Promotion and Tenure Database Creation and Utilization: A 12-Year History.

Trends in faculty demographic composition, promotion success, and retention are important considerations in Academic Health Centers (AHC). This paper reviews the design, implementation, and utility of a faculty promotion and tenure (P&T) database (PROMO/TE©) over 12 years in a large southwestern academic health center. Review of the system design, portfolio creation, P&T tracking, interface with other faculty databases, and lessons learned will be offered. PROMO/TE© was developed to improve the P&T packet creation, application, and review process in one College and was expanded to other colleges at the AHC. The PROMO/TE© system is integrated with Workday® and FACFACTS© to track trends in recruitment, attrition, and P&T trends across gender, underrepresented minorities, and other subgroups. PROMO/TE© has several advantages including improving communication, transparency, uniformity, and efficiency in the P&T packet creation, application, and review process. Increased cost savings ($217,198 annually) were noted with elimination of hard copy packets and decreased time spent. The first college reviewed 743 dossiers in the PROMO/TE© system since its creation in 2012 and there has been on average a 10% increase in P&T approvals since its inception. PROMO/TE© facilitates and tracks trends in the P&T process and has many benefits as well as significant cost savings. PROMO/TE© serves as a potential model for other institutions.

Pediatric Phalanx Fractures.

Phalangeal fractures are the most common type of hand fracture that occurs in the pediatric population and account for the second highest number of emergency department visits in the United States for fractures. The incidence of phalangeal fractures is the highest in children aged 10 to 14 years, which coincides with the time that most children begin playing contact sports. Younger children are more likely to sustain a phalangeal fracture in the home setting as a result of crush and laceration injuries. Salter-Harris type II fractures of the proximal phalanx are the most common type of finger fracture. An unmineralized physis is biomechanically weaker compared with the surrounding ligamentous structures and mature bone, which make fractures about the physis likely. A thorough physical examination is necessary to assess the digital cascade for signs of rotational deformity and/or coronal malalignment. Plain radiographs of the hand and digits are sufficient to confirm a diagnosis of a phalangeal fracture. The management of phalangeal fractures is based on the initial severity of the injury and depends on the success of closed reduction techniques. Nondisplaced phalanx fractures are managed with splint immobilization. Stable, reduced phalanx fractures are immobilized but require close monitoring to ensure maintenance of fracture reduction. Unstable, displaced phalanx fractures require surgical management, preferably via closed reduction and percutaneous pinning.

Pediatric Distal Radius Fractures.

Distal radius fractures are the most common orthopaedic injury that occur in the pediatric population. The annual incidence of distal radius fractures has increased as a result of earlier participation in sporting activities, increased body mass index, and decreased bone mineral density. Most distal radius fractures are sustained after a fall onto an outstretched arm that results in axial compression on the extremity or from direct trauma to the extremity. Physeal fractures of the distal radius are described based on the Salter-Harris classification system. Extraphyseal fractures of the distal radius are described as incomplete or complete based on the amount of cortical involvement. A thorough physical examination of the upper extremity is necessary to rule out any associated injuries. PA and lateral radiographs of the wrist usually are sufficient to diagnose a distal radius fracture. The management of distal radius fractures is based on several factors, including patient age, fracture pattern, and the amount of growth remaining. Nonsurgical management is the most common treatment option for patients who have distal radius fractures because marked potential for remodeling exists. If substantial angulation or displacement is present, closed reduction maneuvers with or without percutaneous pinning should be performed. Patients with physeal fractures of the distal radius that may result in malunion who present more than 10 days postinjury should not undergo manipulation of any kind because of the increased risk for physeal arrest.

Pediatric Scaphoid Fractures.

Scaphoid fractures are the most common type of carpal injuries that occur in children and adolescents. The injury pattern seen in children and adolescents who have scaphoid fractures has recently shifted to resemble that of adults who have scaphoid fractures, with scaphoid waist fractures being the most common injury pattern. This shift has been attributed to increased body mass index in children and adolescents as well as more intense participation in extreme sports by both children and adolescents. The diagnosis of scaphoid fractures is based on both a clinical examination and radiographic fi ndings. If a scaphoid fracture is clinically suspected but initial radiographs are negative, cast immobilization followed by repeat imaging can lead to accurate diagnosis of the injury. MRI can aid in the diagnosis of a scaphoid injury in pediatric patients with incomplete ossifi cation of the scaphoid. Acute nondisplaced scaphoid fractures have a high rate of healing with cast immobilization; however, surgery should be considered in patients who have displaced scaphoid fractures with delayed presentation. In general, patients with scaphoid fractures who undergo appropriate treatment and achieve successful union have excellent long-term functional outcomes.

Readability of Patient Education Materials in Hand Surgery and Health Literacy Best Practices for Improvement.

PURPOSE: This study aimed to update a portion of a 2008 study of patient education materials from the American Society for Surgery of the Hand Web site with new readability results, to compare the results to health literacy best practices, and to make recommendations to the field for improvement. METHODS: A sample of 77 patient education documents were downloaded from the American Society for Surgery of the Hand Web site, handcare.org, and assessed for readability using 4 readability tools. Mean readability grade-level scores were derived. Best practices for plain language for written health materials were compiled from 3 government agency sources. RESULTS: The mean readability of the 77 patient education documents in the study was 9.3 grade level. This reading level is reduced from the previous study in 2008 in which the overall mean was 10.6; however, the current sample grade level still exceeds recommended readability according to best practices. CONCLUSIONS: Despite a small body of literature on the readability of patient education materials related to hand surgery and other orthopedic issues over the last 7 years, readability was not dramatically improved in our current sample. Using health literacy as a framework, improvements in hand surgery patient education may result in better understanding and better outcomes for patients seeing hand surgeons. CLINICAL RELEVANCE: Improved understanding of patient education materials related to hand surgery may improve preventable negative outcomes that are clinically significant as well as contribute to improved quality of life for patients.

Assessment of Telemedicine and Phone Consultation Effects on Rate of Hand Transfers to Trauma Centers and Specialty Services Referrals.

BACKGROUND: Telemedicine consultation can increase patients' access to subspecialty care and decrease the number of unnecessary hospital transfers. In 2014, the Arkansas Hand Trauma Telemedicine Program (AHTTP) was established to extend specialized hand care throughout Arkansas. The purpose of this study is to assess whether transfers are affected when consultation with a hand specialist is performed by phone compared with using a live audiovisual consultation. METHODS: We reviewed data from the first year of the AHTTP. Data collection included type of consultation (telephone only or live audiovisual), need for transfer, and type of transfer (general orthopedic or hand specialist). RESULTS: In 2014, the first year of AHTTP there were 331 hand injuries identified; of those, 298 used the AHTTP with 195 (65%) using telemedicine and 103 (35%) using phone consultation only. The use of video when compared with phone consultation did not significantly affect the decision to transfer (P = .42) or alter the rate of transfer for general orthopedic or hand specialist care (P = .25). CONCLUSIONS: The assessment of both phone and telemedicine modalities showed that there was no significant difference in transfer rates for either consultation, highlighting that communication with a hand surgeon was the key to accurate assessment of the need for transfer.

A Novel Telemedicine System for Care of Statewide Hand Trauma.

Background: Telemedicine is an evolving tool to increase patients' access to subspecialty care. Since 2014, Arkansas has been utilizing telemedicine in the evaluation of patients with hand injuries. The purpose of this study is to assess the effect of this novel telemedicine system for the management of hand trauma on patient transfer. Methods: We reviewed data from the first year of the telemedicine program (2014) and compared it to data from the year prior (2013). Data collection from both years included number of hand consults and need for transfer. From the 2014 data, we also recorded the use of telemedicine, type of transfer, distance of transfer, and time to disposition. Results: During 2013 (pre-telemedicine), there were 263 hand traumas identified. In all, 191 (73%) injuries required transfer to a higher level of care, while 72 (23%) were managed locally. In the first year of the telemedicine program (2014), a total of 331 hand injuries were identified. A total of 298 (90%) resulted in telemedicine consultation with 65% (195) utilizing video encounters. After telemedicine consultation, local management was recommended for 164 injuries (55%) while transfer was recommended for 134 (45%). Using telemedicine, there was a significant decrease in the percentage of transfer for hand injuries (P < .001). Conclusions: The telemedicine program was well utilized and provided patients throughout the state with continuous access to fellowship trained hand surgeons including regions where hand subspecialty care is not available. The program resulted in a significant decrease in the number of hospital transfers for the management of acute hand trauma.

The Use of Telemedicine Decreases Unnecessary Hand Trauma Transfers.

Purpose: The Arkansas Hand Trauma Telemedicine Program (AHTTP) is a novel telemedicine system that was developed in 2014 within a rural state to address the growing need of access to hand trauma care with one trauma center that cares for mangling hand injuries. The purpose is to compare transfers for hand injuries prior to and after the implementation of this system. Methods: The hospital institutional database was queried for all transfers to a level 1 medical center in the state from 2012 to 2015, allowing the comparison of data prior to and after the institution of the AHTTP. Patient disposition from the emergency department was categorized to evaluate the impact of AHTTP. Distance, mode of transport, and transport cost were assessed. Findings: There were 202 transfers for the treatment of isolated hand trauma (92 from 2012 to 2013 and 110 from 2014 to 2015). Prior to the institution of AHTTP, transfer patients were admitted 47.8% of the time compared with 68.2% of the time after the development of the program (P = .02). The approximate cost of transport for patients who were discharged home directly from the emergency department was 38.5% (US $47,233) of the total costs for the 2012-2013 period and was 21.4% (US $34,017) of the costs for the 2014-2015 period (P < .0001). Conclusions: There was a statistically significant decrease in the number of unnecessary transfers and transportation costs after the telemedicine program was started. The implementation of AHTTP in a rural state reduced health care costs and improved the efficiency of hand specialty care.

Prevalence of Ulnar Artery Thrombosis in Orthopedic Surgeons.

Ulnar artery thrombosis (UAT) occurs most commonly in athletes and manual laborers who repeatedly use their palm in high-impact activities. Anecdotal evidence has shown an increased prevalence of UAT in orthopedic surgeons, especially in joint arthroplasty surgeons, compared with the general population. This study sought to determine the prevalence of UAT among orthopedic surgeons and to identify risk factors for developing UAT. Eighty orthopedic surgeons and residents were included in the study. Participants completed a demographic questionnaire, and a timed Allen test was performed on each hand with the radial artery occluded. A reperfusion result greater than 6 seconds was considered abnormal. Participants with a positive Allen test and UAT-associated symptoms were deemed to have UAT. Statistical analysis was performed using the Fisher exact and Wilcox-on rank-sum tests. The prevalence of UAT was 11% (9 of 80) in the study population compared with 1.6% (21 of 1300) in the general population (P<.0001). For surgeons with 15 years or more of practice, the UAT rate was 24% (8 of 33) compared with 2% (1 of 47) for surgeons with less than 15 years of practice (P=.0030). The prevalence of UAT in adult reconstruction surgeons trended toward significance at 40% (2 of 5) compared with 9% (7 of 75) in the other subspecialties (P=.095). Orthopedic surgeons have an increased risk for developing UAT compared with the general population. The risk of UAT is significantly correlated with advancing years in clinical practice and may be associated with the number of arthroplasty cases performed. [Orthopedics. 2019; 42(5):e415-e422.].

Pediatric Phalanx Fractures.

Phalangeal fractures are the most common type of hand fracture that occurs in the pediatric population and account for the second highest number of emergency department visits for fractures in the United States. The incidence of phalangeal fractures is the highest in children aged 10 to 14 years, which coincides with the time that most children begin playing contact sports. Younger children are more likely to sustain a phalangeal fracture in the home setting as a result of crush and laceration injuries. Salter-Harris type II fractures of the proximal phalanx are the most common type of finger fracture. An unmineralized physis is biomechanically weaker compared with the surrounding ligamentous structures and mature bone, which makes fractures about the physis likely. A thorough physical examination is necessary to assess the digital cascade for signs of rotational deformity and/or coronal malalignment. Plain radiographs of the hand and digits are sufficient to confirm a diagnosis of a phalangeal fracture. The management of phalangeal fractures is based on the initial severity of the injury and depends on the success of closed reduction techniques. Nondisplaced phalanx fractures are managed with splint immobilization. Stable, reduced phalanx fractures are immobilized but require close monitoring to ensure maintenance of fracture reduction. Unstable, displaced phalanx fractures require surgical management, preferably via closed reduction and percutaneous pinning.