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The purpose of this study was to test the effect of nurse-managed transitional care on the quality of care and functional ability of individuals following discharge from subacute units. Registered nurses employed on subacute units in a skilled nursing facility provided the nurse-managed transitional care. Using a quasi-experimental design, data were collected on admission to the subacute unit, at the time of discharge, 1 week following discharge, and 3 months following discharge on 242 treatment and comparison participants. The treatment group participants' overall function and quality of the care environment were significantly higher than the comparison group at 1 week and 3 months following discharge. Participants did not differ significantly on basic activities of daily living or number of readmissions.

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PURPOSE: The purpose of this study was to determine the value of peer coaching and its influence on behavior change. METHODS: Coaches who were known to be successfully managing their diabetes were paired with individuals who were struggling with behavior change associated with managing diabetes. The pairs were matched according to age, sex, and physical appearance. Coaches met initially with participants in a face-to-face meeting for 1 hour and talked with them once a week for 10 to 15 minutes for the next 8 weeks. The initial interview and subsequent phone conversations focused on the person's problems and efforts at behavior change. RESULTS: At the end of the study, the pairs participated in a videotaped focus group to discuss their views on coaching and its influence on behavior change. Participants reported that coaching was personal, useful in disease management, and helpful in their quest to establish and adhere to routines of care. Participants also reported making progress toward changing their behavior related to diet, exercise, and blood glucose monitoring. Sustained behavior change was not measured. CONCLUSIONS: Peer coaching appears to have merit as a viable, low-cost intervention with the potential of helping individuals with diabetes who need to change their behavior.

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Twenty-eight proximal phalangeal fractures secondary to low-velocity gunshot wounds in 27 patients treated by stable fixation were retrospectively reviewed. Definitive fixation was performed within 1 week of injury. Fractures were stabilized with either a plate, intramedullary spacer, or a combination of both. When necessary, supplemental fixation was achieved with cerclage wires or interfragmentary screws. Twenty fractures with bone loss or comminution were primarily supplemented with iliac crest bone graft. After surgery, the fingers were splinted in 90 degrees of metacarpophalangeal (MP) flexion. An aggressive supervised therapy program was initiated within 24 hours of surgery. The average length of follow-up care was 9 months (range, 3-29 months). Primary union was achieved in all fractures. The average range of motion was 83 degrees for the MP joint and 66 degrees for the proximal interphalangeal joint. The average total active motion (TAM) for the involved digits was 200 degrees (range, 65 degrees-250 degrees). Fractures without intra-articular extension had a significantly better average TAM (213 degrees) than did those with intra-articular extension (169 degrees; p = .05). Primary bone grafting did not adversely effect the final TAM. There were no infections. Early stable fracture fixation of these injuries achieved union, alignment, and early rehabilitation with no appreciable increase in morbidity.

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We describe an unusual case of carpal coalition in an otherwise asymptomatic 28-year-old man. The combination of scaphoid, trapezium, trapezoid and capitate fusion detailed in this article has not, to the best of our knowledge, been previously recorded.

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Members of three classes of pyridinylimidazoles bind with varying affinities to CSBP (p38) kinase which is a member of a stress-induced signal transduction pathway. Based upon SAR and protein homology modeling, the pharmacophore and three potential modes of binding to the enzyme are presented. For a subset of pyridinylimidazoles, binding is shown to correlate with inhibition of CSBP kinase activity, whereas no significant inhibition of PKA, PKC alpha and ERK kinase activity is observed.

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The use of intramedullary fixation for fixation of fractures of the metacarpal and proximal phalanx is reported. Flexible intramedullary rods are used for unstable transverse and short oblique diaphyseal fractures of the proximal phalanx and metacarpal. The fracture site is not opened and the rods are introduced under xray control. The rods are cut flush with the bone so that there is no soft tissue tethering. Intramedullary spacers are used in comminuted metacarpal fractures associated with crush injuries and gunshot wounds. The fracture site is opened and a single rod is placed to fill the intramedullary canal. A supplementary plate may be used to control rotation, and bone graft is usually necessary. A new spacer has been designed that has proximal and distal locking screws to control length and rotation. This also is used routinely with bone graft. The techniques outlined stabilize the fracture site allowing immediate motion postoperatively.

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A retrospective review of 25 consecutive patients with 28 proximal phalangeal fractures was performed. Fractures of the thumb were excluded. Twenty-five fractures were closed and three were open. All fractures were reduced, closed, and fixed using flexible intramedullary fixation with 0.8-mm prebent nails. Fractures amenable to flexible intramedullary fixation include short oblique and transverse fractures. Contraindications include long oblique, spiral, and bicortical comminuted fractures. The average follow-up time was 10 months (range, 2-20). Five patients with six fractures were lost to follow-up evaluation. All of the remaining 23 fractures healed and there were no infections. An average of 2 degrees angulation was seen on anteroposterior x-ray films. One patient showed 4 degrees of angulation on the lateral x-ray film. No shortening was noted. One fracture showed appreciable malrotation of 10 degrees. Flexible intramedullary rodding of specific proximal phalangeal fractures provides excellent results with a low complication rate. Proper selection of fractures and good surgical technique are necessary to avoid complications.

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A 5-year retrospective review of 83 patients with 98 metacarpal fractures was performed. Fractures of the thumb metacarpal were excluded. Ninety-six closed metacarpal fractures were reduced closed and fixed with flexible intramedullary fixation, using multiple 0.8-mm prebent rods. Two open metacarpal fractures were also fixed with this technique. Fractures amenable to flexible intramedullary fixation include short oblique and transverse fractures. Contraindications include long oblique and bicortical comminuted fractures. The average follow-up time was 9 months (range, 2 to 34 months) with 15 patients lost to follow-up examination. All fractures went on to heal. Three complications occurred: backing out of a rod in one case and bending of the rods after repeat trauma in two. There were no infections. Flexible intramedullary nailing of specific metacarpal fractures affords excellent results with a low complication rate. Proper selection of fractures and good surgical technique are necessary to avoid complications.

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A 4-year retrospective review of 59 consecutive upper extremity abscesses associated with drug abuse by injection is reported. There were 57 patients, with the most common location being the forearm. All abscesses were treated with incision, drainage, and intravenous antibiotics. Seventeen patients required more than one debridement; nine were complicated by fasciitis, osteomyelitis, septic arthritis, or septic tenosynovitis. Thirty-one patients had human immunodeficiency virus testing, and nine results were positive. Bacteriology showed the most common organisms to be streptococcus, Staphylococcus aureus, and Eikenella corrodens. Nineteen percent of the abscesses had anaerobes cultured. Most of the organisms cultured were common oral or skin flora.

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Twenty-four cases of osteomyelitis of the hand after human bite were reviewed. The mechanism of injury was equally divided between incisor bites and clenched fists. Eleven of twelve of the clenched-fist injuries showed a tooth mark in the bone or cartilage at the site of inoculation. The incisor bites showed initial infection of the soft tissues or joint with a secondary infection of the bone. Factors leading to the development of osteomyelitis included a delay of more than 24 hours before debridement or inadequate initial treatment. Bacteriologic study commonly showed mixed infections with skin and oral flora. The infections were prone to relapse, and nine patients required more than one surgical debridement.

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Sequential serologic analysis for Actinobacillus pleuropneumoniae was done on 240 commingled feeder swine at 1 and 21 days after purchase and at slaughter. At the beginning of the experiment, mean weight of the pigs was 18.6 kg, and the pigs were maintained to a mean slaughter weight of 109.95 kg. A fourfold increase in antibody titer against Actinobacillus pleuropneumoniae was demonstrated in 28 (12%) pigs. Mean adjusted rate of gain for infected pigs was 0.74 +/- 0.10 kg/d and 0.77 +/- 0.09 kg/d for uninfected pigs. Differences in feed efficiency were not detected between infected and uninfected pigs. Our findings suggested that 5.64 additional days are required for pigs with subclinical infection to reach market weight of 113.6 kg, compared with that for uninfected herdmates. A vaccination program to prevent subclinical infection may not be cost effective.

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The results of early stable fixation of 64 metacarpal fractures due to low-velocity gunshot wounds in 49 patients were reviewed retrospectively. These reconstructive procedures were performed between 1 and 7 days after injury and involved stable internal fixation supplemented with primary iliac crest bone graft in 40 fractures with bone loss or comminution. Postoperatively, the hands were splinted with 90 degrees of metacorpophalangeal flexion while early interphalangeal motion was emphasized. Follow-up averaged 12 months, with a range of 4 months to 7 years. Primary bone union was achieved in all metacarpals. The average range of motion was 65 degrees for the metacarpophalangeal joint, 72 degrees for the proximal interphalangeal joint, and 60 degrees for the distal interphalangeal joint. Complications included two superficial infections. There were no cases of deep infections or persistent draining wounds. Early, stable fracture fixation of these injuries achieved union, alignment, and early rehabilitation with no appreciable increase in morbidity.

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A case of traumatic aneurysm of the vena comitantes of the ulnar artery is reported, which was seen initially as a painful hypothenar mass after blunt trauma. Ligation and excision produced complete relief without recurrence.

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Aflatoxicosis was diagnosed in a small herd of cattle having access to moldy, unharvested sweet corn. Necropsy of 1 cow that died revealed anasarca and a pale tan liver. In this cow, microscopic examination revealed edema of all soft tissues and liver lesions consistent with aflatoxicosis. Samples of corn taken from the field contained 2,365 ng of aflatoxin/g of corn. Weather conditions were conducive to the formation of aflatoxins by Aspergillus flavus and A parasiticus.

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An epizootic of equine infectious anemia (EIA) involved 35 horses on a farm in south Georgia. During a 126-day period, 21 of these horses became seropositive for EIA. After the initial diagnosis in July, the horses were tested every 7 to 10 days. At least one additional horse was found to be seropositive on each testing day. As soon as they were determined to be seropositive, the horses were removed from the herd and sent to slaughter. The removal of the seropositive horses, however, did not stop the epizootic. We believe the initial infection was from a 7-year-old stallion that recently had been purchased or from 1 of 2 mares that were seropositive for EIA on the first test. None of the horses had been tested for EIA at the time of purchase or within 60 days before the epizootic.

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Closed flexible intramedullary biopsy was performed in 24 patients requiring surgical stabilization of 17 pathologic and ten impending pathologic fractures from metastatic carcinoma. The biopsy was positive for carcinoma in 25 of 27 cases and either confirmed the diagnosis of metastatic disease or revealed a carcinoma cell type of unknown origin. The technique of closed biopsy using an intramedullary flexible, large bore, plastic catheter in patients with metastatic carcinoma produced information comparable to other biopsy techniques.

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