Level II-diagnostic.

No abstract

Mammography use has increased over the past 20 years, yet more than 30% of women remain inadequately screened. Structural barriers can deter individuals from screening, however, cognitive, emotional, and communication barriers may also prevent mammography use. This study sought to identify the impact of number and type of barriers on mammography screening status, and to examine whether number and type of barriers are different for never-screened and off-schedule women. A total of 182 women aged 40 years or older completed a computer kiosk facilitated survey as part of a larger patient navigator intervention. Logistic regression analysis indicated that breast cancer knowledge predicted whether a woman had ever had a mammogram (odds ratio [OR] = 1.04, 95% confidence interval [CI] = 1.02-1.06, p = .0003), while the number of emotional, structural, and communication barriers predicted whether a woman was on-schedule for mammograms (OR = 0.79, 95% CI = 0.65-0.95, p = .0127). The results suggest that to increase the use of mammography at recommended regular intervals, interventions should be tailored toward current screening status.

Purpose This study was conducted to report the functional outcomes of the Huber opposition transfer (abductor digiti minimi muscle) in type II and IIIA hypoplastic thumbs. Methods Patients who had undergone a Huber opposition transfer with at least 5 years of follow-up were included in this study. There were 21 thumbs included; 12 returned for a detailed evaluation and 9 were included with a medical record review. Outcome measures included range of motion and pinch strength; PODCI and PROMIS scores were collected on those who could return. There were 15 type II and 6 IIIA thumbs. Results Range of motion was significantly less than normal for both the interphalangeal (IP) and metacarpophalangeal (MCP) joints. For the returning cohort, key and tripod pinch were 44% and 65% of normal. The median Kapandji score was 9 (range 6–10). PODCI scores were high for global, upper extremity function, happiness, and pain. PROMIS scores were similar to normal, except for parent reports of physical function. For all included patients, there was a revision surgery rate of 22%, primarily related to persistent instability. Conclusions The Huber opposition transfer for type II and IIIA thumbs was shown to provide good subjective outcomes, despite limited range of motion and strength, at a minimum 5-year follow-up. Type of study/level of evidence Therapeutic level IV.

Purpose In the amyoplasia type of arthrogryposis a reverse pronated grasp pattern is often seen. We hypothesized that repositioning the hands, through distal humerus external rotation osteotomies (DHO), would allow for palm-to-palm grasp without arm cross-over, and would improve function and parent/patient satisfaction. Methods The medical records of all patients treated surgically for arthrogryposis were reviewed at the Shriners Hospital in St. Louis, MO. From 2012–2014, nine patients (14 extremities) had undergone a DHO. All patients had pre-operative and post-operative video recordings of functional activities and we assessed functional changes after osteotomies. Pre-operative upper extremity position was graded as 1= palms facing midline, 2=palm facing posterior, and 3=palms facing away from midline. Post-operative Pediatric Outcomes Data Collection Instrument (PODCI) questionnaires were obtained and parent satisfaction was evaluated. Results Mean patient age at the time of surgery was 6.5 years-old. There were 5 patients who underwent bilateral DHOs. All patients had 3 or fewer additional procedures on an upper extremity during the study period. All patients had an improved resting posture of the upper extremity after DHO surgery, with a mean change of 51 degrees (range 15–90 degrees). Grasp pattern was altered in 13 extremities; there was a change in hand position of at least one grade and 5 had complete change from 3 to 1, palms facing away from midline to facing towards midline. There was a wide range in post-operative PODCI scores for function, but Happiness scores were high, mean 89 (range 60–100). Parents universally stated the procedure improved the child’s function “a great deal”. There were two complications, one periprosthetic humerus facture with recurrence of the internal rotation and one patient with scarring of the triceps requiring tenolysis. Conclusions The DHO is an effective procedure for correcting the internal rotation position of the upper extremity in arthrogryposis and the surgery improves hand opposition with minimal complications. Universally there was perceived improved function with high post-operative PODCI Happiness scores. Level of Evidence Therapeutic, Level V