Dupuytren Contractures: An Update of Recent Literature

Dupuytren disease is a fibroproliferative disorder that affects the palmar fascia of the hand and results in varying degrees of nodule and cord formation. Over time, patients may develop progressive contractures, impairing their ability to type, to perform with fine instruments, or to participate in social activities such as shaking hands. Treatment options for Dupuytren contractures include needle aponeurotomy (NA), injection of collagenase Clostridium histolyticum (CCH) with manipulation of the digits, and surgical fasciectomy. Over the past decade, the use of CCH has increased. Recent studies have provided additional data regarding the pathophysiology, indications, outcomes, and costs associated with the treatment for Dupuytren contractures, and this review highlights these advances.

Evaluation of Medical School Grading Variability in the United States: Are All Honors the Same?

PURPOSE

The medical student performance evaluation (MSPE) summarizes a residency applicant's academic performance. Despite attempts to improve standardized clerkship grading, concerns regarding grade inflation and variability at United States medical schools persist. This study's aim was to describe current patterns of clerkship grading and applicant performance data provided in the MSPE.

METHOD

The authors evaluated Electronic Residency Application Service data submitted to a single institution for the 2016-2017 Match cycle. Clerkship grading characteristics regarding grading tiers, school rank, location, and size were obtained. Data regarding methods for summative comparisons such as key word utilization were also extracted. Descriptive statistics were generated, and generalized linear modeling was performed.

RESULTS

Data were available for 137/140 (98%) MD-granting U.S. medical schools. Pass/fail grading was most commonly used during the preclinical years (47.4%). A 4-tier system was most common for clerkship grading (31%); however, 19 different grading schemes were identified. A median of 34% of students received the highest clerkship grade (range, 5%-97%). Students attending a top 20 medical school were more likely to receive the highest grade compared with those attending lower-rated schools (40% vs 32%, P < .001). Seventy-three percent of schools ranked students, most commonly using descriptive adjectives. Thirty-two different adjectives were used.

CONCLUSIONS

There is significant institutional variation in clinical grading practices and MSPE data. For core clerkships where most students received the highest grade, the ability to distinguish between applicants diminishes. A standardized approach to reporting clinical performance may allow for better comparison of residency applicants.

Long-term outcomes of silicone metacarpophalangeal arthroplasty: a longitudinal analysis of 325 cases

An analysis was conducted of 325 consecutive metacarpophalangeal arthroplasties prospectively collected using a single institution's total joints registry over a 14-year time period to characterize long-term radiographic and functional outcomes. Patients were followed for a mean of 7.2 years (2-18) or until revision. The 5-, 10- and 15-year survival free from revision were 98%, 95% and 95%, respectively. The 5-, 10- and 15-year survival rates free from radiographic implant fracture were 93%, 58% and 35%, respectively. The 5-, 10- and 15-year survival rates free from coronal plane deformity greater than 10° were 81%, 37% and 17%, respectively. Patients had significant improvements in their postoperative pain levels and metacarpophalangeal arc of motion. Neither implant fracture, nor coronal plane deformity >10° had a significant association with worse function. Overall, pain relief and functional improvement are reliable, though silicone implants do not protect from progression of coronal plane deformity and have a high fracture rate. Level of evidence: IV.

Fish Oil and Osteoarthritis: Current Evidence

According to the 2005 US census, osteoarthritis (OA) was the leading cause of disability in the United States, affecting more than 50 million people. Current treatments are targeted at reducing symptoms of the inflammatory reaction that occurs after destruction of essential joint cartilage. However, these treatments do not prevent significant pain and activity restriction. We reviewed the literature to address claims that fish oil supplementation can prevent or decrease severity of OA. Our extensive search of databases covered all relevant terms related to omega-3-containing supplements and their effects on OA. We hypothesized there would be insufficient clinical studies to justify recommending supplementation to patients.Laboratory studies have shown that eicosapentaenoic acid and docosahexaenoic acid reduce proinflammatory mediators and increase joint lubrication in vitro. In addition, canine trials have shown clinically significant reductions in various symptom parameters. Results of human clinical trials have not been consistently significant. Well-designed clinical trials are needed to substantiate or refute the potential benefit of fish oils in OA treatment. Long-term studies are needed to assess the possibility of prevention. In addition, standardization of the fish oil industry is needed for consistency of therapy.

A universal pattern of mortality decline in the G7 countries

Human lifespan has increased enormously this century. But we remain uncertain about the forces that reduce mortality, and about the cost implications of ageing populations and their associated social burden. The poor understanding of the factors driving mortality decline, and the difficulty of forecasting mortality are due in part to the pronounced irregularity of annual to decadal mortality change. Here we examine mortality over five decades in the G7 countries (Canada, France, Germany, Italy, Japan, UK, US). In every country over this period, mortality at each age has declined exponentially at a roughly constant rate. This trend places a constraint on any theory of society-driven mortality decline, and provides a basis for stochastic mortality forecasting. We find that median forecasts of life expectancy are substantially larger than in existing official forecasts. In terms of the costs of ageing, we forecast values of the dependency ratio (that is, the ratio of people over 65 to working people) in 2050 that are between 6% (UK) and 40% (Japan) higher than official forecasts.

Sex acts, sex partners, and sex budgets: implications for risk factor analysis and estimation of HIV transmission probabilities

Many epidemiological studies have identified the number of sex partners as a risk factor for the acquisition of HIV, but few studies have identified the number of sex acts as a risk factor. The seeming lack of importance of the number of sex acts as a risk factor has yet to be explained. In this report we conduct an exploratory data analysis to evaluate the relationship between the number of sex acts and the number of sex partners for heterosexuals. Our results indicate that it may be most appropriate to view sexual activity within a sex budget and resource allocation framework. We use the results (a) to suggest an explanation for why the results from some of the risk factor analysis studies have identified a per partnership but not a per act risk, and (b) to assess the implications of the relationship for the estimation of heterosexual transmission probabilities for HIV.