Normal Values of the Second Interosseous Pinch: A Measurement of Pure Ulnar-Innervated Intrinsic Muscles of the Hand.

PURPOSE: The second palmar interosseous muscle is innervated solely by the ulnar nerve, and second palmar interosseous pinch (2IP) strength may be a good indicator of ulnar nerve motor function. The goal of this study was to describe the 2IP test and establish its normative values, stratified by age, sex, and dominance. METHODS: Volunteers were recruited to participate in this study at various community locations. Patients over the age of 18 years were eligible for this study. Demographic information on all subjects was collected. The volunteers were asked to pinch a hydraulic pinch gauge between the index and middle finger proximal phalanges with the proximal and distal interphalangeal joints flexed and without recruiting the thumb. Three 2IP measurements were taken for each hand. Descriptive statistics and analysis of covariance were performed to determine the effect of age, sex, dominance, and side on 2IP. We analyzed the 2IP strength using the 2IP test across 3 trials to determine whether it was affected by repeated testing. RESULTS: Two hundred thirty-eight patients met the inclusion criteria (45 ± 21 years, 55% women, 87% right-hand dominant). There was no statistically significant difference between dominant and nondominant hands or among the 3 trials. There was a statistically significant correlation between age and 2IP strength ranging between 0.32 and 0.44 kg. Age and sex showed a statistically significant association with 2IP strength, with patients of older age and women having weaker 2IP. CONCLUSIONS: We determined normative values for 2IP strength using a sample from a normal population. More studies are needed to validate these results. CLINICAL RELEVANCE: Second interosseous pinch strength may be a useful tool to assess ulnar nerve function.

Novel Strategies to Increase COVID-19 Testing Among Underserved and Vulnerable Populations in West Virginia.

This project addressed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing barriers in rural West Virginia by providing testing enhancements that included (1) a flexible testing staff, (2) mobile testing, (3) essential supplies, and (4) specialized testing in communities of color. A total of 142 775 polymerase chain reaction tests were performed from December 2021 through February 2022; positivity rates were 21% and 17% in clinics and mobile testing venues, respectively. The project results showed that, within a statewide network of health care clinics, administrators quickly identified and distributed enhancements and thus reduced testing barriers. (Am J Public Health. 2022;112(S9):S892-S895. https://doi.org/10.2105/AJPH.2022.307004).

Effects of telemedicine triage on efficiency and cost-effectiveness in spinal care.

BACKGROUND CONTEXT: Ambulatory spine referral triage must be optimized to improve both quality of care and access to specialists. PURPOSE: To evaluate cost savings in an existing model of telemedicine/electronic-triage for ambulatory spine referrals. STUDY DESIGN/SETTING: Retrospective review. Institutional spine center. PATIENT SAMPLE: All patients/referrals made to the institutional spine center of a tertiary medical center from 2011 to 2014 were included in the data analysis. OUTCOME MEASURES: Cost savings and efficiency was evaluated based upon intake to appointment time, rate of referral to surgeons versus nonoperative providers, additional testing required, and extrapolated cost savings based on estimated avoidance of unnecessary office visits and travel. METHODS: All ambulatory spine referrals electronically triaged (E-triaged) from 2011 to 2014 were analyzed. The E-triage database was mined for data from intake until triage completion. Hospital electronic medical record system was mined for data on initial clinic visit, tests ordered, follow-up appointments, and presence of surgical encounters. Financial savings from avoiding unnecessary visits were estimated. RESULTS: There were 16,174 records created from 2011 to 2014, of which 10,832 were E-triaged by spine surgeons. E-triage generated 3,718 nonoperative provider visits within our healthcare system. The "saved" surgical consult that was avoided resulted in total estimated savings of $793,835 to the patient population; 4,446 patients were deemed surgical and were offered appointments with a spine surgeon. CONCLUSIONS: Appropriate triage of ambulatory spine referrals improves access and quality of care. E-triage resulted in $800,000 cost savings. Further studies are required to fully evaluate the effects of an E-triage system on ambulatory spinal care.

Possible Ibuprofen-induced kernicterus in a near-term infant with moderate hyperbilirubinemia.

A 36-week gestation newborn was admitted to the neonatal intensive care unit for treatment of primary pulmonary hypertension and possible sepsis. The infant developed hyperbilirubinemia on day 4 of life and peaked on day 5 at a total serum bilirubin of 19 mg/dL. Phototherapy was started on day 4 and continued for 5 days. On day 8 of life, ibuprofen was started for fever; a concurrent total serum bilirubin was 15.7 mg/dL. The subsequent hospital course was uneventful, and discharge occurred on day 22 of life. Because the patient failed a hearing screen at discharge, he was referred for a diagnostic audiology workup. He subsequently failed formal audiometric testing on two occasions one week apart, and was given a diagnosis of auditory dys-synchrony and/or auditory neuropathy, consistent with kernicterus. At 5½ months of age, he was reported to be hypotonic and to have frequent arching movements. Since the total serum bilirubin did not exceed 19 mg/dL, concern was raised that ibuprofen may have caused displacement of bilirubin from its albumin binding site, resulting in kernicterus due to excessive unbound bilirubin concentrations. Ibuprofen should be administered with caution in preterm infants at risk for kernicterus.