Functional outcomes in floating elbow injuries tend to cluster into two groups-patients with good or excellent results and patients with poor results. Patients with associated nerve injuries have lower functional outcomes at a minimum of 1-year follow-up.

Therapeutic study, level III.

Importance: Designing, implementing, and measuring the effectiveness of sustainable Internationalization at Home programs will support the development of cultural competence among occupational therapy students. Objective: To explore potential sustainable, effective methods for enhancing cultural competence in occupational therapy students through cross-cultural online collaborations. Design: Pretest–posttest, parallel mixed-methods design. Setting: An online collaboration using video conferencing technology and classrooms at the European University Cyprus and the University of St. Augustine for Health Sciences. Participants: Bachelor of science and master of occupational therapy students at the European University Cyprus and the University of St. Augustine for Health Sciences, respectively. Intervention: Online video conferencing collaboration between occupational therapy students in which students discussed their perspectives and experiences regarding social injustice and occupational therapy’s role in working with vulnerable populations. Outcomes and Measures: Each campus participated in focus groups, and students completed individual reflections. Themes were derived from the qualitative information gathered. Quantitative data were collected using the Cultural Awareness Scale for Occupational Therapy Students (CASOTS). Results: CASOTS did not reflect changes in cultural awareness. The qualitative measures identified students’ desire to participate in more frequent and culturally diverse experiences. Challenges included length of preparation and actual communication time. Inclusion of prior asynchronous sessions and methods to overcome the language barrier was suggested for future implementation. Conclusion: Synchronous cross-cultural collaborations may enhance occupational therapy student’s cultural awareness and may be more attractive than traditional in-class teaching. Further development is necessary to overcome challenges. What This Article Adds: Documenting the benefits and barriers of implementing Internationalization at Home experiences will allow academic institutions to create sustainable methods for enhancing occupational therapy students’ cultural competence. Recommendations to further enhance Internationalization at Home experiences provide opportunities for increased cultural collaboration.

IMPORTANCE Despite the widespread use of systemic antibiotics to prevent infections in surgically treated patients with fracture, high rates of surgical site infection persist.OBJECTIVE To examine the effect of intrawound vancomycin powder in reducing deep surgical site infections. DESIGN, SETTING, AND PARTICIPANTSThis open-label randomized clinical trial enrolled adult patients with an operatively treated tibial plateau or pilon fracture who met the criteria for a high risk of infection from January 1, 2015, through June 30, 2017, with 12 months of follow-up (final follow-up assessments completed in April 2018) at 36 US trauma centers.INTERVENTIONS A standard infection prevention protocol with (n = 481) or without (n = 499) 1000 mg of intrawound vancomycin powder. MAIN OUTCOMES AND MEASURESThe primary outcome was a deep surgical site infection within 182 days of definitive fracture fixation. A post hoc comparison assessed the treatment effect on gram-positive and gram-negative-only infections. Other secondary outcomes included superficial surgical site infection, nonunion, and wound dehiscence. RESULTSThe analysis included 980 patients (mean [SD] age, 45.7 [13.7] years; 617 [63.0%] male) with 91% of the expected person-time of follow-up for the primary outcome. Within 182 days, deep surgical site infection was observed in 29 of 481 patients in the treatment group and 46 of 499 patients in the control group. The time-to-event estimated probability of deep infection by 182 days was 6.4% in the treatment group and 9.8% in the control group (risk difference, -3.4%; 95% CI, -6.9% to 0.1%; P = .06). A post hoc analysis of the effect of treatment on gram-positive (risk difference, -3.7%; 95% CI, -6.7% to -0.8%; P = .02) and gram-negative-only (risk difference, 0.3%; 95% CI, -1.6% to 2.1%; P = .78) infections found that the effect of vancomycin powder was a result of its reduction in gram-positive infections.CONCLUSIONS AND RELEVANCE Among patients with operatively treated tibial articular fractures at a high risk of infection, intrawound vancomycin powder at the time of definitive fracture fixation reduced the risk of a gram-positive deep surgical site infection, consistent with the activity of vancomycin.

Prognostic study, level II.