Visual aid for pediatric virtual musculoskeletal exams: A Barbie girl in a telehealth world.

BACKGROUND: Telehealth is rapidly advancing, yet musculoskeletal physical examinations pose a unique challenge with limited clinically tested tools. OBJECTIVE: To measure whether visual aid use improves accuracy and efficiency of musculoskeletal exam maneuvers within a mock pediatric telehealth encounter. DESIGN: Randomized controlled trial. SETTING: Mock telehealth encounter. PARTICIPANTS: A total of 30 volunteer dyads of children aged 4-17 years old and their parent/guardian. To be eligible to participate, the parent/guardian was required to speak and read English proficiently and have access to Zoom technology on a personal electronic device. INTERVENTION: The control group received verbal prompts to complete 12 musculoskeletal exam maneuvers. The intervention group had the addition of a Barbie (Mattel) visual aid. MAIN OUTCOME MEASURES: Primary outcomes were accuracy (number of completed maneuvers) and efficiency (total verbal prompts, total time). Secondary outcomes were ratings of comfort using telehealth technology, ease of understanding, and perceived usefulness of the visual aid. Standard multiple regression analysis was employed, with significance defined as a p value <.05. RESULTS: The intervention group completed an average of 11.67 ± 0.7 maneuvers versus 11.27 ± 1.0 in the control group (p = .21), 13:31 ± 4.02 total time (mm:ss) versus 14:47 ± 4:04 (p = .05), and 4.87 ± 4.4 verbal prompts versus 8.40 ± 4.6 (p = .04), respectively. The overall model of group allocation controlling for age was not statistically significant for total maneuvers (p = .255), total time (p = .061) or total verbal prompts (p = .095). However, group allocation significantly predicted total verbal prompts (p = .032), with participants in the intervention group requiring an average of 4.1 fewer prompts. All participants in the intervention group rated the visual aid as 'definitely helpful'. CONCLUSION: Visual aid use improved virtual musculoskeletal exam maneuver ease and efficiency in a pediatric population.

Three derivatives of phenacyldiphenylphosphine oxide: influence of aromatic and alkyl substituents on the luminescence sensitization of four Ln(NO3)3 salts.

A series of four ß-carbonylphosphine oxide compounds have been synthesized, and their complexes with the nitrate salts of Sm3+, Eu3+, Tb3+ and Dy3+ have been characterized in solution and in the solid state. Analysis of the complexes using IR and NMR suggests that metal-ligand binding occurs mainly through the phosphine oxide group of the ligand, with some involvement of the carbonyl group. All 16 complexes luminesce in solutions of acetonitrile, albeit with varying degrees of intensity. The highest quantum yield values obtained for this series are those where the ligand contains an aryl carbonyl group paired with an electron rich phosphine oxide group (29.8 and 11% for the Tb3+ and Eu3+ complexes, respectively). In contrast, the longest emission lifetime values were found for complexes where the ligand contains a bulky substituent on the carbonyl group paired with an electron rich phosphine oxide (1.86, 1.402, 0.045 ms for the Tb3+, Eu3+ and Sm3+ complexes, respectively).