructing the digit velocity (and position) simply by knowing the hand acceleration during reaching motions towards the target object, ceasing the usual dependence seen in literature from time of movement and distance from the target. In this study, the aim was precisely to analyse reach-to-grasp motions to explore if such relationship exists and how it can be formulated. Offline and real-time results not only seem to suggest the existence of a time-independent, one-to-one relationship between hand transport and hand grip adjustment, but also that such relationship is quite resilient to the different intrinsic and extrinsic properties of the target objects such as size, shape and position.

Towards higher load capacity: innovative design of a robotic hand with soft jointed structure.

In this paper, the innovative design of a robotic hand with soft jointed structure is carried out and a tendon-driven mechanism, a master-slave motor coordinated drive mechanism, a thumb coupling transmission mechanism and a thumb steering mechanism are proposed. These innovative designs allow for more effective actuation in each finger, enhancing the load capacity of the robotic hand while maintaining key performance indicators such as dexterity and adaptability. A mechanical model of the robotic finger was made to determine the application limitations and load capacity. The robotic hand was then prototyped for a set of experiments. The experimental results showed that the proposed theoretical model were reliable. Also, the fingertip force of the robotic finger could reach up to 10.3N, and the load force could reach up to 72.8N. When grasping target objects of different sizes and shapes, the robotic hand was able to perform the various power grasping and precision grasping in the Cutkosky taxonomy. Moreover, the robotic hand had good flexibility and adaptability by means of adjusting the envelope state autonomously. .

A task-dependent analysis of closed vs. open and fine vs. gross motor skills in handedness.

The traditional classifications of motor skills nature (open vs closed; fine vs gross) have not been considered in handedness investigations. Instead, previous research focused on comparing complex vs less complex motor behaviour, leaving a gap in the literature. We compared manual preference between different motor skill characteristics, namely: fine and closed (FC), gross and closed (GC) and gross and open (GO) tasks. The hand preference was assessed with the Global Lateral Preference Inventory in four hundred and forty participants (244 women) aged from 18 to 59 years old. By assessing the degree and direction of handedness in different motor skills, our results showed a stronger lateralization pattern for FC motor skills as compared to GC and GO, with GO also being less lateralized than GC. Our results expand those of previous investigations that used the motor skill complexity definitions by showing how handedness can also be modulated by the interaction between classic motor skills classifications. Future research should consider fine vs. gross and open vs. closed classifications when selecting tasks for analysis of asymmetries of preference.

Effects of repeated unihemispheric concurrent dual-site tDCS and virtual reality games on motor coordination of sedentary adolescent girls.

BACKGROUND: This study investigated the effects of repetitive unihemispheric concurrent dual-site anodal transcranial direct current stimulation (a-tDCSUHCDS) associated with the use of virtual reality games (VR) on the motor coordination of sedentary adolescent girls. METHODS: Thirty-six inactive adolescent girls were randomly assigned into 3 groups (n = 12 per group): (1) VR + a-tDCSUHCDS, (2) VR + sham-tDCSUHCDS, and (3) Control. The VR + a-tDCSUHCDS and VR + s-tDCSUHCDS groups received the intervention three times a week for four weeks. In each experimental session, participants first received either 20 min of a-tDCSUHCDS (2 mA at each anodal electrode) targeting the primary motor cortex (M1) and the left dorsolateral prefrontal cortex (DLPFC) or sham and then performed VR for 1 h. The control group received no intervention. Eye-hand coordination (EHC) and bimanual coordination (BC) were measured at baseline, post-intervention, and two weeks later (retention test) using the automatic scoring mirror tracer and continuous two-arm coordination test, respectively. RESULTS: Results showed that the EHC was significantly higher in the VR + a-tDCS and VR + s-tDCS groups at post-intervention (all ps< 0.001) and the retention test (all ps< 0.001) compared to the control group. Moreover, the EHC was significantly higher in the VR + a-tDCS group compared to the VR + s-tDCS group (p = 0.024) at the retention. Similarly, VR + a-tDCS and VR + s-tDCS improved BC compared to the control group at post-intervention (all ps< 0.001) and retention test (all ps< 0.001). In addition, higher BC was observed in the VR + a-tDCS group compared to the VR + s-tDCS group (p< 0.001) at the retention test. CONCLUSIONS: Our results suggest that adding a-tDCSUHCDS to VR over 12 sessions may have an additional effect on VR training for improving and retaining motor coordination in sedentary adolescent girls.

[Clinical application of perforator-based propeller flaps in repair of hand wound].

Objective: To investigate the effectiveness of the perforator-based propeller flaps (PPFs) based on digital artery (DA) and dorsal metacarpal artery (DMA) in repairing hand wounds. Methods: The clinical data of 45 patients with hand wounds between January 2018 and March 2023 were retrospectively analyzed. There were 27 males and 18 females with an average age of 41.2 years (range, 14-72 years). The causes of injury included twist injury in 15 cases, crush injury in 19 cases, and cut injury in 11 cases. The injured parts included 32 cases of digits, 10 cases of dorsal hand, and 3 cases of palmar hand, all of which had tendon, joint, and bone exposure. The time from injury to operation ranged from 2 to 8 hours (mean, 4.3 hours). The wound sizes after debridement ranged from 1.8 cm×1.0 cm to 5.0 cm×3.5 cm. Twenty-eight cases were repaired by the PPFs based on DA and 17 cases were repaired by the PPFs based on DMA. The flap size ranged from 2.5 cm×1.1 cm to 8.5 cm×4.0 cm. The defects of the donor sites in 14 patients were closed directly and the defects in the left 31 patients were resurfaced with free full-thickness skin graft from the proximal medial forearm. Results: All the flaps survived after operation. Two cases of the PPF based on DA and 1 case of the PPF based on DMA underwent partially blisters at the distal end and healed after dressing change. The incisions in the donor site healed by first intention and the skin grafts survived. All patients were followed up 10-33 months, with a mean of 15.4 months. At last follow-up, the static two-point discrimination of the PPFs based on DA and DMA were 4-14 mm and 8-20 mm with the averages of 8.1 mm and 13.3 mm, respectively. According to the Michigan Hand Outcomes Questionnaire, 20 patients were very satisfied with the appearance of the PPF based on DA and 8 patients were satisfied; 8 patients were very satisfied with the appearance of the PPF based on DMA and 9 patients were satisfied. Based on the Vancouver Scar Scale (VSS), the appearance scores of the donor site of the PPFs based on DA and DMA were 2-7 and 4-9, with the averages of 4.2 and 6.1, respectively. Conclusion: The two kinds of PPFs are reliable in blood supply and easy to harvest, which provide a good method for emergency repair of small and medium area wounds in the hand.

HIV-1 and methamphetamine co-treatment in primary human astrocytes: TAARgeting ER/UPR dysfunction.

Objectives: Human immunodeficiency virus 1 (HIV-1) can invade the central nervous system (CNS) early during infection and persist in the CNS for life despite effective antiretroviral treatment. Infection and activation of residential glial cells lead to low viral replication and chronic inflammation, which damage neurons contributing to a spectrum of HIV-associated neurocognitive disorders (HAND). Substance use, including methamphetamine (METH), can increase one's risk and severity of HAND. Here, we investigate HIV-1/METH co-treatment in a key neurosupportive glial cell, astrocytes. Specifically, mitochondria-associated endoplasmic reticulum (ER) membrane (MAM) signaling pathways, such as calcium and the unfolded protein response (UPR), are key mechanisms underlying HAND pathology and arise as potential targets to combat astrocyte dysfunction. Methods: Primary human astrocytes were transduced with a pseudotyped HIV-1 model and exposed to low-dose METH for seven days. We assessed changes in astrocyte HIV-1 infection, inflammation, mitochondrial antioxidant and dynamic protein expression, respiratory acitivity, mitochondrial calcium flux, and UPR/MAM mediator expression. We then tested a selective antagonist for METH-binding receptor, trace amine-associated receptor 1 (TAAR1) as a potetnial upstream regulator of METH-induced calcium flux and UPR/MAM mediator expression. Results: Chronic METH exposure increased astrocyte HIV-1 infection. Moreover, HIV-1/METH co-treatment suppressed astrocyte antioxidant and metabolic capacity while increasing mitochondrial calcium load and protein expression of UPR messengers and MAM mediators. Notably, HIV-1 increases astrocyte TAAR1 expression, thus, could be a critical regulator of HIV-1/METH co-treatment in astrocytes. Indeed, selective antagonism of TAAR1 significantly inhibited cytosolic calcium flux and induction of UPR/MAM protein expression. Conclusion: Altogether, our findings demonstrate HIV-1/METH-induced ER-mitochondrial dysfunction in astrocytes, whereas TAAR1 may be an upstream regulator for HIV-1/METH-mediated astrocyte dysfunction.

Discoloration and Dilemma: A Case Report of Hand-Foot Syndrome Associated With Capecitabine Use.

This case highlights the occurrence of hand-foot syndrome due to the use of an antimetabolite group of drugs, capecitabine, which was used in the chemotherapy of a 56-year-old male patient who was diagnosed with rectosigmoid carcinoma. The patient was diagnosed with rectosigmoid carcinoma two months ago and underwent laparoscopic lower anterior resection and colorectal anastomosis. Subsequently, the patient commenced chemotherapy treatment with a combination of oxaliplatin and capecitabine. The patient presented to us with complaints of loose stools for the past three days, and discoloration of the palms, soles, and tongue was noted and subjected to a biopsy, which revealed features compatible with chronic, nonspecific dermatitis. The occurrence of such palmar-plantar erythrodysesthesia with capecitabine is yet to be extensively studied.

Opportunistic Screening for Osteoporosis Using Hand Radiographs - A Feature Augmentation Study Technique (FAST).

Patients with low bone mineral density (BMD) face an increased risk of fractures, yet are frequently undiagnosed. Consequently, it is imperative to have opportunistically screen for low BMD in patients undergoing other medical evaluations. This retrospective study encompassed 422 patients aged ≥ 50 who underwent both dual-energy X-ray absorptiometry (DXA) and hand radiographs (modality of digital X-ray) from three different vendors within a 12-month period. The dataset was randomly divided into training/validation (n=338) and test (n=84) datasets. we sought to predict osteoporosis/osteopenia and establish correlations between bone textural analysis and DXA measurements. Our results demonstrate that the deep learning model achieved an accuracy of 77.38%, sensitivity of 77.38%, specificity of 73.63%, and an area under the curve (AUC) of 83% in detecting osteoporosis/osteopenia. These findings suggest that hand radiographs can serve as a viable screening tool for identifying individuals warranting formal DXA assessment for osteoporosis/osteopenia.

Segmentary exclusion syndrome in hand traumatology - definition, rehabilitation and orthosis.

BACKGROUND: Segmentary exclusion syndrome is a motor behavioral disorder consisting in non-use or underuse of a limb or limb segment following local inflammation, most often of traumatic origin, primarily affecting the fingers and hand. It can be associated with somatosensory disorder, limitation of range of motion, and pain. PURPOSE OF THE STUDY: The objective of this article is to further describe segmentary exclusion syndrome, and to present practical rehabilitation techniques and strategies focused on prevention, assessment and treatment.

HIV-associated neurocognitive disorder: key implications of the microbiota-gut-brain axis.

HIV-associated neurocognitive disorder (HAND) is now recognized to be relatively common in people living with HIV (PLWH), and remains a common cause of cognitive impairment. Unfortunately, the fundamental pathogenic processes underlying this specific outcome of HIV infection have not as yet been fully elucidated. With increased interest in research related to the microbiota-gut-brain axis, the gut-brain axis has been shown to play critical roles in regulating central nervous system disorders such as Alzheimer's disease and Parkinson's disease. PLWH are characterized by a particular affliction, referred to as gut-associated dysbiosis syndrome, which provokes an alteration in microbial composition and diversity, and of their associated metabolite composition within the gut. Interestingly, the gut microbiota has also been recognized as a key element, which both positively and negatively influences human brain health, including the functioning and development of the central nervous system (CNS). In this review, based on published evidence, we critically discuss the relevant interactions between the microbiota-gut-brain axis and the pathogenesis of HAND in the context of HIV infection. It is likely that HAND manifestation in PLWH mainly results from (i) gut-associated dysbiosis syndrome and a leaky gut on the one hand and (ii) inflammation on the other hand. In other words, the preceding features of HIV infection negatively alter the composition of the gut microbiota (microbes and their associated metabolites) and promote proinflammatory immune responses which singularly or in tandem damage neurons and/or induce inadequate neuronal signaling. Thus, HAND is fairly prevalent in PLWH. This work aims to demonstrate that in the quest to prevent and possibly treat HAND, the gut microbiota may ultimately represent a therapeutically targetable "host factor."

Implementing an Internal Audit: Evaluating Hand Scrub Compliance in a Tertiary Care Hospital.

Background Aseptic protocol adherence and sterilization are the most important factors in a patient's satisfactory recovery after surgery. The standard hand scrubbing procedure helps control infection and keeps the surgical site clean by adhering to aseptic principles. Methods Thirty-six young residents and house officers participated in this prospective audit after ethical clearance was obtained. The World Health Organization (WHO) standard criteria were adhered to both before and after the intervention. Participants were observed in the surgical operation theatre (OT) without prior notice to ensure hand hygiene compliance before surgical procedures. The intervention included a video presentation as well as a live demonstration. Results Only 64.41% (n=23) of residents and house officers followed the recommended standard hand hygiene procedures before the intervention. This percentage rose to 93.92% (n=33) following the intervention, suggesting a noteworthy improvement. Conclusion Significant changes in the acceptance rates for the essential requirements of hand hygiene were observed after the evaluation in the second cycle. Adhering to WHO guidelines for procedures will help reduce the risk of infections and promote awareness of asepsis in practice.

Who Does What in Hand Osteoarthritis Care? A Qualitative Study of Boundary Work Between Rheumatologists and Occupational Therapists in Norway.

Purpose: The pressure on professionals within the healthcare workforce is increasing due to staffing shortages, economic demands and changing care models. Through boundary work theories, our study explores how task-shifting in hand osteoarthritis (OA) care impacts the professional boundaries and division of labor between rheumatologists and occupational therapists (OTs) in Norwegian specialist healthcare. Methodology: Seventeen semi-structured qualitative interviews were conducted at two hospitals in Norway. Participants included ten rheumatologists and five OTs. Data were analyzed using reflexive thematic analysis. Results: The analysis resulted in three themes (1) Forms of responsibility and task transfers, (2) Circumventing the rules to ensure efficient practices and appropriate patient care, (3) Broadening and specializing; movement of professional demarcations. Overall, we found that medical tasks in hand OA care are increasingly delegated to, and adopted by, OTs, blurring the rheumatologist-OT boundary. Some of the task delegations skirted Norwegian legal boundaries, in efforts to streamline clinic operations. OTs expanded their scope of practice by adopting new tasks, whereas rheumatologist increased their specialist status by shedding unwanted tasks. Conclusion: Task shifting between rheumatologists and OTs in hand OA care was characterized by boundary blurring activities. The results support a shift in hand OA management from rheumatologists to OTs.

Flexor Carpi Radialis Tendinitis: A Case Series and Algorithm.

Purpose: Flexor carpi radialis (FCR) tendinitis is an uncommon but important cause of volar radial wrist pain that can be a diagnostic and therapeutic challenge. We present a series of patients with FCR tendinitis managed successfully with an algorithm developed by the senior author. Methods: A retrospective review of patients treated for FCR tendinitis at a hand practice was performed. The percent of the FCR rupture, determined with magnetic resonance imaging (MRI) and intraoperative confirmation, determined specific treatment. Patients with less than 50% rupture on MRI were treated conservatively. Surgery was indicated if this failed to yield relief or MRI suggested >50% rupture. On intraoperative examination, patients with less than 50% rupture underwent tenosynovectomy and excision of trapezial osteophytes. Patients with greater than 50% rupture underwent an FCR-sacrificing procedure. Patient-reported outcomes including severity of pain with activities of daily living and ability to return to previous levels of activity were obtained. Results: Sixteen patients were treated for FCR tendinitis. Five were treated conservatively, with complete relief of symptoms and return to full activity without sequelae in three of five cases. Four of the 11 surgical patients were found to have <50% tendon rupture and underwent an FCR-sparing procedure. The remaining seven patients had >50% tendon involvement, which required an FCR-sacrificing procedure. All surgical patients achieved satisfactory results in both functional and clinical outcomes. Conclusions: This series demonstrates acceptable patient outcomes using the described FCR algorithm utilizing 50% FCR involvement as a benchmark. Type of study/level of evidence: Therapeutic IV.

Simple, Office-Based Intervention Improves Patient-Provider Relationship in New Patient Hand Visits.

Purpose: Effective patient-doctor communication is linked to improved patient functional and physiological health status, better adherence to physician recommendations, and increased patient satisfaction. However, studies show that patients have difficulty understanding and recalling information discussed during a medical encounter. The purpose of this study was to assess patient engagement, patient-doctor communication, and patient-doctor interactions with the utilization of a patient encounter card to help aid in communication. Methods: New patients presenting to a single hand surgeon during an 8-month period between 2019 and 2020 were recruited for this study. Patients were recruited in pre and postintervention phases, defined by the rollout of a patient encounter card. Patients studied in the preintervention group were defined as the control population and experienced a typical office visit. The postintervention group experienced a typical office visit with the addition of a patient encounter card distributed to patients prior to meeting with the physician and screened by the physician during the visit to guide the encounter. Patient satisfaction and engagement surveys were collected during patient checkout process. Results: Two hundred eighty-seven patients (70% participation rate) were enrolled in the preintervention (145) and postintervention (142) phases. The utilization of a patient encounter card for setting a visit agenda resulted in a significant increase in self-reported patient engagement, improving from 74% to 88%. In both phases, 98% of patients felt that the physician listened well or very well and reported high levels of confidence in the provider being able to address their primary health concerns (72% and 79%, respectively). Overall, patient satisfaction was maintained pre and postintervention (96% and 98%, respectively). Conclusions: Use of the encounter card improved patients' feelings of engagement during their visits. Further research is required to determine the impact of these tools on providers' engagement and patient outcomes to improve quality of care in hand surgery. Type of study/level of evidence: Therapeutic II.