Significant declines in rates of reported work-related injuries and illnesses were observed over the 20-year period among these union carpenters. Greater declines were observed among workers with less union tenure and for claims resulting in PLT.
Objective: We describe a structured approach to developing a standardized curriculum for surgical trainees in East, Central, and Southern Africa (ECSA). Summary Background Data: Surgical education is essential to closing the surgical access gap in ECSA. Given its importance for surgical education, the development of a standardized curriculum was deemed necessary. Methods: We utilized Kern's 6-step approach to curriculum development to design an online, modular, flipped-classroom surgical curriculum. Steps included global and targeted needs assessments, determination of goals and objectives, the establishment of educational strategies, implementation, and evaluation. Results: Global needs assessment identified the development of a standardized curriculum as an essential next step in the growth of surgical education programs in ECSA. Targeted needs assessment of stakeholders found medical knowledge challenges, regulatory requirements, language variance, content gaps, expense and availability of resources, faculty numbers, and content delivery method to be factors to inform curriculum design. Goals emerged to increase uniformity and consistency in training, create contextually relevant material, incorporate best educational practices, reduce faculty burden, and ease content delivery and updates. Educational strategies centered on developing an online, flipped-classroom, modular curriculum emphasizing textual simplicity, multimedia components, and incorporation of active learning strategies. The implementation process involved establishing thematic topics and subtopics, the content of which was authored by regional surgeon educators and edited by content experts. Evaluation was performed by recording participation, soliciting user feedback, and evaluating scores on a certification examination. Conclusions: We present the systematic design of a large-scale, context-relevant, data-driven surgical curriculum for the ECSA region.
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This case report describes the arthroscopic findings in two patients with nail-patella syndrome (NPS). In both cases, a midline synovial septum was encountered that completely subdivided the knee into medial and lateral compartments. One patient required two subsequent arthroscopic procedures, and the synovial septum was found to have recurred even after it had been resected at the initial surgery. The etiology and clinical significance of this anatomic anomaly are unknown, however, surgeons should be aware of its existence and the potential difficulties it may present during knee arthroscopy in patients with NPS.
PURPOSE: The purpose of this investigation is to examine the relationship between forced sedentariness attributed to the management of a lower extremity injury and change in BMI in pediatric patients. INTRODUCTION: Over the past 30 years, childhood obesity has significantly increased. Lack of physical activity and rising levels of sedentary living are associated with rising childhood obesity. As the effects of childhood obesity are long lasting, it is important to characterize childhood conditions that lead to increases in BMI. Traumatic lower extremity injuries in children commonly result in casting and forced immobilization. Children and adolescents who cease physical activity at a younger age are at a higher risk for weight gain and inactive lifestyles as adults. Presently, the data examining short term and longitudinal effects of injury on weight changes are lacking. Therefore, the purpose of this investigation is to examine the relationship between forced sedentariness attributed to the management of a lower extremity injury and change in BMI in pediatric patients. METHODS: Eighty eight subjects aged 5 to 18 with lower extremity fractures managed with non-weight bearing for a minimum of 6 weeks were identified. This group was compared to a cohort of controls, who presented to the pediatric orthopaedic clinic for upper extremity injuries. For each subject, BMI was calculated from height and weight data obtained at each clinic visit for which the data were available for a minimum of 6 months. Percent change in BMI was then calculated and compared between the lower extremity injury group and controls utilizing ANOVA. Logistic regression was then performed to determine if age, gender, and undergoing surgery were correleated with a BMI change of greater than 10%. RESULTS: The results of initial ANOVA analysis demonstrated no difference in BMI trends between children with lower extremity injuries and controls. On average, both groups showed a modest increase in BMI over time (lower extremity injuries = 3.40%, controls = 3.23%). Logistic analysis of the lower extremity revealed male gender to be associated with a 10% increase in BMI during the study period, though this was not significant (p = 0.153) CONCLUSIONS: Our investigation yielded a negative result. As there is limited literature on BMI trends in children, our power calculation may have underestimated the subjects needed to demonstrate a statistically significant difference between groups. SIGNIFICANCE: The increases observed in both groups may indicate that the experience of being injured is associated with increases in BMI regardless of the location of injury. Further investigation would involve assessing BMI trends prospectively to identify opportunities to obviate possible weight gain with injury.
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