bluuebunny/crossref_metadata_2025 huggingface dataset:
New Graduates' Perceptions of Clinical Practice
Authors: Oermann Marilyn H , Moffitt-Wolf Ann
Published: April 2021

ABSTRACT

This study describes the stresses and challenges experienced by graduate nurses in clinical practice during their initial orientation period and examines the relationship of social support to these stresses. Thirty-five graduate nurses completed a modified Pagana Clinical Stress Questionnaire and social support measure during their orientation period. The graduates experienced a moderate degree of stress in their orientation. Stresses identified most frequently were: lack of experience as a nurse, interactions with physicians, lack of organizational skills and new situations and procedures. Although orientation was stressful, when describing emotions experienced during this period, graduates reported positive emotions most frequently. Pearson correlation revealed no significant relationship between social support and stress. Significant correlations were found, however, between social support and stimulation in clinical practice (r=.57, p=.001) and development of self-confidence (r=.39, p=.029). Findings highlighted the important role of the preceptor during orientation.
Student Pre-entry Experience and First Year of Employment
Authors: Duncan Kathleen
Published: April 2021

ABSTRACT

Background: Student clinical and work-related experiences are available at many healthcare organizations, but little is known about how these experiences contribute to the employer/nurse work relationship that begins after graduation. This study examined the relationship of senior BSN students' past employer experience in describing first-year employer commitment and turnover.

Methods: The sample was 63 senior BSN students. Experience factors measured included job selection factors, pre- and one-year commitment, organizational climate, employer support, and first-year turnover.

Results: Organizational climate was the experience-related factor most important in explaining first-year commitment.

Conclusion: Findings suggest the importance of supportive work environments to new nurses both before and after accepting the first graduate nurse position.
Gaming: A Teaching Strategy to Enhance Adult Learning
Authors: Henry Joan M
Published: April 2021

ABSTRACT

Background: As a nurse educator, I encountered many complaints from staff nurses about mandatory inservice education programs, stating that they are repetitious, time-consuming, often too basic, and at times, downright boring. One exception was an Infection Control Week education session that was done in the form of a game. This session set attendance records and had very positive feedback from staff nurses. As a result of this feedback, the use of gaming as a teaching strategy in nursing education was explored.

Method: A review of the literature on gaming as a teaching strategy was conducted with special attention to its history, current use, and successes in nursing education.

Results: Introduced as a formal teaching strategy more than 75 years ago, gaming offers many advantages over more traditional teaching methods. Games connect theory more closely to real life situation and add innovation, diversity, and the opportunity for immediate feedback. Although gaining in popularity, gaming is not extensively used in nursing education as it is not considered a serious educational tool. However, recent literature suggests much success with its use.

Conclusion: Gaming as a teaching strategy has proven to be an effective way of conveying information in a stimulating, appealing manner. Games facilitate both beginning and experienced nurses' learning by providing an opportunity for experience without the danger or fear of jeopardizing patient safety.
Capturing the Impact of the Doctor of Nursing Practice Degree on West Texas Health Care
Authors: Boswell Carol , Mintz-Binder Ronda , Batcheller Joyce , Allen Patricia , Baker Kathy A.
Published: April 2021

Background:

This article describes findings from a Phase 1 investigation exploring the influence of Doctor of Nursing Practice (DNP)-prepared nurses in West Texas.

Method:

Following a focus group session with eight practicing DNPs, the focus group shared how their roles effected safer health care.

Results:

Final takeaways included their commitment to safer health care and prevention, moving care to the community, and a wish for more variety in projects generated in workplaces. Three themes emerged from the data: DNP leadership practice affects health outcomes through improved quality of care, influence, and innovation; DNP strengths include communication, leadership, and ability to change others' thinking; and the influence of DNP-prepared leaders at all external levels occurs through both increasing awareness of the role and influencing in multiple areas. DNP challenges include lack of understanding by others of the role and the lack of recognition and respect for their educational preparation.

Conclusion:

Leading, innovating, and communicating during constantly changing care models are key skills needed during the current health care crisis. These skills are basic to DNP practice.

[
J Contin Educ Nurs
. 2021;52(4):192–197.]
BOWLER'S THUMB IN A BASEBALL PLAYER: A CASE REPORT
Authors: Belsky Mark R , Millender Lewis H
Published: April 2021

ABSTRACT: A professional baseball player presented with a tender, painful and clinically enlarged ulnar digital nerve to the thumb which prevented him from batting. Thumb sensation was normal. At surgery, a 1.5 cm-length of the digital nerve was found to be thickened and enlarged. His condition was cured by detaching the adductor tendon and transplanting the nerve dorsal to the adductor muscle.
Reconstruction of Ankle Malunion: Indications and Results
Authors: Fogel Guy R , Sim Franklin H
Published: April 2021

ABSTRACT: Nine patients had reconstructive surgery for ankle malalignment with tibiotalar incongruity. The clinical result was correlated with the roentgenographic appearance at last followup. Fracture malunions involved supination-external rotation in five patients, pronationabduction in two, pronation-extemal rotation in one, and supination-adduction in one. Osteotomy or osteotomy and bone grafting with soft tissue releases was performed in each case, and tibiofibular syndesmosis fixation was used in three. Two patients had good reductions, three fair, and four poor. Talar displacement and tilt could be corrected in six. At followup, five patients had radiologic evidence of arthrosis. Eight have continued worki ng or are i ndependent i? retirement. Timing of the reconstruction is important. Osteotomy for bimalleolar fractures is indicated in a young patient with mild deformity and minimal arthrosis. Reduction of trimalleolar fractures must be accomplished early to be successful. Aggressive treatment of osteochondral defects may enhance results.
Selective Hindfoot Arthrodesis in Rheumatoid Arthritis
Authors: Ruff Michael E , Turner Richard H
Published: April 2021

ABSTRACT: Rheumatoid arthritis that involves the hindfoot is disabling because it affects the patient's ability to walk. Fifteen patients with ankle pain who demonstrated isolated hindfoot arthritis clinically and radiographically underwent 19 selective hindfoot arthrodeses. At followup averaging 3 ½ years, results were rated good in 16, fair in four, and none were rated poor. Selective hindfoot fusion is effective in relieving pain and restoring the foot to ambulatory status.
Biological Fixation of a Modified Moore Prosthesis
Authors: Engh Charles A , Bobyn J Dennis , Gorski Jerrold M
Published: April 2021

ABSTRACT: Clinical experience with a poroussurfaced modified Moore prosthesis designed for biological fixation is described. Principles of noncemented arthroplasty including details of patient selection, implant design and selection, and surgical technique are emphasized. Analysis of the first 100 patients with a minimum followup of two years indicates that the short term clinical results are similar to those obtained with conventional cemented hip arthroplasty.
A Review of Delayed Unions of Open Tibia Fractures Treated With External Fixation and Pulsing Electromagnetic Fields
Authors: Stein Gary A , Anzel Sanford H
Published: April 2021

ABSTRACT: Seventeen cases of open tibia fractures complicated by delayed union were reviewed. Only severe injuries requiring external fixation for tissue management and multiple surgical procedures were included in this study. All were ultimately treated with pulsing electromagnetic fields. Our purpose was to evaluate the efficacy of electrical stimulation in these cases and any synergism with combined surgical procedures. Fifteen of 17 cases (88.2%) united within an average of 5.65 months after electrical stimulation was implemented. The average time interval from injury to application of electrical stimulatin was 13.75 months. Pin tract infections occurred in an alarmingly high number of patients; however, all responded to treatment. A notable synergistic relationship with bone grafting was found when stimulation was applied postoperatively.
Feasibility of Bone Healing Measurement With External Fixation: Experimental Study
Authors: Bourgois R , Burny F
Published: April 2021

ABSTRACT: The measurement of fracture healing is a problem before us now; many techniques are now being developed. One of them is strain gauge measurement, allowing control of the development of the callus stiffness. The mathematical models and the experimental controls always had to deal with "preliminary assumptions." Theoretically, the output of a single strain gauge bonded on the fixation rod drops rapidly accordingly to the quality of the healing. Our aim is to verify experimentally the validity of the method in cases where the "preliminary assumptions" are not strictly true.

We investigated the influence of the fixation rod on the loading of the tibia using strain gauges bonded on the bone. The tibial cortex was afterwards weakened by a 1 mm broad saw cut (and later a 5 mm one) in the middle of the bone. We again found the hyperbolic pattern of the theoretical curves.

The experiments confirm the theoretical result: the measurement of stress drops rapidly as the degree of healing increases. An asymmetrical healing does not seem to modify significantly the pattern of the curve.
The Back School: A Total Back Management Program
Authors: Simmons James W , Dennis M David , Rath Diane
Published: April 2021

ABSTRACT: The back school, a comprehensive total back management program, promoted a significant level of decrease in the back pain frequency of the 68 patients, 32 male and 36 female, undergoing the educational program. The participant's progress was evaluated through a questionnaire designed to assess the degree of success and identify factors that may influence the outcome. A significant correlation of pain relief with the overall mental ability to comprehend and deal with the pain was demonstrated. No other factors measured, ranging from age to work status, affected the response of the patients to the educational program. The emphasis of the back school program is lifestyle analysis, education, and exercise.
Autogenous Bone Grafting in Clinical Osteomyelitis and Septic Nonunion (The Papineau Technique)
Authors: Sanders Melanie , Albright James A
Published: April 2021

ABSTRACT: The technique of extensive wound debridement and secondary use of autogenous cancellous bone chips can be used to salvage both septic nonunions and chronic osteomyelitis. The same technique may also be used to bridge large bony defects of traumatic origin. With time, the cancellous bone becomes completely incorporated and strengthens, allowing full use of the limb. There are few complications with the procedure. Nonunion may develop on occasion and require a closed bone graft once the wound is free of infection and closed. The major surgical principles are: 1) adequate debridement with removal of all infected tissue, 2) a viable base to support the graft, 3) the use of autogenous cancellous bone, 4) adequate immobilization, and 5) delayed wound closure.1-5
EFFECT OF MODIFIED AEROBIC TRAINING ON MOVEMENT ENERGETICS IN POLIO SURVIVORS
Authors: Dean Elizabeth , Ross Jocelyn
Published: April 2021

ABSTRACT

Given that individuals with disabilities may be unable to achieve maximal oxygen uptake in an exercise test and that maximal exercise testing may cause increased fatigue, pain, and muscle weakness, we examined the role of submaximal exercise testing and training based on objective as well as subjective parameters in polio survivors. Experimental (N = 7) and control subjects (N =13) were tested before and after a 6-week period. The experimental subjects participated in a 6-week exercise training program for 30 to 40 minutes, three times a week. The program consisted of treadmill walking at 55% to 70% of age-predicted maximum heart rates; however, exercise intensity was modified to minimize discomfort/pain and fatigue. Neither objective nor subjective exercise responses were significantly different in the control group over the 6 weeks. No change was observed in cardiorespiratory conditioning in the experimental group. However, movement economy, which is related to the energy cost of walking, was significantly improved; and walking duration was significantly increased at the end of training. Modified aerobic training may have a role in enhancing endurance and reducing fatigue during activities of daily living in polio survivors.
THE USE OF POSTOPERATIVE SUCTION DRAINAGE IN TOTAL HIP ARTHROPLASTY
Authors: Acus Raymond W , Clark John M , Gradisar Ivan A , Kovacik Mark W
Published: April 2021

ABSTRACT

Two hundred eight primary total hip arthroplasties were reviewed to evaluate the effect of closed suction drainage. This review included 45 hips in which closed drains were used and 163 hips in which drains were not used. These two groups were compared for possible differences in wound problems, temperature elevations, changes in Hgb/Hct, and the need for transfusions. There was no statistically significant difference in postoperative temperatures or decrease in Hgb. However, there were four superficial wound infections in the drained group and three superficial wound infections in the nondrained group (P<.025). There were no deep infections in either group. These findings suggest closed suction drainage provides no apparent advantage in uncomplicated primary total hip arthroplasty.
SCAPHOCAPITATE FRACTURE SYNDROME
Authors: Maser Steven A , Harding Susan P , Harhay Joseph S , Webber John B
Published: April 2021

ANSWER PLEASE
DISLOCATION FOLLOWING THA: COMPARISON OF TWO ACETABULAR COMPONENT DESIGNS
Authors: Brien William W , Salvati Eduardo A , Wright Timothy M , Burstein Albert H
Published: April 2021

ABSTRACT

One hundred ninety-seven consecutive primary cemented total hip arthroplasties using 22 mm heads were evaluated for the rate of dislocation. All surgery was performed by one surgeon through a posterior approach. A Charnley type femoral component was used in each case. Patients were divided into three groups based on the acetabular component used. Group I had 60 Charnley HPW cups implanted between January 1985 and December 1986; group II had 70 Tibac cups implanted between January 1987 and August 1987; and group ?? had 67 Charnley HPW cups implanted between September 1987 and February 1988. The groups were similar with regards to age, sex, original diagnosis, and surgical technique. There was a total of 11 dislocations (5.6%), of which 8 (11.4%) occurred in group II (Tibac cup). Furthermore, 6 patients (3%) developed recurrent hip dislocations, 5 (7.1%) of which were from group II. Group II had a statistically significant increase in the dislocation rate (P<.05). The authors conclude that the dislocation rate with the 22 mm Tibac cup is unacceptably high and that the design of the Charnley cup affords greater stability to the artificial hip joint than the hemispherical design of the Tibac cup.
ARTHROSCOPIC MANAGEMENT OF WRIST TRIANGULAR FIBROCARTILAGE COMPLEX INJURIES IN THE ATHLETE
Authors: Whipple Terry L , Geissler William B
Published: April 2021

ABSTRACT

Wrist arthroscopy can facilitate early definitive diagnosis of debilitating soft tissue injuries in athletes. Many such injuries can be treated successfully with minimally invasive arthroscopic techniques, reducing the morbidity associated with surgical exposure and permitting earlier return to competition. The triangular fibrocartilage complex (TFCC) is vulnerable to injury from rotational forces or axial load applied to the hand. Under arthroscopic control, injuries to the central articular disk can be treated by excision of unstable tissue fragments; peripheral separation of the disk from the dorsal or volar ligaments can be repaired with sutures to achieve complete healing. Avulsion fractures from the dorsal ulnar margin of the sigmoid notch of the radius are better treated through a small arthrotomy after initial arthroscopic evaluation.
OSTEOSARCOMA OF THE DIAPHYSIS OF LONG BONES: CLINICOPATHOLOGIC FEATURES AND TREATMENT OF 51 CASES
Authors: Sim Franklin H , Frassica Frank J , Unni K Krishnan
Published: April 2021

ABSTRACT

Of 1000 osteosarcoma cases recorded in the Mayo Clinic records, approximately 7% of the lesions occurred in the diaphysis of long bones, mostly in the femur, tibia, and humerus. The average age of the patients with these lesions was 28 years (range: 8 to 67). The duration of their symptoms before diagnosis was greater than that for patients with conventional osteosarcoma in the metaphysis. In approximately 20% of the cases, the radiographic appearance mimicked that of Ewing's sarcoma. Amputation surgery was the major form of treatment. The 2-, 5and 15-year survival was 42%, 29%, and 20%, respectively.
TREATMENT OF ACQUIRED MUSCLE SPASTICITY USING PHENOL PERIPHERAL NERVE BLOCKS
Authors: Botte Michael J , Abrams Reid A , Bodine-Fowler Sue C
Published: April 2021

ABSTRACT

The use of phenol motor nerve blocks is advantageous in the early period of acquired spasticity (ie, that occurring following traumatic brain injury or incomplete spinal cord injury), when increased muscle tone is often the most severe. Because acquired spasticity is dynamic and usually improves slowly, a temporary treatment method used to ameliorate increased muscle tone is desirable. Phenol nerve infiltration provides a temporary motor nerve block that lasts for weeks or months. It allows passive limb mobilization in a comprehensive rehabilitation program that attempts to prevent fixed soft tissue contractures. Permanent or irreversible methods such as operative tendon lengthening, muscle release or recession, or neurectomy are usually best delayed until the spasticity

has become static, when the need for surgical correction becomes more firmly indicated, and outcomes of operative intervention are more predictable. Although phenol nerve blocks were initially administered at the spinal cord level to control spasticity, the potential side effects have caused a loss of popularity of this method of administration. The safer and more common use of phenol infiltration at the peripheral nerve level is now more accepted for brain injury and spinal cord injury patients. This report reviews the indications, current concepts, and development of the different methods used to administer phenol nerve blocks. Comparisons to other methods to control spasticity are discussed.
CLUBFOOT DEFORMITY IN DOWN'S SYNDROME
Authors: Miller Paul R , Kuo Ken N , Lubicky John P
Published: April 2021

ABSTRACT

The association of Down's syndrome (trisomy 21) with clubfeet has not previously been elaborated. Eight patients with a total of 15 clubfeet were identified for review. Five of these had trisomy 21 noted by chromosomal analysis, and 1 had a mosaic pattern. Two patients did not have chromosomal documentation, but had characteristic features of Down's syndrome. Interestingly, 2 patients had evidence of arthrogryposis as well as Down's syndrome. Four of the 8 patients had other orthopedic anomalies, including scoliosis, atlantoaxial instability, brachydactyly, and coxa valga. All 8 patients had an initial period of casting prior to any surgical intervention. Fourteen of the 15 feet required surgical intervention to afford correction of the deformity. The 6 feet with relatively long-term follow up (average: 5 years) showed that there was 1 excellent, 4 good, and 1 fair result using the criteria of Turco. It appears that, even though Down's syndrome is usually characterized by ligamentous laxity, when clubfeet are associated with this syndrome they are often resistant to nonoperative treatment, and surgical treatment seems to produce an acceptable result.
THE HALO SKELETAL FIXATOR: CURRENT CONCEPTS OF APPLICATION AND MAINTENANCE
Authors: Botte Michael J , Byrne Thomas P , Abrams Reid A , Garfin Steven R
Published: April 2021

ABSTRACT

The halo device provides the most rigid cervical immobilization of all cervical orthoses. Despite its established efficacy, reported complications include pin loosening (36% to 60%), pin-site infection (20% to 22%), severe pin discomfort (18%), ring migration (13%), pressure sores (4% to 11%), unacceptable scars (9% to 30%), nerve injury (2%), dyspha

gia (2%), prolonged bleeding at pin sites (1%), and dural puncture (1%). Appreciation of skull anatomy and established application guidelines can help minimize these complications. A relative "safe zone" for anterior pin placement is located 1 cm above the orbital rim, superior to the lateral two thirds of the orbit. This position avoids injury to the nearby frontal sinus (medially), temporalis fossa (laterally), and sensory nerves (supraorbital and supratrochlear nerves medially, and zygomaticotemporal nerve laterally). Posterior pin positions are less critical, located roughly diagonal to the contralateral anterior pins. Pins should enter the skull perpendicular to the cortex, with the ring or crown sitting below the equator of the skull, passing about 1 cm above the helix of the ear. Pins are inserted at 8 in-lbs and re-tightened once at 48 hours. A loose pin can be re-tightened to 8 in-lbs if resistance is met; otherwise, a loose pin requires replacement in a nearby site. Superficially infected pins are managed with oral antibiotics and local pin care. Refractory infections require pin removal, parenteral antibiotics, and incision and drainage as indicated. Dysphagia (difficulty in swallowing), produced by exaggerated cervical extension, may necessitate repositioning of the C-spine. Dural pin puncture is managed with hospitalization, antibiotics, and elevation of the head of the bed to decrease cerebrospinal fluid pressure and allow dural healing. Pressure sores are treated by prevention with well-padded vests/casts and the use of skin precautions, especially in sensory-deprived spinal cord injury patients. Inability to maintain reduction with a halo fixator usually requires open reduction and internal fixation of the cervical spine.
A PORTABLE TENSIOMETER FOR ASSESSING KNOT-TYING TECHNIQUE
Authors: Franz David A , Batra Erich K , Morgan Raymond F , Edlich Richard F
Published: April 2021

ABSTRACT

The purpose of this study was to determine the influence of orthopedic surgeons' tying techniques on knot security using 2-0 and 4-0 monofilament and multifilament nylon sutures. Using an Instron® Tensile Tester and a portable tensiometer, knot security was achieved with these sutures using four-throw square knots (1 = 1 = 1 = 1). After didactic and psychomotor skill training, medical students were taught to construct the four-throw square knot using either a two-hand tie or an instrument tie. Using the portable tensiometer, their knot-tying techniques were judged to be superior to those used by orthopedic surgeons. The orthopedic surgeon's faulty technique can easily be corrected by didactic information and psychomotor skill training.
COMPARTMENT PRESSURE MONITORING DURING INTRAMEDULLARY FIXATION OF TIBIAL FRACTURES
Authors: Moehring H David , Voigtlander James P
Published: April 2021

ABSTRACT

Twenty-six legs in 25 patients were monitored prospectively for compartment pressures during intramedullary nailing of open and closed tibial shaft fractures. Twentythree patients were treated within 24 hours of admission. Twenty-three unreamed and three reamed intramedullary rods were utilized. Compartment pressures were measured initially, following fracture reduction, and during reaming. Pressures were also measured at the completion of nailing with the ankle dorsiflexed and at rest (plantar flexed) to determine positional effects on compartment pressures. Nine fractures (35%) were found to have persistently elevated pressures (>40 mm Hg) and underwent immediate fourcompartment fasciotomy. The remaining group of 17 fractures (65%) was monitored throughout the intraoperative period. No patient monitored intraoperatively developed postoperative compartment syndrome.
THE DIFFICULT DIAGNOSIS OF POSTERIOR TIBIALIS TENDON RUPTURE IN SPORTS INJURIES
Authors: Marcus Randall E , Goodfellow Donald B , Pfister Michael E
Published: April 2021

ABSTRACT

Posterior tibialis tendon rupture is a diagnosis that is often missed in sports-related injuries. This is thought to be secondary to the nonspecific clinical findings in healthy, active individuals, and the lack of any laboratory or radiographic test to reliably confirm the diagnosis. We report five cases of surgically confirmed posterior tibialis tendon rupture secondary to sports-related trauma. Based on our review of these patients, the diagnosis of posterior tibialis tendon rupture should be strongly suspected in the adult patient presenting with a history of a twisting ankle injury, especially in the setting of highimpact loading and generalized medial ankle pain and swelling. A flexible asymmetric pes planus and forefoot pronation deformity with absence of posterior tibialis tendon function on manual testing is seen on examination. The patient is usually unable to perform ipsilateral single leg heel rise and has less severe pes planus of the contralateral foot. This study reviews the presentation, pathophysiology, diagnosis, and treatment of posterior tibialis tendon rupture.
Cemented Arthroplasty: 20 Years Onward
Authors: Ling R S M
Published: April 2021

Femoral Component Fixation Options in the 1990s
Snowboard Traumatology: An Epidemiological Study
Authors: Pigozzi Fabio , Santori Nicola , Di Salvo Valter , Parisi Attilio , Di Luigi Luigi
Published: April 2021

ABSTRACT

In the past 10 years, snowboarding has become a popular winter sport among young people, and the number of accidents has increased proportionately. The incidence of traumas from snowboarding is shown to be 4 to 6 for every 1 000 medical examinations, which is similar to that of downhill skiing. However, other important statistical differences exist between the two sports.

This study of 1 06 snowboarding-related injury cases analyzes the epidemiology of these injuries in Italy. Results found that 45.1% of injuries are located in the upper limbs and that significant advantages are obtained with the introduction of guards to protect the upper limbs during descent. Serious ligament injuries to the knee are more rare in snowboarding than in downhill skiing. In both sports, injuries are more common with rigid boots, which lead to a higher incidence of injury to the upper limbs. Finally, a high percentage of injury to beginners was found in this study. Training courses for those who are considering taking up the sport of snowboarding could significantly lower their risk of trauma.
Cementless Sockets: Optimums and Outcomes
Authors: Paprosky Wayne G
Published: April 2021

Acetabular Fixation Options in the 1990s
The Vertebral Artery: Surgical Anatomy
Authors: Lu Jike , Ebraheim Nabil A
Published: April 2021

ABSTRACT

Anterior cervical decompressive surgery is widely performed for spondylosis, herniated intervertebral disk, tumor, infection, and trauma in the subaxial cervical spine region. Laceration of the vertebral artery is the most challenging of surgical dilemmas during anterior cervical spine surgery, as gaining control of the massive hemorrhage from a ruptured vertebral artery is difficult and could possibly result in an uncertain neurologic morbidity. As such, the understanding the surgical anatomy of the vertebral artery is essential to prevent iatrogenic injuries.
Computed Tomographic Evaluation of the Internal Structure of the Lateral Sacral Mass in the Upper Sacra
Authors: Ebraheim Nabil A , Lin David , Xu Rongming , Stanescu Stephan , Yeasting Richard A
Published: April 2021

ABSTRACT

Because dimensions of the upper sacral cortexes vary greatly among individuals, preoperative computed tomographic (CT) evaluation of individual sacrum may help surgeons choose sacral screw insertion techniques. Axial CT scans were performed on 40 dry sacrum specimens to quantitatively evaluate the internal structure of the lateral sacral mass in the first and second segments. The results showed that the greatest cortical thickness in the Sl vertebra was found in the anterior cortex (3.4±0.9 mm), followed by the anterolateral (3.2±1.2 mm), and anteromedial (2.9±1 mm). The greatest cortical thickness in the S2 region was noted in the anteromedial cortex (2.4±0.5 mm), followed by the anterior and anterolateral (2.2±0.9 mm). The mean percentage of the anterior cortex thickness versus the lateral sacral mass depth was 12.8±3.7 for Sl and 11.1 ±2.8 for S2. Bicortical screw placement is recommended to achieve stronger fixation, but care should be taken not to violate the vital structures anterior to the sacrum.
Reconstruction of the Anterior Column of the Thoracic and Lumbar Spine With a Carbon Fiber Stackable Cage System
Authors: Boriani S , Biagini R , Bandiera S , Gasbarrini A , De Iure F
Published: April 2021

A carbon fiber stackable cage system is presented to promote the reconstruction of the anterior column after vertebrectomy or corpectomy in tumor and trauma surgery. Modularity, immediate stability, early fusion of the graft, radiolucency, and no risk of disease transmission are the main advantages of this system.
World Experience with Low Contact Stress Mobile-Bearing Total Knee Arthroplasty: A Literature Review
Authors: Stiehl James B
Published: April 2021

Abstract

This article reviews recent data regarding the low contact stress (LCS) mobile-bearing total knee prosthesis recently published in the literature; conclusions are based on literature controls. The LCS Total Knee System (DePuy Orthopaedics Ine, Warsaw, lnd) has addressed the issues of implant polyethylene wear and implant-generated osteolysis. Patellar implant complications have been minimal despite the use of a mobile, metal-backed component. The original US Food and Drug Administration clinical investigation demonstrated favorable experience with cementless fixation. Results from numerous series indicate that the main problem with a mobile-bearing device is an early prosthetic failure resulting from bearing dislocation or breakage. Inadequate surgical technique will lead to femorotibial malalignment or ligamentous instability, which are factors that commonly result in revision. With the LCS Total Knee System, surgeons can use a tibia-cut-first approach with careful ligamentous balancing and flexion block spacing. The valgus lateral knee approach is an additional technique that has proved useful with this method.
Use of Injectable Calcium Phosphate in the Treatment of Intra-Articular Distal Radius Fractures
Authors: Tyllianakis Minos , Giannikas Dimitrios , Panagopoulos Andreas , Panagiotopoulos Elias , Lambiris Elias
Published: April 2021

Abstract

This study reviewed 19 patients with intra-articular fractures of the distal end of the radius treated with augmented external fixation and injectable calcium phosphate (Norian SRS; Norian Corp, Cupertino, Calif) between November 1997 and July 2000. Average patient age was 52 years, and average follow-up was 16.3 months. Patients were evaluated clinically and radiographically using the modified Mayo Wrist Score and Knirk and Jupiter's criteria, respectively. Overall results are comparable to those from other studies of intra-articular distal radius fractures in which other grafts have been used.
A Comparison of the Effects of Solid, Articulated, and Posterior Leaf-Spring Ankle-Foot Orthoses and Shoes Alone on Gait and Energy Expenditure in Children with Spastic Diplegic Cerebral Palsy
Authors: Smiley Sara J , Jacobsen F Stig , Mielke Cary , Johnston Robert , Park Carol , Ovaska Gary J
Published: April 2021

Abstract

Fourteen children with spastic diplegie cerebral palsy were evaluated wearing three different ankle-foot orthoses and shoes alone. The ankle-foot orthoses included solid, articulated ankle, and posterior leaf-spring types. Evaluation measures included computerized gait analysis, Energy Efficiency Index data, and individual preference. Highly significant kinematic differences were found at the ankle with shoes alone approaching normative data and braces showing abnormal dorsiflexion. No significant differences were found in velocity, cadence, stride length, or in the Energy Efficiency Index. Eight children preferred articulated braces, six chose posterior leaf-spring, and none chose the solid brace.
Arthroscopy Following Total Knee Arthroplasty
Authors: Teng Hsiu-Peng , Lu Yih-Chau , Hsu Chien-Jen , Wong Chi-Yin
Published: April 2021

Abstract

Conservative treatment had previously been used in our institution to treat the painful stiff knee joint following total knee arthroplasty (TKA). However, the result was not satisfactory. Arthroscopic surgery was then performed in ? patients with painful knee joints with limited motion who had previously undergone TKA. Good results were achieved in eight patients. An average improvement of 56.3° was achieved for knee range of motion. Flexion improved up to 90° in all patients in the early postoperative period following arthroscopy. However, the benefits declined with time. To avoid the potential complications of manipulation and open arthrotomy, arthroscopic surgery is an option for treating the painful stiff knee joint.
Adjunctive Use of Ultraporous β-Tricalcium Phosphate Bone Void Filler in Spinal Arthrodesis
Authors: Meadows Gilbert R
Published: April 2021

Abstract

Spinal fusion is one of the most common clinical indications for bone grafting. However, synthetic bone substitutes are needed to ameliorate limited availability, donor site morbidity, and potential disease transmission concerns associated with autograft and allograft. One new synthetic bone substitute, Vltoss (Orthovita, Malvern, Pa), is an ultraporous formulation of β-tricalclum phosphate (β-TCP). This study examines 50 patients who received ultraporous β-TCP bone void filler as an adjunct to autogenous bone graft while undergoing spinal fusion procedures. All patients underwent decompressive laminectomy with bilateral posterolateral intertransverse fusion (PLITF) using bone graft mixed with ultraporous β-TCP, with and without instrumentation. Some patients also underwent posterior lumbar interbody fusion (PLIF) using cages and bone graft. Thirty-two patients were studied for at least 5-7 months postoperatively. Of these patients, 1 00% demonstrated good consolidation on follow-up radiographs. The use of iliac crest bone graft (ICBG) was avoided entirely in 7 (14%) of the 50 patients, and 30% less ICBC volume was required on average in others. Only 3 patients (7%) had donor site-associated pain. Controlled studies are being conducted to support the clinical impression that ultraporous β-TCP used as a bone void filler in spinal arthrodesis facilitates bone healing at both the spinal and donor operative sites, and contributes to less overall morbidity.
Spondylolysis: Returning the Athlete to Sports Participation With Brace Treatment
Authors: d'Hemecourt Pierre A , Zurakowski David , Kriemler Susi , Micheli Lyle J
Published: April 2021

Abstract

Between 1988 and 1995, 73 adolescent athletes treated with the Boston Overlap Brace for spondylolysis were reviewed to evaluate improvement in pain score and activity level. A favorable clinical outcome was achieved in 80%. Girls and boys who participated in high-risk sports were five times more likely to have an unfavorable clinical outcome than those who participated in low-risk sports (odds ratio=5, 95% confidence interval=2.4-7.5, P=.003). In addition, acute onset of pain and hamstring tightness were associated with a worse outcome. Athletes with symptomatic spondylolysis treated with an antilordotic brace can expect improvement in their clinical course and return to sports participation in 4-6 weeks.
A Cost Analysis of Bone Morphogenetic Protein Versus Autogenous Iliac Crest Bone Graft in Single-Level Anterior Lumbar Fusion
Authors: Polly David W , Ackerman Stacey J , Shaffrey Christopher I , Ogilvie James W , Wang Jeffrey C , Stralka Susan W , Mafilios Michael S , Heim Stephen E , Sandhu Harvinder S
Published: April 2021

Abstract

An economic model was developed to compare costs of stand-alone anterior lumbar interbody fusion with recombinant human bone morphogenetic protein 2 on an absorbable collagen sponge versus autogenous iliac crest bone graft in a tapered cylindrical cage or a threaded cortical bone dowel. The economic model was developed from clinical trial data, peer-reviewed literature, and clinical expert opinion. The upfront price of bone morphogenetic protein (S3380) is likely to be offset to a significant extent by reductions in the use of other medical resources, particularly if costs incurred during the 2-year period following the index hospitalization are taken into account.
The Diabetic Foot: Update on a Common Clinical Syndrome
Authors: Stein Haim , Yaacobi Esther , Steinberg Raya
Published: April 2021

Abstract

A cross-sectional study was conducted in 3995 non-hospitalized diabetic patients to evaluate symptoms commonly associated with "diabetic foot" syndrome. Each patient was examined twice over 2 years during routine follow-up. The male/female ratio differed significantly between the study group and general population. Men were more prevalent in the diabetic group up to age 49 years. Thereafter, the proportion of females increased. The clinical signs present in various combinations in those with diabetic feet were dermatological findings, foot and toe deformities, open wounds and ulcerations, pulselessness, and neurological deficiencies. The female/male ratio for each symptom was significantly higher for women except for ulcerations, which were more common in men.
Noninvasive Measurement of Compartment Syndrome
Authors: Dickson Kyle F , Sullivan Michael J , Steinberg Bruce , Myers Leann , Anderson Edward R , Harris Mitch
Published: April 2021

Abstract

This study compared the effectiveness of a commercially available invasive intracompartmental pressure measuring device with an investigational noninvasive hardness measuring device in 75 patients undergoing examination for possible compartment syndrome. Legs, forearms, thighs, and arms were tested.

Pressure values and hardness ratios were compared to one another as continuous variables and to the clinical diagnosis of compartment syndrome as discrete variables. The compartment with the highest pressure reading within a limb diagnosed with compartment syndrome was compared to limbs without compartment syndrome. Due to the low specificity of the noninvasive measurement of hardness compared to the invasive pressure measurement (0.82 versus 0.96), this study does not support the use of the hardness monitor in the. diagnosis of compartment syndrome.
Academic Middle Managers for Baccalaureate Nursing: Work Motivation and Satisfaction
Authors: Carpenter Karen D
Published: April 2021

ABSTRACT

Seventy-nine percent of academic middle managers for baccalaureate nursing reported that they did not plan to continue in their current management positions, or advance in academic leadership positions (George, 1981). This study examined the relationships between the job characteristics, a mediating variable "growth need strength", and the general job satisfaction and work motivation of academic middle managers for baccalaureate nursing.

The sample was drawn from the population of academic middle managers for baccalaureate nursing in 126 colleges and universities across the United States that oner both baccalaureate and higher nursing degree programs. Sixty seven percent returned the Job Diagnostic Survey Short Form (JDSSFX

The findings were interpreted through an examination of three analytical techniques: zero-order correlations, multiple regression, and multiple regression with interaction.

Findings indicate that the dependent variable, "internal work motivation," can be measured in the population, but it cannot be predicted using the seven job characteristics measured by the JDSSF.

The job characteristic autonomy was significant in predicting "general job satisfaction." General job satisfaction also proved to be some combination of security satisfaction and growth need satisfaction. Both independent variables "autonomy" and "feedback from the job itself were significant in predicting growth need satisfaction.

As a mediating variable, "growth need strength" was not significant in predicting general job satisfaction in a linear model, nor was it significant when entered as an interactive term. However, the multiplicative model did increase, by four percent above the linear model, the amount of variance predictable in general job satisfaction.

To increase the general job satisfaction and growth need satisfaction of academic middle managers for baccalaureate nursing, administrators may wish to increase the degree to which freedom, independence, and discretion of the middle manager is allowed in scheduling their work and in determining the work procedures to be used and to expand opportunities for middle managers to obtain direct and clear information about the effectiveness of their performance from the work activity itself.
Lesbian Phobia Among BSN Educators: A Survey
Authors: Randall Carla E
Published: April 2021

ABSTRACT

This exploratory study identified the attitudes of BSN educators in a midwestern state towards lesbians. A 50% (N100) return rate of mailed questionnaires elicited responses to 48 statements about lesbians and lesbianism on a modified Likert scale. The questionnaire included general demographic data and responses to statements seeking information about topics of lesbianism or lesbian issues. Specific areas addressed included moral and ethical responses, knowledge statements, sexuality or sex related statements, normalness of lesbians and lesbian behavior, and social contact with lesbians. Notable findings revealed that BSN educators were not personally fearful of sexual advances from lesbians; however, they did indicate concern about lesbians molesting and caring for children as well as lesbians in the role of educators. More than half believed that lesbianism is not a natural expression of human sexuality.
The Relationship Between Changing Answers and Performance on Multiple-Choice Nursing Examinations
Authors: Jordan Lila , Johnson Don
Published: April 2021

ABSTRACT

The purpose of this study was to investigate answer changing among undergraduate nursing students on multiple choice examinations. The sample included 284 students enrolled in the upper division of a baccalaureate nursing program. Answer sheets were examined for erasures to determine the number and direction of changes made. The results of the study indicated that most students changed at least one answer. Analysis of the data indicated that there was a significant difference between changing from wrong to right versus changing from right to wrong. About 55.3% gained points as a result of changing answers while only 18.3% lost points.
The Relationship Between Clinical Decision-Making Skills in Nursing and General Critical Thinking Abilities of Senior Nursing Students in Four Types of Nursing Programs
Authors: Brooks Karen L , Shepherd Jan M
Published: April 2021

ABSTRACT

This descriptive study was undertaken to investigate the relationship between clinical decision-making skills in nursing and critical thinking abilities of senior nursing students in four types of nursing education programs: generic baccalaureate, associate, and diploma - the basic RN programs, along with the upper division baccalaureate (specifically RN completion) program. Fifty senior students from each type of program were conveniently selected. Clinical decision-making in nursing was measured by the Nursing Performance Simulation Instrument. General critical thinking abilities were determined by the Watson-Glaser Critical Thinking Appraisal. Among the basic RN programs, the higher level of general critical thinking ability was attained by generic baccalaureate seniors (mean score, 61.3) compared with the associate (50.0) and diploma (51.3) seniors. The clinical decisionmaking scores in nursing skills were virtually identical for the three basic programs - generic (32.2), associate (32.2), and diploma (32.3). That is, mean performance scores of the 2-year associate degree, 3-year diploma, and 4-year generic baccalaureate degree students on the Nursing Performance Simulation Instrument showed no statistically significant difference. The mean critical thinking score for the upper division baccalaureate seniors (61.1) was comparable to that of the generic baccalaureate seniors. Clinical decision-making mean score for the upper division seniors was significantly higher (38.0) than those of the other three groups. A weak though significant positive correlation (r= 0.249) between clinical decisionmaking and critical thinking across all four types of programs was found.
We Need to Know More: Nurse Educators' Interest and Expertise in Gerontology
Authors: Ryden Muriel B , Johnson Julie A
Published: April 2021

ABSTRACT

An assessment was made of 129 faculty who teach nursing students about the care of aged clients to determine their level of interest and expertise in 21 content areas related to gerontology. Faculty rated their expertise consistently lower than the relevance of, and their interest in, each of the content areas. Areas identified as most important for their professional growth tended to be areas where faculty ranked their expertise as already being high. The mean self-rated expertise of faculty who taught a course in gerontological nursing was significantly higher than those who did not. Most respondents lacked formal education in gerontology: 9% of respondents had gerontology in their undergraduate program; 27% in their graduate program. Only 4% were certified as gerontological nurses or gerontological nurse practitioners.
Description of a Stressful Encounter: Appraisal, Threat, and Challenge
Authors: Burns Kenneth R , Egan Ellen C
Published: April 2021

ABSTRACT

The purpose of this study was to examine a potentially stressful event for students, the midterm examination, using the Lazarus transactional stress model. At two time periods during an academic term, 50 students responded to questionnaires focused on the midterm examination and its outcome. Responses were used to identify changes in appraisals, personal stakes, perceptions of threat and challenge; to determine these variables' relations to each other and to the examination grade; and to determine the best predictors of threat, challenge, and grade. Results indicated that threat and challenge perceptions were the only variables that changed as the situation evolved; they were negatively correlated. The best predictor of threat and challenge was control, while the only variable that correlated with grade was harm.