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BACKGROUND: Ulnar collateral ligament reconstruction (UCLR) has afforded baseball players with excellent results; however, previous studies have described only short-term outcomes. PURPOSE: To evaluate long-term outcomes after UCLR in baseball players. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: All UCLRs performed on competitive baseball players with a minimum 10-year follow-up were identified. Surgical data were collected prospectively and patients were surveyed by telephone follow-up, during which scoring systems were used to assess baseball career and post-baseball career outcomes. RESULTS: Of 313 patients, 256 (82%) were contacted at an average of 12.6 years; 83% of these baseball players (90% pitchers) were able to return to the same or higher level of competition in less than 1 year, but results varied according to preoperative level of play. Baseball career longevity was 3.6 years in general and 2.9 years at the same or higher level of play, but major and minor league players returned for longer than did collegiate and high school players after surgery (P < .001). Baseball retirement typically occurred for reasons other than elbow problems (86%). Many players had shoulder problems (34%) or surgery (25%) during their baseball career, and these occurrences most often resulted in retirement attributable to shoulder problems (P < .001). For post-baseball career outcomes, 92% of patients were able to throw without pain, and 98% were still able to participate in throwing at least on a recreational level. The 10-year minimum follow-up scores (mean ± standard deviation) for the Disabilities of the Arm, Shoulder and Hand (DASH), DASH work module, and DASH sports module were 0.80 ± 4.43, 1.10 ± 6.90, and 2.88 ± 11.91, respectively. Overall, 93% of patients were satisfied, with few reports of persistent elbow pain (3%) or limitation of function (5%). CONCLUSION: Long-term follow-up of UCLRs in baseball players indicates that most patients were satisfied, with few reports of persistent elbow pain or limitation of function. During their baseball career, most of these athletes were able to return to the same or higher level of competition in less than 1 year, with acceptable career longevity and retirement typically for reasons other than the elbow. According to a standardized disability and outcome scale, patients also had excellent results after UCLR during daily, work, and sporting activities.

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OBJECTIVE: To determine if written feedback improves the chart documentation and knowledge of physicians doing evaluations for child sexual abuse and to learn what other factors are associated with better documentation and knowledge. DESIGN: Randomized, controlled trial. SETTING: A statewide network of physicians performing child abuse evaluations. PARTICIPANTS: All physicians who performed evaluations for sexual abuse during 1991 to 1992. One hundred forty-seven physicians were randomized to control (n = 75) and intervention (n = 72) groups, 122 (83%) remained at follow-up, and 87 of the 122 (71%) had done evaluations for child sexual abuse. INTERVENTIONS: Tailored written feedback based on chart reviews and relevant articles were sent to a randomly selected one-half of the physicians during a 3-month period. MAIN OUTCOME MEASURES: The quality of documentation and physician knowledge before and after the intervention. RESULTS: Documentation by chart review of up to five randomly chosen records per physician (preintervention, n = 552; postintervention, n = 259) by reviewers blinded to intervention status and physician knowledge was assessed by survey (78% completion). Change in documentation and knowledge for physicians in the intervention group was not statistically significant compared with the control group. The risk ratio for a mean overall history rating of excellent/good was 0.89 (0.63, 1.25) and for a mean overall physical examination rating of excellent/good was 1.03 (0.73, 1.45). Both groups improved significantly during the time period. The largest improvements in the time period were in documenting the history of where abuse occurred, in the physical examination position, hymenal description, penile findings, and knowing that chlamydia infection should be assessed by culture. A structured medical record, female physicians, and credits in continuing medical education were associated with better documentation. CONCLUSIONS: Tailored feedback to the physician with directed educational materials did not seem to improve most aspects of documentation and knowledge of child sexual abuse, although notable improvement was seen during the time period studied. This study suggests that chart audits may not be the best use of resources for trying to improve physician behavior; credits in continuing medical education and use of structured records may be more likely to be beneficial.

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The purpose of this quasi-experimental study was to determine the effectiveness of an occupation based health and fitness program. Subjects were 1,504 police trainees (85% male, 15% female) with an ethnic distribution of 82% white, 16% African American, and 2% other. Data were collected at 25 sites across the state of North Carolina. The sites were randomly assigned to either the experimental group (implemented the intervention) or the control group (continued usual training). As compared with controls, subjects at the experimental sites improved significantly in cardiovascular fitness (aerobic power), general muscular strength (number of sit ups per minute), and flexibility, and lowered their body fat. The intervention required minimal equipment and was taught primarily by peers who received a 1 week training program. This occupational approach to improving health could be particularly useful in occupations with many workers who seldom engage in leisure time physical activity.

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Many studies over the last 20 years have used logistic regression to model the relationship between the risk of developing coronary heart disease (CHD) and the levels of risk factors such as high blood pressure, high serum cholesterol, and cigarette smoking. Subsequently, several investigators have proposed the use of some of the published estimated logistic risk functions to predict risk in new populations. Because of great variation in definition of event, duration of follow-up, population characteristics, definition of risk variables, and selection of other variables in the logistic functions, direct use of such established functions would generally not have validity for the prediction of absolute risk levels. A review of fifteen of these studies indicates on the one hand generally similar results in direction and order of magnitude of effects of the major risk factors, confirming the importance of these risk factors of CHD. On the other hand the reviews indicate sufficient variation to suggest that extrapolation to new populations even to predict relative risk is not justified.

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This article is intended for behavioral and biomedical researchers who have become involved increasingly in health promotion research in social settings. It describes how researchers may more precisely plan and profit from employing formative evaluation, which is too frequently more casually undertaken than is summative evaluation. Formative evaluation includes responses from the student subjects of such programs and school administrative and instructional staff, as well as other elements unique to the school setting such as existing curricula and the logistics of time and space. In order to tailor such programs to the unique properties of the school setting, a continual feedback loop should be in place. Such loops can channel both quantitative and qualitative data to the researcher to assist in adapting projects to changing conditions during the course of their implementation. This article presents a case history of the application of formative evaluation drawn from a health promotion project conducted by the authors. It includes as background for this case history, definitions of formative evaluation and an analysis of its costs.

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Scleromyxedema (generalized lichen myxedematosus) is a rare variant of papular mucinosis characterized clinically by generalized waxy papules and marked cutaneous induration. Histologically, there is fibromucinous infiltration of the superficial dermis. Most patients also have had a monoclonal serum protein of cathodal mobility. The case to be presented is remarkable for the following reasons: 1. the presence of esophageal aperistalsis; 2. the presence of prominent dermal eosinophilia; and 3. the absence of a serum monoclonal paraprotein.

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An outbreak of disease in young pigeons associated with a herpesvirus is reported. The clinical history, macroscopic and microscopic appearance of lesions and virus isolation are described. Most affected birds showed lesions in the upper alimentary tract epithelium as well as in skin, nasal mucosa and salivary glands. Lesions in liver, spleen and pancreas were uncommon. A herpesvirus capable of producing CPE on tissue culture and lesions on chorioallantoic membrane of developing chicken embryos was isolated and described. Inoculation of experimental pigeons with the virus failed to reproduce the disease.

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