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OBJECTIVE: To evaluate functional and radiologic outcome in patients with a Neer type II lateral clavicle fracture treated with the clavicle hook plate. DESIGN: Multicenter retrospective study. SETTING: Five level I and II trauma centers. PATIENTS: Forty-four patients, average age 38.4 years (18-66 years), with a Neer type II lateral clavicle fracture treated with the clavicle hook plate between January 1, 2003, and December 31, 2006. INTERVENTION: Open reduction and internal fixation with the clavicle hook plate. Removal of all 44 implants after consolidation at a mean of 8.4 months (2-33 months) postoperatively. MAIN OUTCOME MEASUREMENTS: At an average follow-up of 27.4 months (13-48 months), functional outcome was assessed with the Constant-Murley scoring system. Radiographs were taken to evaluate consolidation and to determine the distance between the coracoid process and the clavicle. RESULTS: The average Constant score was 92.4 (74-100). The average distance between the coracoid process and the clavicle was 9.8 mm (7.3-14.8 mm) compared with 9.4 mm (6.9-14.3 mm) on the contralateral nonoperative side. We observed 1 dislocation of an implant (2.2%), 2 cases of pseudarthrosis (4.5%), 2 superficial wound infections (4.5%), 2 patients with hypertrophic scar tissue (4.5%), and 3 times an acromial osteolysis (6.8%). Thirty patients (68%) reported discomfort due to the implant. These implant-related complaints and the acromial osteolysis disappeared after removal of the hook plate. With all the patients, direct functional aftercare was possible. CONCLUSIONS: The clavicle hook plate is a suitable implant for Neer type II clavicle fractures. The advantage of this osteosynthesis is the possibility of immediate functional aftercare. We observed a high percentage of discomfort due to the implant; therefore, we advise to remove the implant as soon as consolidation has taken place.

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A 83-year-old woman developed several small abscesses in the palm of her left hand, caused by a scattering, infected false aneurysm of the radial artery where a catheter had been inserted.

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Our objectives were to determine the reporting of symptoms, the medical outcome and the work status of meat plant workers diagnosed with clinical carpal tunnel syndrome (CTS). Forty-seven cases of CTS were identified from a previously reported study, and were matched by age, gender and hand use. Cases and controls were followed up for 24 months. The Provincial Workers' Compensation Board and company health records were used to determine the reporting of symptoms, interventions and work status. Thirty-one study cases and all control cases were followed for the full 24 months (16 study cases were lost to follow-up). In total, 12 cases reported symptoms of CTS during the 24 months (eight study cases and four controls). Of the eight study cases, one required surgical release of the carpal tunnel. After a period of work modification, five of the eight study cases returned to regular duty and the remainder were placed on permanent job restrictions. Of the four controls, one subject had a surgical release and returned to regular work, two subjects' jobs were permanently modified, and the fourth returned to regular duty. Occupation-related CTS in meat packers appears to be transient and responsive to conservative measures, with a surgical rate comparable to other occupations.

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OBJECTIVES: To determine prevalence and incidence of carpal tunnel syndrome (CTS) in a modern meat packing plant. The secondary objective was to explore the relation between ethnicity and CTS. METHODS: Six hundred and sixty five workers were interviewed and examined to find the prevalence of CTS. Subsequently, 421 workers without CTS were followed up and examined at a median interval of 253 days; of those, 333 remained without CTS and were again examined at a median interval of 148 days. RESULTS: The prevalence and incidence of CTS was 21% and 11/100 person-years, respectively. The incidence for Asian mixed, white, and other ethnicities was 12.0, 12.2, and 7.2 cases/100 person-years, respectively. The observed incidence for men and women was 9.7 and 18.4 cases/100 person-years, respectively. This difference was not quite significant (p = 0.068) with an estimated relative risk (women v men) of 1.9 (95% confidence interval (95% CI) 0.9 to 3.8). The interaction between sex and use of tools was significant (p = 0.04), however, although the relative risk for CTS in women who used tools was 4.2 the numbers were small and not significant. The relative risk for men who used tools was 0.64 and not significant. The percentage of incident cases with comorbid disease was only 6.3% (3/47). CONCLUSIONS: The prevalence and incidence of CTS in this workforce were higher than in the general population. However, the prevalence of CTS in this modern, mechanised plant was not significantly different from that reported in older plants. No relation was found between ethnicity, age, body mass index, and CTS for either prevalence or incidence. Comorbid disease among the cases of CTS is significantly less than that found in other industry.

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OBJECTIVE: To describe the development, test-retest reliability, internal consistency, and convergent validity of the McKnight Risk Factor Survey-III (MRFS-III). The MRFS-III was designed to assess a number of potential risk and protective factors for the development of disordered eating in preadolescent and adolescent girls. METHOD: Several versions of the MRFS were pilot tested before the MRFS-III was administered to a sample of 651 4th through 12th- grade girls to establish its psychometric properties. RESULTS: Most of the test-retest reliability coefficients of individual items on the MRFS-III were r > .40. Alpha coefficients for each risk and protective factor domain on the MRFS-III were also computed. The majority of these coefficients were r > .60. High convergent validity coefficients were obtained for specific items on the MRFS-III and measures of self-esteem (Rosenberg Self-Esteem Scale) and weight concerns (Weight Concerns Scale). CONCLUSIONS: The test-retest reliability, internal consistency, and convergent validity of the MRFS-III suggest that it is a useful new instrument to assess potential risk and protective factors for the development of disordered eating in preadolescent and adolescent girls.

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The purpose of this study was to determine the prevalence and incidence of trigger finger (TF) in a meat-packing plant and explore the relationship between hand-tool use and the development of TF. A cross-sectional study was competed wherein 665 workers were interviewed and examined to determine the point prevalence. Subsequently, 454 TF-negative workers were followed up and examined twice at a median interval of 225 days. The point prevalence of TF was 14%. The person-year incidence rate was 12.4% and 2.6% for tool use and non-tool use workers, respectively. Forty-three cases of TF (75.2%) in the incidence arm of the study used a hand tool, for a relative risk of 4.7 (P < 0.002; 95% confidence interval, 1.5-23.9). Although a significant relationship was found between ethnicity and the presence of TF in the prevalence data, this was not confirmed in the incidence study. There is an increased prevalence of TF in this meat-packing plant and high worker turnover may underestimate the true prevalence rates. Hand-tool use increases the risk of developing TF.

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OBJECTIVE: To determine current practice patterns for managing acute myocardial infarction in rural Alberta, particularly to examine the availability of thrombolytic therapy. DESIGN: Mailed questionnaire based on a clinical vignette. SETTING: All 104 acute care hospitals in rural Alberta with fewer than 100 beds. PARTICIPANTS: The Chief of Staff at each hospital. MAIN OUTCOME MEASURES: Proportion of hospitals providing thrombolytic therapy, choice of thrombolytic agent, rates of elective transfer after thrombolysis, and barriers preventing universal use of thrombolytic therapy. RESULTS: Questionnaires were completed by 101 physicians. Three hospitals had no medical staff. Thrombolytic therapy was available in 80.8% of the hospitals. Hospitals that did not offer thrombolysis were smaller (average bed capacity 21.9 versus 37.7, P < 0.001), had fewer medical staff (average number 2.4 versus 5.5, P < 0.001), and had fewer nurses holding Advanced Cardiac Life Support certification (P = 0.015) than hospitals providing thrombolysis. Physicians identified inadequate nursing resources as the greatest barrier to providing thrombolysis. Of physicians using thrombolysis, 71.4% chose streptokinase. Half of the physicians preferred elective transfer after the procedure. CONCLUSIONS: Thrombolytic therapy for acute myocardial infarction is standard practice in small hospitals in Alberta.

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BACKGROUND: The assessment of predictive validity is the essential core from which a sound model of prediction is built. METHOD: Three methods for assessing predictive validity in health care education research were reviewed: longitudinal profile development, cross-validation, and inspection of the adjusted R2. A total of 47 articles published between 1973 and 1993 in nine health care disciplines were critically reviewed to determine whether the studies tested for predictive validity by using these methods. RESULTS: Very few of the 47 studies used at least one of the three methods for assessing predictive validity. Furthermore, the proportion of variance explained that is reported in the articles is typically small even before assessment of predictive validity. It is sobering to note that these small values may be inflated, since shrinkage is likely to occur when assessing predictive validity on a second, or cross-validation, sample. CONCLUSION: The scarcity of testing of predictive validity in the studies reviewed highlights the necessity of future research to establish the degree of predictive validity, if improvements in predicting success in health care education research are to be realized.

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On some occasions, mixing knowledge of results (KR) and Blank trials (No-KR) during acquisition has increased retention relative to when Blanks were absent. The proposal that Blank trials improve retention because they encourage the development of the internalized error recognition system was not supported.

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