The Functional Dexterity Test in Adult Populations: An Exploration of a Simplified Test Protocol and Parameters Guided by Statistical Outcomes.

BACKGROUND: The Functional Dexterity Test (FDT) is a standardized assessment used to quantify dexterity, in-hand manipulation, related to function. Recommendations to modify the scoring have been proposed to eliminate penalties, adapt the test protocol, and change the outcome parameter. A new psychometrically sound scoring system has been used in the pediatric population; however, research in the adult population requires exploration. PURPOSE: The purpose of this study was to test if alterations in test administration, outcome recording, and outcome parameters show predictive validity for measured outcomes for age, ethnicity, and self-identified gender. The new method of administering the FDT eliminates penalties for improper performance and uses a score of speed derived from the timed score. It was theorized that eliminating assessment of reported errors in quality of movement in the quantitative scoring may improve the test validity. STUDY DESIGN: Clinical Measurement. METHODS: The FDT was administered to 148 healthy adults aged between 18 and 78 years. No penalties were included in the quantitative scoring. Age, self-identified gender, ethnicity, and self-reported hand dominance were recorded. Time to complete the test was measured in seconds per usual protocol. The result was recorded as time and calculated as speed. Linear regression was performed to predict FDT speed from age, hand dominance, and self-identified gender. RESULTS: The three predictors (age, hand dominance, and gender) associated with a linear decline in dexterity were significant (p ≤0.02). Dexterity showed a linear decline with age, and participants showed faster speeds with the dominant hand. Gender was a significant predictor of speed, with males having faster speeds by an average of 0.047 pegs per second (p = 0.01). CONCLUSIONS: Scores using a simplified administration and speed as an outcome showed moderate predictive validity with age, gender, and the dominant hand used in this adult population. Future research exploring relationships with activities of daily living is needed.

Striking a Better Integration of Work and Life: Challenges and Solutions.

Plastic surgeons are a diverse group but share a drive for excellence and dedication to their patients and the advancement of the specialty. Long hours at work and the need to be on call have limited the time that many have to spend on activities outside of the workplace. Reconciliation of the demands of surgery and private life can at times seem impossible. A failure to achieve balance between work and home life is associated with reduced job and life satisfaction, impaired mental health, family conflict, and ultimately burnout. Although the obstacles are many and varied, the authors have attempted to identify the challenges and propose solutions. The authors focus on women in plastic surgery in this article, but acknowledge that these issues are not unique to women or plastic surgery.

Safety in office-based full abdominoplasty.

BACKGROUND: As demand for outpatient procedures has increased, abdominoplasties are now judiciously being performed in accredited outpatient facilities. Previous reports on outpatient abdominoplasties are limited by small cohorts and have not distinguished among different types of body contouring procedures. Furthermore, these reports included patients who remained in the hospital overnight, rather than patients who were discharged within hours postoperatively. OBJECTIVES: The authors review a case series of patients who underwent full abdominoplasty procedures performed in an outpatient facility with same-day discharge. METHODS: Charts were retrospectively reviewed for 319 consecutive patients who underwent full abdominoplasty with the senior author (CLM) between 1992 and 2010. The charts of 206 patients for whom complete electronic medical record data were available were analyzed as a separate cohort. Demographic, operative, and postoperative data were collected. Systemic and local complications were assessed, as were revision rates. RESULTS: No patients in this series developed any systemic complications, including deep venous thrombosis or pulmonary embolism, blood transfusion, intra-abdominal perforation, or death. The most common local complication was seroma, at a rate of 19.4%. CONCLUSIONS: This report serves to add to the literature a large cohort of patients who underwent full abdominoplasty and were discharged within hours of surgery. The study shows that full abdominoplasty procedures can be safely performed without systemic complications in an outpatient setting. Based on these data, the ever-present sentiment that abdominoplasty is the plastic surgery procedure associated with the highest rate of venous thromboembolism should be carefully evaluated. LEVEL OF EVIDENCE: 4.

Clinical and ultrasonographic features of abdominal tuberculosis in HIV positive adults in Zambia.

BACKGROUND: The diagnosis of abdominal tuberculosis (TB) is difficult, especially so in health care facilities in developing countries where laparoscopy and colonoscopy are rarely available. There is little information on abdominal TB in HIV infection. We estimated the prevalence and clinical features of abdominal (excluding genitourinary) TB in HIV infected adults attending the University Teaching Hospital, Zambia. METHODS: We screened 5,609 medical inpatients, and those with fever, weight loss, and clinical features suggestive of abdominal pathology were evaluated further. A clinical algorithm was used to specify definitive investigations including laparoscopy or colonoscopy, with culture of biopsies and other samples. RESULTS: Of 140 HIV seropositive patients with these features, 31 patients underwent full evaluation and 22 (71%) had definite or probable abdominal TB. The commonest presenting abdominal features were ascites and persistent tenderness. The commonest ultrasound findings were ascites, para-aortic lymphadenopathy (over 1 cm in size), and hepatomegaly. Abdominal TB was associated with CD4 cell counts over a wide range though 76% had CD4 counts <100 cells/microL. CONCLUSION: The clinical manifestations of abdominal TB in our HIV-infected patients resembled the well-established pattern in HIV-uninfected adults. Patients with fever, weight loss, abdominal tenderness, abdominal lymphadenopathy, ascites and/or hepatomegaly in Zambia have a high probability of abdominal TB, irrespective of CD4 cell count.

Race, place, space: meanings of cultural competence in three child welfare agencies.

Despite a consensus on the need to take culture into account in social services delivery, remarkably little data is available on the processes of culturally competent organizational development. This article addresses how workers, supervisors, and managers involved in culturally competent organizational change perceive the goals and dilemmas of these efforts during the initial stages. Data are drawn from three nonprofit child and family agencies in one metropolitan area. The data demonstrate that cultural competence means disparate and conflicting things to differently positioned members of each organization. The authors argue that conflicts may be inherent in the process of culturally competent organizational development, particularly to the extent that such efforts attempt to redistribute power in the workplace. Efforts to develop cultural competence must identify, surface, and renegotiate these conflicts.