How Does A Structured Review Instrument Impact Learning at Resident Journal Club?

Journal club article review is an integral aspect of graduate medical education. A structured review instrument (SRI) is a checklist form that serves to guide through critical appraisal of the literature. The goal of this study was to objectively evaluate the effect of an SRI on journal critical appraisal in foot and ankle residency programs. A prospective study evaluated resident critical appraisal of journal club articles at 2 residency sites. Baseline resident critical appraisal scores were obtained the first 5 months of the academic year. The SRI form was then implemented into journal club sessions starting the sixth month until the end of the academic year. Resident critical appraisal scores were then compared. The use of SRI significantly improved resident scores compared with pre-SRI assessment scores (p < .001). The SRI tool is easily implemented and makes measurable improvement in resident critical appraisal of the reviewed literature. The use of an SRI tool should be considered in all residency programs to improve resident critical appraisal skills. Further study is warranted to determine specific competencies in which SRI provide the most benefit.

Lesser Digit Implants.

Lesser digit deformities that require surgical intervention may be corrected by interphalangeal arthrodesis. The traditional fixation device used to stabilize an interphalangeal arthrodesis is a smooth Kirschner wire (K-wire). Its use, however, has been associated with risks. The K-wires are known to migrate and break, and there are increased risks of pin tract infection. Choices for digital implants include nonresorbable, resorbable, and allograft. There are more than 60 newer intramedullary fixation devices available for use in digital surgery. Intramedullary implants also have their own inherent risks. Further research into patient outcomes and cost-effectiveness of these new devices is still needed.

Joint Clinical Consensus Statement of the American College of Foot and Ankle Surgeons® and the American Association of Nurse Practitioners®: Etiology, Diagnosis, and Treatment Consensus for Gouty Arthritis of the Foot and Ankle.

Gout is a condition that commonly affects the foot and ankle, and practitioners who treat these structures should be aware of the methods to diagnose and treat this form of arthritis. Practitioners also need to recognize extra-articular manifestations of the disease. Although the acutely red, hot, swollen joint is a common presentation, chronic tophaceous gout can be associated with pain, nodule formation, and cutaneous compromise. Since the underlying causes that lead to excessive monosodium urate deposition may be treatable, early and accurate diagnosis can be very beneficial and may even prevent articular degeneration.

Dual-Component Intramedullary Implant Versus Kirschner Wire for Proximal Interphalangeal Joint Fusion: A Randomized Controlled Clinical Trial.

We undertook a multicenter, parallel treatment arm, randomized controlled trial to compare the outcomes after surgery for the treatment of lesser digital hammertoe using either a Kirschner wire or a 2-piece intramedullary, stainless steel implant for fixation of the proximal interphalangeal joint. Our primary aim was to compare the incidence of arthrodesis and complications, and our secondary aim was to compare the subjective foot-related outcomes measured using the Bristol Foot Score and the Foot Function Index, stratified by fixation group. We hypothesized that the use of the dual-component implant would result in greater patient satisfaction, a greater incidence of radiographic arthrodesis, and fewer complications after hammertoe repair. The overall mean age of the participants was 58.72 ± 13.48 (range 18 to 84) years, their mean body mass index was 30.14 ± 6.55 (range 20.7 to 46.98) kg/m(2), and no statistically significant differences in the demographic variables were present between the treatment groups at baseline or during the follow-up period. Of the 91 participants, 46 (50.55%) were randomly allocated to the Kirschner wire group and 45 (49.45%) to the intramedullary implant group. No statistically significant differences were observed between the 2 fixation groups in the incidence of complications; however, the 2-piece intramedullary implant group was associated with a greater mean Bristol Foot Score and Foot Function Index score and a greater incidence of fusion.

Basin-wide analysis of the dynamics of fecal contamination and fecal source identification in Tillamook Bay, Oregon.

The objectives of this study were to elucidate spatial and temporal dynamics in source-specific Bacteroidales 16S rRNA genetic marker data across a watershed; to compare these dynamics to fecal indicator counts, general measurements of water quality, and climatic forces; and to identify geographic areas of intense exposure to specific sources of contamination. Samples were collected during a 2-year period in the Tillamook basin in Oregon at 30 sites along five river tributaries and in Tillamook Bay. We performed Bacteroidales PCR assays with general, ruminant-source-specific, and human-source-specific primers to identify fecal sources. We determined the Escherichia coli most probable number, temperature, turbidity, and 5-day precipitation. Climate and water quality data collectively supported a rainfall runoff pattern for microbial source input that mirrored the annual precipitation cycle. Fecal sources were statistically linked more closely to ruminants than to humans; there was a 40% greater probability of detecting a ruminant source marker than a human source marker across the basin. On a sample site basis, the addition of fecal source tracking data provided new information linking elevated fecal indicator bacterial loads to specific point and nonpoint sources of fecal pollution in the basin. Inconsistencies in E. coli and host-specific marker trends suggested that the factors that control the quantity of fecal indicators in the water column are different than the factors that influence the presence of Bacteroidales markers at specific times of the year. This may be important if fecal indicator counts are used as a criterion for source loading potential in receiving waters.