bluuebunny/crossref_metadata_2025 huggingface dataset:
Competencies for Preceptorship in the Brazilian Health Care System
Authors: Rodrigues Carla Daiane Silva , Witt Regina Rigatto
Published: February 2014

Background:

Preceptorship is an emerging component of the Brazilian health care system for human resources education. This study attempted to identify competencies for preceptorship in this system.

Methods:

An exploratory descriptive study was conducted with the Delphi technique. The participants were primary health care professionals from the South of Brazil who were working in nine professional areas, including nursing. The participants had served as preceptors in an educational program promoted by the Ministries of Education and Health.

Results:

Forty-three competencies were identified and classified into nine domains: education, professional values, basic public health sciences, management, health care, teamwork, communication, community orientation, and professional development.

Conclusion:

The findings showed that preceptors were committed to the education of future health care professionals. The development of pedagogical skills was emphasized, as was the necessity of education before preceptorship. These competencies constitute a useful reference for continuing professional education.

J Contin Educ Nurs
2013;44(11):507–515.
Iranian Nurses’ Experience With Applying Information From Continuing Education Programs in Clinical Practice
Authors: Nayeri Nahid Dehghan , Khosravi Laleh
Published: February 2014

Background:

One goal of continuing education is to improve nurses’ performance and the quality of patient care. However, in most cases, nurses do not use the information gained through continuing education in the clinical environment. This study was conducted to explore nurses’ experiences with applying new knowledge obtained from these programs in clinical settings.

Methods:

This study used qualitative content analysis. Data were gathered through interviews with participants. After the interviews were transcribed, a coding process was used and continued until categories and subcategories were developed.

Results:

Five main categories emerged: (1) personal interest and self-confidence; (2) organizational structure and atmosphere; (3) professional nature; (4) opportunity to put education into practice; and (5) design of educational programs. Most of the nurses considered obligatory participation in these classes a way to gain annual educational upgrades.

Conclusion:

A considerable amount of the annual budget is allocated to continuing education. Therefore, the findings of this study, which described nurses’ experience with applying what they learned through continuing education in clinical practice, can offer valuable information to help managers improve continuing education programs and the application of new knowledge in the clinical environment.

J Contin Educ Nurs.
2013;44(12):564–572.
Evaluating Nurses’ Knowledge of Chemotherapy
Authors: Yu Hui-Yun , Yu Shu , Chen I-Ju , Wang Kai-Wei K. , Tang Fu-In
Published: February 2014

Background:

The characteristics of the drugs that are used in chemotherapy have given rise to many issues, one of which is whether nurses are competent when working with chemotherapy.

Methods:

Nurses’ knowledge of chemotherapy was evaluated with a questionnaire that included 20 true-or-false questions. The questionnaire was developed from literature and expert input and validated by subject experts (content validity). A pilot study (contrasted-groups approach) was also conducted.

Results:

A total of 203 nurses participated in the study and achieved an average overall correct answer rate of 60.9%. Most of the respondents, 63.5% (129 of 203), had a score of less than 70, and 77.3% (157 of 203) hoped to undergo more training on chemotherapy. Their knowledge of chemotherapy came mainly from consultation with colleagues (4.0 ± 0.8) and in-hospital continuing education (3.9 ± 0.8).

Conclusion:

The evidence-based results suggested that nurses have insufficient knowledge about chemotherapy. More fundamentally, however, nurses need more education about chemotherapy in nursing school and through in-hospital continuing education.

J Contin Educ Nurs.
2013;44(12):553–563.
TeamSTEPPS
®
Simulation-Based Training: An Evidence-Based Strategy to Improve Trauma Team Performance
Authors: Harvey Ellen M. , Wright Andrea , Taylor Dallas , Bath Jennifer , Collier Bryan
Published: February 2014

Initial assessment and treatment of critically injured patients is time sensitive, creating a high-stress environment for trauma team members and patients. Effective leadership, communication, and clinical acumen are essential team dynamics for best patient outcomes. Innovative multidisciplinary TeamSTEPPS
®
simulation-based training is an effective model for teams in high-risk health care settings. Use of this simulation model has led to improved trauma team performance and patient outcomes while incorporating new physician and nursing personnel into a time-sensitive, high-stress environment.

J Contin Educ Nurs
2013;44(11):484–485.
Preceptors’ Perceptions of Clinical Nursing Education
Authors: Madhavanpraphakaran Girija K. , Shukri Raghda K. , Balachandran Shreedevi
Published: February 2014

The behavior of clinical preceptors plays a key role in the learning process of students. This study explored preceptors’ perceptions of the clinical teaching–learning process of final-year undergraduate nursing students. After ethical permission was obtained, a 30-item questionnaire was administered to 76 preceptors at Sultan Qaboos University Hospital in 2011. Most preceptors had more than 10 years of experience. The majority (87%) of preceptors rated students’ response to constructive feedback positively, and 75% evaluated students’ professional behaviors and communication positively. Several factors were identified as interfering with preceptorship, including lack of protected time and heavy workload of preceptors, poor correlation of theory and practice, and lack of interest in direct patient care by students. Most preceptors identified factors that facilitate preceptorship as students’ commitment to direct patient care and consistent shift duty with the assigned preceptor during the entire clinical rotation. These results may help faculty appreciate preceptors’ views and acknowledge areas of success, as well as areas that need improvement.

J Contin Educ Nurs.
2013;45(1):28–34.
Disclosures: What and Why
Authors: Dickerson Pamela S. , Dickerson Pamela S.
Published: February 2014

Before beginning a continuing nursing education activity, learners are entitled to receive certain information about the learning experience. This column describes those disclosures and discusses their importance.

J Contin Educ Nurs.
2014;45(1):8–9.
Newly Qualified South African Nurses’ Lived Experience of the Transition From Student to Community Service Nurse: A Phenomenological Study
Authors: Roziers Reinette L. , Kyriacos Una , Ramugondo Elelwani L.
Published: February 2014

Background:

This study attempted to fill a gap in the published South African literature regarding newly qualified nurses’ preparedness for and experience of role transition to a 1-year compulsory commitment of community service nurse.

Methods:

Husserlian descriptive phenomenology, characterized by inductive extraction of units of meaning from transcribed audiotaped recordings, was used to establish the “essence” of the lived experience of role transition. Data were collected from eight participants through two semistructured individual interviews: in July 2011, 2 weeks before the start of community service, and in September 2011, 6 weeks after community service placement.

Results:

Findings showed that before placement, participants experienced a sense of achievement in having successfully completed a 4-year diploma program. However, they also experienced uncertainty and fear about the immediate future. In the first month after placement, community service nurses experienced reality shock.

Conclusion:

Preparation for the role transition from student nurse to graduate community service nurse requires a 4-year structured program that includes training in conflict management, assertiveness, and practical ethics.

J Contin Educ Nurs.
2014;45(2):91–100.
A Registered Nurse Refresher Course: Serving the Community
Authors: Borgfeld Joyce K.
Published: February 2014

The Texas Board of Nursing recognizes that nurses may interrupt practice or change practice settings throughout their career and requires experienced nurses who have not practiced in more than 4 years to take a refresher course. In response to community requests for a local option for inactive nurses to reenter practice, the Department of Lifelong Learning in the university’s school of nursing launched an RN refresher course in summer 2010. This article describes the scope of the RN refresher course, program costs, and future endeavors. More importantly, the article describes the nurses who are returning to nursing practice, including their age range, educational preparation, and length of time out of practice. Steady growth in enrollment, expanding clinical affiliations in the local area and selected areas throughout the state, and positive employment outcomes have facilitated course sustainment and growth.

J Contin Educ Nurs.
2014;45(2):77–82.
Education as a Springboard for Transformational Leadership Development: Listening to the Voices of Nurses
Authors: Galuska Lee A.
Published: February 2014

Nurses must assume a transformational leadership role in increasing the quality, safety, access, and value in the health care system. To lead effectively in this transformation process, nurses must be prepared for leadership roles. A strong leadership knowledge base acquired through education provides the springboard for nursing leadership competency development. This metasynthesis of 27 studies provides a broad understanding of the contribution and effectiveness of education for leadership competency from the perspective of nurses who have experienced it. Four overarching themes emerged: evidence-based relevant content, optimized learning strategies, benefits to the learner and others, and tensions and threats to the application of learning. This study affirms the value of a strong educational foundation for nursing leadership. With the support of a firm, yet flexible, educational platform, nurses will be positioned to more effectively lead and partner in health care transformation.

J Contin Educ Nurs.
2014;45(2):67–76.
Perceived Facilitators and Barriers to Baccalaureate Degree Completion Among Registered Nurses With an Associate's Degree
Authors: Schwarz Laura Marie , Leibold Nancyruth
Published: February 2014

Background:

A strong movement is underway in the United States to increase the percentage of baccalaureate-prepared registered nurses (RNs). However, the percentage of associate's-prepared RNs who go on to pursue baccalaureate education remains low. The authors sought to determine facilitators and barriers that associate's-prepared RNs experience in progressing toward baccalaureate nursing education.

Method:

A convenience sample (n= 81) of associate's-prepared RNs was used to collect data on perceived facilitators and barriers to progression toward baccalaureate nursing education.

Results:

Facilitators included a desire for personal growth, professional and career enhancement, programmatic and articulation friendliness, and encouragement by others. Barriers included family and job constraints, financial concerns, and lack of differential treatment between associate's-prepared RNs and baccalaureate-prepared RNs.

Conclusion:

Although at first glance the identification of four facilitators and three barriers may appear to indicate an advance toward progression to baccalaureate education, the magnitude of the barriers may outweigh that of the facilitators. Therefore, the magnitude of both facilitators and barriers is worthy of future study.

J Contin Educ Nurs.2014;45(4):171–180.
The Potential Role of Resilience Education for Preventing Mental Health Problems for College Students
Authors: DeRosier Melissa E. , Frank Ellen , Schwartz Victor , Leary Kevin A.
Published: February 2014

CME Educational Objectives

1.

Understand the various stressors experienced by college students.

2.

Learn how stress, resilience, and mental health in college are interrelated.

3.

Explore how resilience education can improve the mental health of college students.

The transition to college can be an exciting, albeit stressful, time in students’ lives, as many begin living apart from family and friends for the first time and must adapt to new and increasingly demanding academic, social, and financial pressures while adjusting to life in an unfamiliar environment. As a result of this transition, first-year college students tend to experience greater stress, anxiety, and psychological distress (eg, depression) relative to upperclassmen.
1
The extent to which students are able to cope with stressors during the first year of college has important implications not only for their social-emotional adjustment, but also for the likelihood of their academic success and persistence in postsecondary education.
2
Mindfulness Meditation for Increasing Resilience in College Students
Authors: Rogers Holly B.
Published: February 2014

CME Educational Objectives

1.

Discuss the interplay between stress and resilience.

2.

Describe the unique characteristics of emerging adulthood.

3.

Describe the beneficial effect of mindfulness training on resilience.

Resilience, the ability to recover psychologically from stressful or traumatic events, is often discussed in the psychiatric literature in terms of an individual’s ability to recover from significant trauma. Much of the information about what builds or inhibits an individual’s resilience is based on research on people who have survived severe traumas or on animal models of severe trauma. However, in the world of college counseling, the emphasis is slightly different. Although there are certainly a number of college students presenting to student counseling centers who have survived horrific challenges, a much more common presentation is the student who is having trouble adapting to more-routine life events, such as failing in academic endeavors or being rejected by a love interest. Helping emerging adults (EAs) build the resilience they need to manage their day-to-day stresses is one of the core challenges for clinicians working with college students.
A 21-Day-Old Boy with an Annular Eruption
Authors: Berry Adam , Abramovici Gil , Chamlin Sarah L.
Published: February 2014

A healthy 21-day-old black male was referred to pediatric dermatology for evaluation of a facial and scalp eruption that had been present for less than 1 week. The child’s parents had applied a topical corticosteroid cream for several days without any improvement noted. The child was otherwise well and thriving. Review of systems was negative. Family history was unremarkable for autoimmune or infectious skin diseases.

On physical examination the patient was alert, active, and vigorous. He had multiple 1 to 2.5-cm erythematous annular, scaly plaques with pustules on the periphery on his upper cheeks, forehead, and anterior scalp (

Figures
1
–
2

). No alopecia was noted. Occipital and neck lymph nodes were not palpable. A potassium hydroxide skin preparation was negative for fungal elements and a fungal culture was performed. Serum laboratory testing was also performed.

To read more and to earn CME credit for reading this article, access the full text by going to
Healio.com/Pediatrics
and searching: doi: 10.3928/00904481-20131223-12.
Family Caregivers of Individuals with Frontotemporal Dementia: Examining the Relationship Between Coping and Caregiver Physical and Mental Health
Authors: Wong Cindy C. , Wallhagen Margaret I.
Published: February 2014

To identify strategies to assist family caregivers of individuals with frontotemporal dementia (FTD) in dealing with their caregiving demands, nurses must understand these family members’ unique needs and how they currently deal with their demands. The purpose of this study was to examine the relationship between coping and caregiver physical and mental health among FTD family caregivers. Participants were primary caregivers of individuals with FTD (with behavioral symptoms) living at home (N= 61). A small positive association was noted between problem-focused coping and caregiver physical health (r= 0.29,p< 0.05), and a small but nonsignificant positive correlation was noted between emotion-focused coping and caregiver mental health (r= 0.21,p= 0.10). However, multiple regression analysis showed that emotion-focused coping (β = 0.46,p< 0.05) made a statistically significant, unique contribution to caregiver mental health and explained approximately 14% of its variance. These findings support the potential value of emotion-focused coping strategies when dealing with behavioral symptoms manifested by individuals with FTD. [Journal of Gerontological Nursing, 40(1), 30–40.]
Sexuality and Chronic Illness
Authors: Steinke Elaine E.
Published: February 2014

How to Obtain Contact Hours by Reading this Article

Instructions

1.2
contact hours will be awarded by Villanova University College of Nursing upon successful completion of this activity. A contact hour is a unit of measurement that denotes 60 minutes of an organized learning activity. This is a learner-based activity. Villanova University College of Nursing does not require submission of your answers to the quiz. A contact hour certificate will be awarded once you register, pay the registration fee, and complete the evaluation form online at
https://villanova.gosignmeup.com/dev_students.asp?action=browse&main=Nursing+Journals&misc=564
. To obtain contact hours you must:

1.

Read the article, “Sexuality and Chronic Illness” found on pages 18–27, carefully noting any tables and other illustrative materials that are included to enhance your knowledge and understanding of the content. Be sure to keep track of the amount of time (number of minutes) you spend reading the article and completing the quiz.

2.

Read and answer each question on the quiz. After completing all of the questions, compare your answers to those provided within this issue. If you have incorrect answers, return to the article for further study.

3.

Go to the Villanova website listed above to register for contact hour credit. You will be asked to provide your name; contact information; and a VISA, MasterCard, or Discover card number for payment of the $20.00 fee. Once you complete the online evaluation, a certificate will be automatically generated.

This activity is valid for continuing education credit until October 31, 2015.

Contact Hours

This activity is co-provided by Villanova University College of Nursing and SLACK Incorporated.

Villanova University College of Nursing is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.

Activity Objectives

1.

Identify the sexual concerns and counseling needs of those with a chronic disease diagnosis related to cardiovascular conditions, pulmonary disorders, and cancer.

2.

Describe at least four specific sexual counseling strategies and two psychological concerns of patients and/or partners regarding sexuality.

Disclosure Statement

Neither the planners nor the author have any conflicts of interest to disclose.

Sexual function is often affected in individuals living with chronic illness and their partners, and multiple comorbidities increase the likelihood of sexual dysfunction. This review focuses on the areas of cardiovascular disease, respiratory conditions, and cancer, all areas for which there are practical, evidence-based strategies to guide sexual counseling. Although nurses have been reluctant to address the topic of sexuality in practice, a growing number of studies suggest that patients want nurses to address their concerns and provide resources to them. Thus, nurses must be proactive in initiating conversations on sexual issues to fill this gap in practice. [
Journal of Gerontological Nursing, 39
(11), 18–27.]
The Invisible Elderly: Lesbian, Gay, Bisexual, and Transgender Older Adults
Authors: Jablonski Rita A. , Vance David E. , Beattie Elizabeth
Published: February 2014

More than 2 million older adults identify as lesbian, gay, bisexual, or transgender (LGBT). The purpose of this article is to present an overview of the physical and mental health needs of LGBT older adults to sensitize nurses to the specific needs of this group. Nurses are in a prominent position to create health care environments that will meet the needs of this invisible, and often misunderstood, group of people. [
Journal of Gerontological Nursing, 39
(11), 46–52.]
Therapeutic Interactions to Enhance the Mental Health and Wellness of Dementia Caregivers and Patients
Authors: Clarke Philip B. , Shaw Edward G. , Villalba Jose A. , Alli Rabeena , Sink Kaycee M.
Published: February 2014

Individuals with dementia and their family caregivers have higher rates of stress and mental health concerns than the general population. Gerontological nurses have unique and valuable opportunities to conduct therapeutic interactions that support the mental health and well-being of patients and family members. Information regarding dementia patient and family caregiver stressors are presented, followed by engaging strategies for opening therapeutic conversations about these topics. Ways in which gerontological nurses can facilitate coping skills and strengths identification are also outlined. [
Journal of Gerontological Nursing, 39
(11), 7–10.]
Sexually Transmitted Infections and Older Adults.
Authors: Johnson Beverly K.
Published: February 2014

Older adults continue to be sexually active in their later years. A range of sexually transmitted infections (STIs) such as chlamydia, gonorrhea, syphilis, and HIV have been reported among older adults. Risk factors for STIs in older populations include (a) normal sexual changes associated with aging (e.g., increased time to attain an erection, decreased vaginal lubrication, decreases in sexual hormones); (b) psychosocial changes (e.g., loss of partner or spouse and re-entering the dating scene); and (c) risky sexual behaviors, including no or infrequent use of condoms. Screening of adults for STIs should occur regardless of age based on guidelines such as those from the Centers for Disease Control and Prevention and the U.S. Preventive Services Task Force. As discussed in this article, nurses can use assessment guides and engage in interventions such as counseling and education with older adults to reduce STI risk or refer for treatment. Numerous online resources exist for both nurses and older adults to increase knowledge of STIs. [
Journal of Gerontological Nursing, 39
(11), 53–60.]
Automated Fall Detection With Quality Improvement “Rewind” to Reduce Falls in Hospital Rooms
Authors: Rantz Marilyn J. , Banerjee Tanvi S. , Cattoor Erin , Scott Susan D. , Skubic Marjorie , Popescu Mihail
Published: February 2014

The purpose of this study was to test the implementation of a fall detection and “rewind” privacy-protecting technique using the Microsoft
®
Kinect
™
to not only detect but prevent falls from occurring in hospitalized patients. Kinect sensors were placed in six hospital rooms in a step-down unit and data were continuously logged. Prior to implementation with patients, three researchers performed a total of 18 falls (walking and then falling down or falling from the bed) and 17 non-fall events (crouching down, stooping down to tie shoe laces, and lying on the floor). All falls and non-falls were correctly identified using automated algorithms to process Kinect sensor data. During the first 8 months of data collection, processing methods were perfected to manage data and provide a “rewind” method to view events that led to falls for post-fall quality improvement process analyses. Preliminary data from this feasibility study show that using the Microsoft Kinect sensors provides detection of falls, fall risks, and facilitates quality improvement after falls in real hospital environments unobtrusively, while taking into account patient privacy. [
Journal of Gerontological Nursing, 40
(1), 13–17.]
Comparison of Family Satisfaction in
Australian Ethno-Specific
and
Mainstream
Aged Care Facilities
Authors: Runci Susannah J. , Eppingstall Barbara J. , van der Ploeg Eva S. , O’Connor Daniel W.
Published: February 2014

The aim in this study was to identify specific aspects of care that increased satisfaction of family members of Greek and Italian residents with dementia in mainstream or ethno-specific aged care facilities in Australia. Relatives of 83 aged care residents with Greek or Italian backgrounds who were also cognitively impaired were interviewed. They rated their satisfaction with the facility and suggested improvements regarding the care provided. Family members with relatives in ethno-specific care were more satisfied, in terms of the facility’s ability to meet the resident’s language and cultural needs, social/leisure activities, and the food provided. The presence of a bilingual staff member and greater perceived reduction in family caregiver stress upon admission were associated with higher satisfaction. Results implicate the role of activities programs, catering, resident interaction, supporting caregivers upon admission, and bilingual staff members to increase family satisfaction, with the potential to improve the care provided to residents in mainstream care. [
Journal of Gerontological Nursing, 40
(4), 54–63.]
Music-Assisted Bathing: Making Shower Time Easier for People with Dementia
Authors: Ray Kendra D. , Fitzsimmons Suzanne
Published: February 2014

It is estimated that 90% of nursing home residents need assistance with bathing. The purpose of this article is to describe a music-assisted care technique that can be used by caregivers when bathing nursing home residents with dementia. Research suggests that music has many therapeutic benefits for people with dementia. Using music to soothe anxiety can be an effective intervention to assist with lessening of agitation during activities of daily living, especially bathing. This article will provide nursing and direct care staff tools to successfully conduct the music-assisted bathing protocol. Consideration for choosing appropriate music for bathing, the creation of individualized personalized playlists, and acknowledgement of desired outcomes are presented. Incorporating music-assisted bathing may address neuropsychiatric symptoms of dementia by lessening agitation and improving mood, which in turn can increase job satisfaction. [
Journal of Gerontological Nursing, 40
(2), 9–13.]
Using a Book Chat to Improve Attitudes and Perceptions of Long-Term Care Staff About Dementia
Authors: Larocque Natasha , Schotsman Chloe , Kaasalainen Sharon , Crawshaw Diane , McAiney Carrie , Brazil Emma
Published: February 2014

This study sought to evaluate a book chat intervention based on Lisa Genova’s novel,
Still Alice
, to influence long-term care (LTC) staff perceptions and attitudes when caring for individuals with dementia. A qualitative descriptive design was used. Eleven participants partook in a 2.5-hour book chat at a southern Ontario LTC facility. Following the book chat, participants answered two open-ended questions to assess how the book chat influenced their views on dementia. Thematic content analysis was used to analyze the qualitative questionnaire. Content analysis of the participants’ responses revealed that the book chat positively influenced their attitudes and perceptions toward dementia, particularly by providing more insight into the individual’s personal struggle with the disease. Furthermore, participants found that the book chat influenced their care practices. By creating innovative learning opportunities, attitudes and perceptions about dementia care can be transcended and greatly benefit staff, family, and residents. [
Journal of Gerontological Nursing, 40
(5), 46–52.]
Effect of Acetabular Orientation on Stress Distribution of Highly Cross-linked Polyethylene Liners
Authors: Lam Luthan , Drew Timothy , Boscainos Petros
Published: February 2014

Several case reports have documented the fracture of highly cross-linked polyethylene (HCLPE) liners used in total hip arthroplasty (THA). Although uncommon, fractured liners result in considerable morbidity for patients and require revision surgery. One postulated mechanism that leads to this type of implant failure is malorientation of the acetabular component. The purpose of this study was to investigate the effect of acetabular orientation on the stress distribution of HCLPE liners used in THA by means of finite element analysis. Three-dimensional models of a commonly used HCLPE liner were created corresponding to 12 different acetabular component orientations (inclination ranging from 20° to 70° and version ranging from 20° of retroversion to 40° of anteversion). A static stress analysis of the finite element models was performed under conditions simulating peak gait loads. The results of the analysis revealed that excessive inclination and extremes of version were associated with an increase in peak stress magnitudes. The locations of peak stress also were found to lie within the rim notch and locking ring groove regions, which were consistent with the fracture locations reported in published case reports. Therefore, the acetabular component should be oriented carefully during implantation to reduce the risk of rim loading and subsequent liner fracture. In addition, an alternative liner design may further help reduce stress risers and risk of fracture.
Effect of Medial Epicondylar Osteotomy on Soft Tissue Balancing in Total Knee Arthroplasty
Authors: Mihalko William M. , Saeki Kazuhiko , Whiteside Leo A.
Published: February 2014

Balancing and surgical exposure of a severe varus knee during total knee arthroplasty (TKA) can be difficult. Use of a medial epicondylar osteotomy to solve these problems has been reported. This study compared knee stability in cadaveric specimens after TKA, after medial epicondylar osteotomy, and after conventional subperiosteal release of the medial collateral ligament (MCL). Five cadaveric knees were tested after TKA, after medial epicondylar osteotomy, and after repair of the osteotomy to compare the results to 5 cadaveric knees that underwent complete subperiosteal release of the MCL. A retrospective review of clinical cases also was performed of 118 varus knees exposed using the standard medial parapatellar approach and subperiosteal release of the MCL to compare results to the literature using a medial epicondylar osteotomy. Coronal and transverse plane laxity increased significantly at 60° and 90° flexion in the knees after medial epicondylar osteotomy. Suture repair of the osteotomy did not affect stability. The knees with MCL release had a significantly lower degree of coronal and transverse plane laxity at 60° and 90° than knees with an epicondylar osteotomy. The retrospective case review found satisfactory exposure and correct ligament balance was achieved in all cases. The findings of this study question the need for an epicondylar osteotomy in severe varus osteoarthritic knees. Because the knee remains unstable in flexion after this technique, an implant with higher constraint should be used.
Biomechanical Comparison of Interference Screw and Cortical Button With Screw Hybrid Technique for Distal Biceps Brachii Tendon Repair
Authors: Arianjam Afshin , Camisa William , Leasure Jeremi M. , Montgomery William H.
Published: February 2014

Various fixation techniques have been described for ruptured distal biceps tendons. The authors hypothesized that no significant differences would be found between the mean failure strength, maximum strength, and stiffness of the interference screw and hybrid technique. Fourteen fresh-frozen human cadaveric elbows were prepared. Specimens were randomized to either interference screw or hybrid cortical button with screw fixation. The tendon was pulled at a rate of 4 mm/s until failure. Failure strength, maximum strength, and stiffness were measured and compared. Failure strength, maximum strength, and stiffness were 294±81.9 N, 294±82.1 N, and 64.4±40.5 N/mm, respectively, for the interference screw technique and 333±129 N, 383±121 N, and 56.2±40.5 N/mm, respectively, for the hybrid technique. No statistically significant difference existed between the screw and hybrid technique in failure strength, maximum strength, or stiffness (
P
>.05). The interference screws primarily failed by pullout of the screw and tendon, whereas in the hybrid technique, failure occurred with screw pullout followed by tearing of the biceps tendon. The results suggest that this hybrid technique is nearly as strong and stiff as the interference screw alone. Although the hybrid technique facilitates tensioning of the reconstructed tendon, the addition of the cortical button did not significantly improve the failure strength of the interference screw alone.
Adherence to the AAOS Upper-extremity Clinical Practice Guidelines
Authors: Matzon Jonas L. , Lutsky Kevin F. , Maloney Michael , Beredjiklian Pedro K.
Published: February 2014

The American Academy of Orthopaedic Surgeons (AAOS) recently developed several clinical practice guidelines (CPGs) involving upper-extremity conditions. The purpose of this study was to evaluate the adherence to these CPGs by members of the American Society for Surgery of the Hand (ASSH).

An e-mail containing a brief study description and access to the survey was sent to ASSH current and candidate members. The survey contained questions involving the existing upper-extremity AAOS CPGs: diagnosis and treatment of carpal tunnel syndrome, treatment of distal radius fractures, and treatment of glenohumeral arthritis. Overall, 469 responses were obtained, for a response rate of 32%. Descriptive statistics were used to evaluate the responses.

Members of ASSH do not universally adhere to the AAOS CPGs. For patients with carpal tunnel syndrome, 53% of respondents wait the recommended time to change nonoperative treatment after failure of a given modality, and 32% of respondents always order electrodiagnostic testing when considering surgery. Furthermore, 30% of respondents immobilize the wrist postoperatively. In regard to distal radius fractures, 11% of respondents always prescribe vitamin C after treatment, and 49% respondents never do so. However, ASSH members follow some of the recommendations. These include nighttime splinting (98%) and corticosteroid injections (85%) in the nonoperative treatment of carpal tunnel syndrome. For distal radius fractures, almost 85% of respondents consider the suggested postreduction criteria when determining operative versus cast treatment. Further study is warranted to understand the reasons for and possible solutions to the inconsistent adherence to the AAOS CPGs.
Patient and Family Satisfaction With En Bloc Total Resection as a Treatment for Solitary Spinal Metastasis
Authors: Kato Satoshi , Murakami Hideki , Demura Satoru , Yoshioka Katsuhito , Ota Takashi , Shinmura Kazuya , Yokogawa Noriaki , Kawahara Norio , Tomita Katsuro , Tsuchiya Hiroyuki
Published: February 2014

Many studies have evaluated patient satisfaction surgeries for primary cancers. No studies have evaluated patient satisfaction in metastasectomies. The authors examined patient and family satisfaction with en bloc total resection of solitary spinal metastases and evaluated the factors that correlated with dissatisfaction. From 1998 to 2010, total en bloc spondylectomy (TES) was performed in 110 patients with solitary spinal metastases at the authors’ institution. Questionnaires were sent by mail to 110 patients and their families in January 2012. Questionnaire included a subjective assessment of the results of surgery and the following questions: (1) Would you have the surgery again if you were returned to your presurgery status? and (2) Do you feel that you are a patient without cancer? To identify factors for dissatisfaction with the outcomes of TES, univariate and multivariate analyses were performed. Questionnaires were successfully delivered to 104 patients and their families. Responses were collected from 47 patients and 61 family members. Forty-five patients were very satisfied or satisfied with the outcomes of TES, and the other 2 were neutral. Fifty-four family members were very satisfied or satisfied, 5 were neutral, and 2 were dissatisfied. Forty-five patients indicated they would have the surgeries again. Thirteen patients indicated that they felt like patients without cancer. In multivariate analysis, patient death less than 2 years postoperatively and major postoperative complications were associated significantly with dissatisfaction.
Fixation of Multifragmentary Patella Fractures Using a Bilateral Fixed-angle Plate
Authors: Thelen Simon , Betsch Marcel , Schneppendahl Johannes , Grassmann Jan , Hakimi Mohssen , Eichler Christian , Windolf Joachim , Wild Michael
Published: February 2014

This biomechanical study is the first to compare 3 fixation methods—bilateral fixed-angle plate, modified anterior tension wiring, and cannulated lag screws with anterior tension wiring—in multifragmentary distal patella fractures.

A T-shaped 3-part fracture simulating a multifragmentary articular distal patella fracture (AO/OTA 34-C2.2) was created in 18 human cadaver knee specimens. Three groups were created using homogenous ages and bone mineral densities based on the fixation method received. Repetitive testing over 100 cycles was performed by moving the knee against gravity from 90° flexion to full extension. Failure was defined as fracture displacement greater than 2 mm. In all patellae using fixed-angle plates, an anatomical fracture reduction could be maintained throughout cyclic testing, whereas anterior tension wiring and lag screws with tension wiring showed significant fracture displacement after 100 cycles, with mean fracture gaps of 2.0±1.3 and 1.9±1.6 mm, respectively. The differences in fracture gaps between the fixed-angle plate group and the other 2 groups were statistically significant. In both groups using tension wiring, half of the constructs (3 of 6 in each group) failed due to a fracture displacement greater than 2 mm. The bilateral fixed-angle plate was the only fixation method that sustainably stabilized a multifragmentary articular distal patella fracture during cyclic loading when compared with modified anterior tension wiring and cannulated lag screws with anterior tension wiring.
Periprosthetic Patellar Fracture Fixation Using Suture Anchors
Authors: Maniar Rajesh N. , Nayak Ravi M. , Vatchha Shahrookh , Singhi Tushar
Published: February 2014

Treatment of type II periprosthetic patellar fractures presents difficulties in decision-making particularly when displacement is greater than 10 mm. Poor results have been reported with internal fixation, whereas conservative management has been associated with a high incidence of extensor lag. This article reports a patient with a displaced type II patellar fracture following total knee arthroplasty.

One month after undergoing total knee arthroplasty, a 72-year-old man presented to the emergency department with difficulty walking. Physical examination revealed an extensor lag with a palpable defect in the extensor mechanism. Radiographs showed a transverse, comminuted fracture through the distal third of the patella with a separation of approximately 15 mm. The patient underwent surgery, at which time the patellar component was found to be intact and well fixed to the proximal fragment. Three suture anchors were introduced into the proximal fragment through the fracture site. Tunnels were drilled in the distal fragment (through the fracture gap) corresponding to the location of the anchors; the sutures were threaded through these tunnels. Anatomical reduction was achieved with towel clips, and the sutures were tied at the distal pole. After the knots were tied, anatomical reduction was maintained, and the sutures were additionally used as cerclage around the patella. One year postoperatively, the fracture showed union, and the patient had good range of motion with no extensor lag. No patellar subluxation, avascular necrosis, or refracture occurred.
Distal Biceps Brachii Tendon Rupture Resulting in Acute Compartment Syndrome
Authors: Grandizio Louis C. , Suk Michael , Feltham Glen T.
Published: February 2014

Distal biceps brachii tendon rupture is an uncommon injury. Compartment syndrome of the upper arm is rarely described in the literature. The diagnosis of upper arm compartment syndrome requires a high index of suspicion, and emergent surgical treatment with fasciotomy in the acute setting is necessary to avoid devastating neurovascular complications. This article reports a case of acute compartment syndrome of the anterior compartment of the upper arm after a complete rupture of the distal biceps brachii tendon.

A healthy 45-year-old man presented with increasing arm pain; paresthesia in the lateral antebrachial cutaneous nerve distribution; and a tense, swollen anterior compartment of his upper arm. Side port catheter absolute pressure measurement was 83 mm Hg with a diastolic blood pressure of 92 mm Hg. The patient underwent an emergent fasciotomy and was found to have a complete rupture of his distal biceps brachii tendon. He subsequently underwent distal biceps tendon repair and delayed primary closure of his incision. Postoperatively, his paresthesia improved and he has no neurological deficit.

There is a paucity of case reports describing compartment syndrome after rupture of either the proximal or distal end of the biceps brachii tendon, and none of the reports describe compartment syndrome of the upper arm after rupture of the distal biceps tendon. This article highlights an unusual complication of an uncommon injury and reviews diagnostic and treatment principles for the management of acute compartment syndrome of the upper arm.
Cervical Corpectomy With Ultra-low-dose rhBMP-2 in High-risk Patients: 5-year Outcomes
Authors: Pourtaheri Sina , Emami Arash , Hwang Ki , Allert Jesse , Brothers Alex , Issa Kimona , Mont Michael A.
Published: February 2014

Twenty-four consecutive patients with cervical spondylosis who were treated with cervical corpectomy and recombinant human bone morphogenetic protein-2 (rhBMP-2) with standalone anterior instrumentation were evaluated. Mean number of levels fused was 2.4. There were significant improvements in visual analog scale neck pain and Oswestry Disability Index scores and cervical lordosis. Cervical corpectomy with a lower dose of rhBMP-2 was found to be safe and efficacious for patients who are at a higher risk for pseudarthrosis. [
Orthopedics.
2013; 36(12):931–935.]
Arthroscopy During Ulnar Shortening for Idiopathic Ulnar Impaction Syndrome
Authors: Koh Kyoung Hwan , Lee Hyun Il , Chang Yong Suk , Park Min Jong
Published: February 2014

Arthroscopy during ulnar shortening osteotomy for ulnar impaction syndrome is subject to debate regarding its clinical usefulness. The purposes of this study were to analyze the arthroscopic findings in patients who underwent ulnar shortening osteotomy and to assess the role of arthroscopic evaluation during osteotomy. Medical records and arthroscopic findings of 50 consecutive patients who had been diagnosed with idiopathic ulnar impaction syndrome were retrospectively evaluated. Pathologic changes of the articular disk of the triangular fibrocartilage complex (TFCC), chondromalacia of the lunate and triquetrum, and tears of the lunotriquetral interosseous ligament (LTIL) were evaluated during arthroscopy. Palmer’s classification was used to classify the TFCC lesions. Perforation of the TFCC was observed in 20 patients, and central tears were observed in 10. Thirty-eight patients exhibited chondromalacia of the lunate, including 4 unstable cartilage flaps. Partial tears of the LTIL were detected in 24 patients, including 9 unstable flap tears. In 21 (42%) of 50 patients, arthroscopic findings were not appropriate to define the disease stage with Palmer’s original description. Eight wrists exhibited tears or perforations of the TFCC without evidence of chondromalacia. Seven patients had an LTIL tear without perforation of the TFCC. Lunotriquetral interosseous ligament tears without lunate chondromalacia were found in 7 patients. Arthroscopic debridement was performed in 23 patients based on the clinical judgment that the procedure would help alleviate symptoms postoperatively. Arthroscopy during ulnar shortening osteotomy addresses intra-articular pathologies and may be helpful for symptom improvement.
Efficacy of Ultrasound-guided Intra-articular Injections of Platelet-rich Plasma Versus Hyaluronic Acid for Hip Osteoarthritis
Authors: Battaglia Milva , Guaraldi Federica , Vannini Francesca , Rossi Giuseppe , Timoncini Antonio , Buda Roberto , Giannini Sandro
Published: February 2014

Intra-articular injections of platelet-rich plasma (PRP) and hyaluronic acid (HA) represent efficacious medical treatments for osteoarthritis (OA), although no comparative study on long-term efficacy in hip OA exists. The goals of the current study were to compare the clinical efficacy of PRP vs HA at 12 months of follow-up in patients with hip OA and evaluate the influence of the type of infiltration and patient age, sex, body mass index, and degree of OA on temporal clinical evolution. One hundred patients with chronic unilateral symptomatic hip OA were consecutively enrolled and randomly assigned to 1 of 2 groups: group A received PRP and group B received HA administered via intra-articular ultrasound-guided injections. Patients were evaluated at baseline and after 1, 3, 6, and 12 months using the Harris Hip Score (HHS) and visual analog scale (VAS). An overall improvement was detected in both groups between 1- and 3-month follow-up. Despite a slightly progressive worsening between 6- and 12-month follow-up, the final clinical scores remained higher compared with baseline (
P
<.0005), with no significant differences between PRP and HA. Regarding clinical temporal evolution, multivariate analysis showed that HHS was not influenced by the type of infiltration, patient age, sex, body mass index, or degree of OA, whereas a significant association was detected between OA grade IV and VAS evolution (
P
<.0005). Intra-articular injections of PRP are efficacious in terms of functional improvement and pain reduction but are not superior to HA in patients with symptomatic hip OA at 12-month follow-up.