bluuebunny/crossref_metadata_2025 huggingface dataset:
SİTOKİNLER VE KANATLILARDA SİTOKİNLERİN AŞI ADJUVANTI OLARAK KULLANIMI
Authors: ÖNEL Aziz Utku , YILDIRIM Murat
Published: April 2021

Kanatlı hayvanlarda hastalıkların önlenmesi ve sağaltımı aşıların ve antibiyotiklerin kullanılması ile sağlanır. Antibiyotiklerin uzun yıllar boyunca kullanılması antibiyotiğe dirençli bakterilerin ortaya çıkması ile ilgili sorunları beraberinde getirmiştir. Hastalıkların önlenmesinde kullanılan aşılardaki adjuvantlar, sağlık üzerinde yan etkilere sahip olabilir ve immun yanıtı yetersiz bir şekilde uyarabilir. Bu nedenle kanatlı endüstrisinde yeni aşı stratejilerinin geliştirilmesi oldukça önemli bir konu haline gelmiştir. Sitokinler, yangı reaksiyonlarında hayati rol oynayan hücreler tarafından salgılanan immun sistem hücrelerinin aktivasyonu ve düzenlenmesini sağlayan peptitlerdir. Kanatlı immunolojisi ve genetik alanındaki gelişmeler, özellikle tavukta çeşitli sitokinlerin keşfedilmesine ve bu sitokinlerin işlevsel özelliklerinin ve mekanizmalarının anlaşılmasını sağlamıştır. Kanatlı hayvanlarda enfeksiyöz ajanlara karşı kullanılan aşılarda sitokinlerin potansiyel bir aşı adjuvantı olarak kullanılması yönünde birçok çalışma gerçekleştirilmiştir. Bu derlemede kanatlı sitokinlerinin çeşitleri, fonksiyonel özellikleri ve sitokinlerin aşı adjuvantı olarak kullanımı hakkında bilgi vermek amaçlandı.
Pas de pétrole, mais de l’Auto-Tune !
Authors: Creton Caroline , Bellanger Julien
Published: April 2021

Cher, T-Pain, Saez, Châton, Booba, Benjamin Biolay, Bon Iver, Yung Beef, Lady Gaga, Neil Young ou encore PNL, tous ces artistes ont en commun l’usage de l’Auto-Tune. Ce dernier désigne un logiciel permettant d’ajuster, de corriger la voix à la suite d’un enregistrement ou durant une performance. Si initialement, l’Auto-Tune permet de chanter juste, cela est également utilisé pour produire des modulations sonores donnant un caractère artificiel, robotique, non linéaire à la voix humaine. Le premier titre avec une présence marquée de l’Auto-Tune est « Believe » de Cher sorti en 1998 qui connaît un succès retentissant. Depuis, si quelques artistes – à l’image de Jay-Z et son titre D.O.A. pour « Death of Auto-Tune » (2009) – dénoncent cette pratique, l’Auto-Tune a conquis l’industrie musicale et serait utilisé dans la quasi-totalité des productions (Reynolds, 2019), toutes les esthétiques confondues. Malgré cette diffusion, encore peu de recherches académiques abordent cette question. Quels sont les enjeux liés à l’Auto-Tune ?
L’objet goethéen et les autres
Authors: Mosconi Muriel
Published: April 2021

Quelle est l’incidence clinique et théorique de la typologie des objets de l’identification – objets aristotélicien, goethéen et lacanien – que Lacan amène lors de la dernière séance du séminaire « L’Identification » le 27 juin 1962 ?
Le nom, lien à l’identité et aux identifications
Authors: Belon Danièle
Published: April 2021

De l’inconscient langage à l’inconscient réel nous dégagerons la fonction du nom, du nom propre en particulier pour donner les coordonnées d’où s’enracine l’identité et se construisent les identifications. Nous irons ainsi du Nom-du-Père aux Noms-du-Père, du symptôme au sinthome et aborderons quelques conséquences cliniques.
Identité et signature
Authors: Meunier Anne
Published: April 2021

À travers son histoire on verra que la signature donne au nom propre une singularité calligraphique. À travers son usage ou son non usage, alors que Michel Foucault traite de la « fonctionauteur », Lacan propose à ses élèves avec Scilicet d’écrire des choses non signées. De quoi la signature est-elle la trace ?
Identifications et identité : du tore de la névrose au nœud du dire
Authors: Bousseyroux Michel
Published: April 2021

Du tore de la névrose au dire borroméen du symptôme : glissement progressif des identifications vers l’identité dans l’analyse.
Le dire de l’analyse et l’identité
Authors: Leray Pascale
Published: April 2021

Comment une analyse peut-elle dans son accomplissement délivrer au sujet son identité singulière ? Ce travail traite cette question en fondant cette identité sur le réel irréductible du symptôme du sujet. Y atteindre implique d’en dégager la lettre avec laquelle se traduit la façon dont le sujet a affaire à la jouissance opaque et hors sens de son inconscient. Cette opération, qui dégage le Un tout seul de la jouissance, requiert la mise en acte du dire dans l’analyse avec ses différents effets de coupure et de renouage, lesquels modifient le rapport du sujet à cette jouissance de son inconscient. Ce texte propose d’examiner différentes conséquences de cette modification pour le sujet dès lors qu’il consent à cet Un sinthomatique qui le singularise.
La phobie et le vivant
Authors: Coste Jean-Claude
Published: April 2021

Il faut distinguer le déclenchement et le devenir de la phobie. Ce travail s’attache à étudier dans cette formation clinique la part de vivant non symbolisé qui y insiste.
Le travail de l’inconscient et les transformations du petit Hans
Authors: Lapinalie Bernard
Published: April 2021

Nous verrons comment Lacan s’est d’abord intéressé à la phobie du petit Hans pour montrer le travail de l’inconscient structuré comme un langage, mais aussi la curieuse conclusion qu’il a faite du cas en mettant sur le même plan Hans et Léonard de Vinci.
Les psychanalystes au tournant de la plaque tournante
Authors: Nguyên Albert
Published: April 2021

Ce texte se propose d’examiner la fonction de la phobie à partir de cette phrase de Lacan extraite du compte rendu sur l’Acte analytique : « La ligne de résistance tient sur cet ouvrage démesurément avancé que peut l’être une phobie. C’est dire qu’il est désespéré de faire entendre qu’on n’a rien entendu de l’inconscient si on n’est pas allé plus loin. » Aller plus loin fait envisager la castration, la douleur d’exister, la traversée de la mort, le piège narcissique. Les conséquences éthiques du trajet, celles sur l’angoisse et le désir y seront examinées.
Mise à jour de la question de la panique et de la phobie
Authors: Nominé Bernard
Published: April 2021

Après avoir distingué la panique des phobies au niveau de la structure, ce texte parcourt les élaborations de Lacan concernant la phobie du petit Hans, depuis le séminaire sur la relation d’objet, jusqu’au séminaire « RSI ». Il en ressort que Lacan a toujours placé la phobie au carrefour de trois registres : réel, symbolique et imaginaire. Dans ces dernières élaborations, Lacan a esquissé un nouage particulier pour la phobie qui réussit ainsi à arrimer la jouissance phallique à l’image du corps. Si ce point est naturellement délicat chez le garçon, qu’en est-il pour la petite fille ? C’est à cela que ce texte tente de répondre en examinant l’observation du cas de la petite anglaise présentée par Anneliese Schnurmann.
Le traumatisme en psychanalyse, de Freud à Lacan
Authors: Gilet-Le Bon Stéphanie
Published: April 2021

Pourquoi certains et pas d’autres tiennent le coup dans les grandes catastrophes tandis que pour d’autres des évènements anodins peuvent traumatiser ?
« Paniques, peurs, trauma »
Authors: Mérian Roger
Published: April 2021

« C’est quand même du malaise que Freud note, du Malaise dans la civilisation , que procède toute notre expérience 2 . » Cette phrase de Lacan nous invite à nouer psychanalyse en intention et psychanalyse en extension. Cette introduction au travail permet de mesurer l’écart entre la psychanalyse et les théories fondées aujourd’hui sur la victimisation généralisée des sujets et sur le traitement identique pour tous, en mettant l’accent sur le fait aux dépens du sujet. Si un même événement entraînait les mêmes effets chez toutes les personnes concernées, celles-ci n’auraient plus rien à en dire de singulier. Le texte de Maurice Blanchot « L’instant de ma mort » permet ainsi d’éclairer ce qui noue peurs et paniques avec le traumatisme.
Affect de toujours : formes d’hier et d’aujourd’hui
Authors: Touchon Fingermann Dominique
Published: April 2021

Inhibition, symptôme, angoisse se présentent aujourd’hui fréquemment ainsi dans les entretiens préliminaires, travestis des formes que le discours contemporain leur préfabrique, ainsi les vieilles phobies et paniques nous parviennent-elles « remastérisées ». La psychanalyse telle que l’ont conçue Freud et Lacan prend l’angoisse en considération : depuis lors, c’est notre condition éthique, nous ne saurions la négliger sans par là même malmener le désir. Mais si nous voulons avoir de la considération pour l’angoisse aujourd’hui, il faut la prendre de qui ça vient, c’est-à-dire des sujets du discours capitaliste, qui débarquent chez nous avec leurs symptômes calibrés en forme d’ anxiety disorder , en réponse à l’angoisse qui de toujours leur fera trouver les formes qui auront lieu dans le monde, angoisse que le DSM ne prend pas en considération car elle est au dessus de ses forces.
La phobie, le totem et la boue…
Authors: Leblanc Jean-Pierre
Published: April 2021

La psychanalyse donne une dignité au symptôme qu’aucune autre approche ne conçoit de cette manière. Ainsi, le symptôme phobique, loin de se réduire à une formation morbide qu’il faut éradiquer au plus vite, est une invention du sujet pour se constituer comme tel, une manière de nouage qui lui permet de ne pas disparaître dans la rencontre avec l’innommable de la jouissance. Lacan, dans « Des noms du père », va jusqu’à articuler cette forme de nomination qu’est le symptôme phobique avec ce signifiant fondamental qu’est le totem. La dignité du symptôme réside donc dans son enjeu, un enjeu lié à la constitution même du sujet. Cela souligne la responsabilité de qui accepte d’entendre ce sujet quand il est aux prises avec l’embarras que son invention lui procure, ce qui l’a conduit à s’adresser à un analyste.
Les passions fondamentales, dans la relation à l’autre et dans la psychanalyse
Authors: Strauss Marc
Published: April 2021

La relation à l’autre est passion. Passion d’un réel qui se représente dans le lien au partenaire. Elle emprunte trois voies, l’amour, la haine et l’ignorance. Aucune ne se définit sans sa relation aux deux autres, c’est pourquoi elles sont indissociablement nouées. Ce qui nous impose d’une part de ne jamais oublier la part de la haine dans l’amour et d’autre part de laisser sa place à cette passion plus secrète qu’est celle de l’ignorance, à laquelle Lacan a donné une valeur essentielle à partir de l’expérience de la psychanalyse.
Les passions de l’image
Authors: Talabard Catherine
Published: April 2021

Il s’agit d’aborder la clinique de l’envie et de la jalousie à partir d’un cas clinique, comment un sujet a construit son l’image dans le miroir, les variations de celle-ci quand il ne peut plus compter sur l’image trouvée auprès de doubles. L’envie et la jalousie se déclinent pour ce jeune homme comme passions de l’image. Est-ce l’envie devant l’objet dont il est privé, ou bien l’envie serait-elle devant l’image de la complétude qui apparaît du côté de l’Autre ?
Lol V. Stein n’est pas jalouse
Authors: Moreau Emmanuelle
Published: April 2021

Freud fait de la jalousie un affect névrotique qui se retrouve dans la vie psychique. La scène augustinienne à laquelle Lacan rattache cet affect met en jeu un rival mais aussi l’objet regard. Il en fait un moment fondateur. Mais que se passe-t-il quand une telle scène ne produit pas de jalousie ? Lol V. Stein, personnage imaginaire, vient illustrer ce qui peut se produire pour un sujet et sur ce qu’il advient de son désir.
Perspectives
Authors: Faleni Geneviève
Published: April 2021

À partir du travail d’un historien qui expose sa version de « la fabrique du sexe » et de la différenciation homme/femme, est abordée la voie nouvelle ouverte par Freud sur ces questions. Quelques jalons sont posés quant au pas supplémentaire opéré par Lacan avec la répartition des jouissances et le nœud borroméen.
Les appelants du sexe
Authors: Talabard Catherine
Published: April 2021

Dans « Propos directifs pour un congrès sur la sexualité féminine », Lacan situe les tenants du désir et les appelants du sexe. En effet, dans l’inconscient il n’y a pas le signifiant de la femme, celle-ci se définit avec un signifiant qui lui manque. Elle se fait objet du désir d’un homme et ainsi se réfère au phallus, elle sait manier les semblants. Cependant, c’est aussi à partir de cette béance, de cette structure trouée du Grand Autre qu’elle symbolise le sexe. Je m’appuie sur la clinique différentielle pour interroger les cas où la sexuation n’a pas pu s’inscrire dans la castration, le phallus n’ayant pas été symbolisé.
Habiter le langage ou le temps de la récusation
Authors: Drapier Jean-Pierre
Published: April 2021

Discours de la Science et discours capitaliste changent radicalement la manière dont le sujet moderne appréhende sexuation et sexualité : masculin et féminin, hétéro ou homo sexualité sont des signifiants qui peinent à offrir une inscription à chacun. Faut-il repenser le tableau de la sexuation de Lacan ?
L’Inconscient, le sexe, et le semblant
Authors: Lapinalie Bernard
Published: April 2021

Nous verrons comment les notions de discours et de semblant ont été déterminantes dans le chemin de Lacan pour aborder enfin la différence des sexes dans ce qui fait leur essence avec en particulier la jouissance féminine, et en arriver à son tableau de la sexuation.
« C’est une question de grammaire »
Authors: Combres Anne-Marie
Published: April 2021

« C’est une question de grammaire. » Cette affirmation, liée à un changement d’identité sexuée pour la personne qui l’énonce, peut-elle éclairer notre recherche pour une clinique différentielle des sexes ? L’examen de cette question s’appuie sur le témoignage que donne Marie-Pierre Pruvot dans son livre Marie, parce que c’est joli et le documentaire de S. Lifshit : Bambi  ».
Silences et transfert
Authors: Faure Alexandre
Published: April 2021

Cet article propose de réinterroger les valeurs du silence, à partir de l’articulation des silences aux manifestations de transfert. Côté analyste, comment ne pas faire du silence un silence dogmatique, voire un silence de refuge , selon l’expression de Lacan ? Côté analysant, comment entendre la pluralité des silences à partir du repérage de l’objet en jeu et de sa fonction ? En suivant le commentaire qu’il a fait du tableau de Munch Le Cri , je m’arrêterai plus précisément sur ce que Lacan nomme le « phénomène limite du champ du grand Autre », à savoir son absence de réponse – et ses conséquences. Qu’est-ce qu’une réponse  ? Du reste, comme trait différentiel de la présence de l’analyste, le silence porte la parole de l’analysant, tout autant qu’il semble faire signe d’un désir d’entendre. L’ indécence du silence serait-elle alors de faire causer  ?
Présence du transfert
Authors: Terral François
Published: April 2021

Le confinement qui a fait suite à l’épidémie de Covid 19 a vu l’émergence d’une pratique clinique à distance. Quid de l’efficace du transfert dans ces conditions ? La réponse à cette question ne va pas de soi. C’est l’occasion de revenir à un certain nombre de questions théoriques et éthiques.
L’obstacle e(s)t la condition
Authors: Latour Marie-José
Published: April 2021

Je souhaiterais mettre la pertinence de la formulation de notre thème à l’épreuve de la présentation de patients. Qu’est-ce que peut nous apprendre ce dispositif, mettant en jeu un unique entretien et qui fait le cœur de nos collèges cliniques, sur le nouage du transfert et du symptôme, de la parole et du corps, quant à la mise en perspective d’un traitement possible par la psychanalyse ?
Le « truc » analytique
Authors: Hatat Brigitte
Published: April 2021

Si l’acte analytique est sans sujet, s’il n’y a pas de sujet supposé savoir de l’acte, comment comprendre ce que dit Lacan en 1978 : « Le sujet supposé savoir, c’est quelqu’un qui sait. Il sait le truc, […] la façon dont on guérit une névrose. »
La politique du symptôme : opération symptôme
Authors: Touchon Fingermann Dominique
Published: April 2021

Le discours contemporain et l’emprise du marché sur la science réduisent les symptômes à de « simples » dysfonctionnements qui viennent déranger l’ordre du monde. L’expérience de la psychanalyse propose une autre politique du symptôme : il s’agit d’une véritable révolution car la traversée d’une analyse permet à la fin d’extraire, de la souffrance qui trouble l’ordre du sujet sa valeur singulière, la « note propre de la dimension humaine 1  » de chaque un. Nous déclinerons les trois temps de l’opération symptôme : de la mise en question de son non-sens originel, à la pratique du sens que le transfert soutient, jusqu’à en distinguer cette note propre comme la marque d’origine qui tombe sous le sens à la fin. Cela fait toute la différence qui peut être utilisée à d’autres fins.
Le maniement du transfert, la responsabilité du psychanalyste
Authors: Stéphan Marie-Paule
Published: April 2021

La demande d’amour est commune à toutes les relations libidinales, mais c’est à partir de sa position que l’analyste en fait une demande autre et transforme cet amour en un « amour qui s’adresse au savoir ». Son instauration, son soutien, son terme sont de la responsabilité du psychanalyste, une responsabilité liée à la fin de sa propre cure et à son orientation.
Development of a Chautauqua for Nurses
Authors: Popiel Elda S
Published: April 2021

Colorado Chautauqua for Nurses was a "brain child" of the former Executive Director of the Colorado Nurses' Association, Virginia Paulson. This article is dedicated to "Ginny" who died of cancer August 9, 1982, and her memorial service was held during Chautauqua 1982.
An Urban Consortium: A Low Cost Quality Approach to Critical Care Education
Authors: Slate Ethel , May Louise , Doucet Mary , Stark June
Published: April 2021

ABSTRACT

In 1979, nursing directors selected joint educational programming as a strategy to meet the continued learning needs of critical care nurses. The result of this decision was the formation of a multi-hospital educational consortium. This consortium was utilized to plan, implement and evaluate continuing education programs for critical care nurses. The results indicated that this approach was cost effective, satisfied learning needs, further developed nurse educators and became a model for other joint hospital collaborative efforts.
Gaming: A Teaching Strategy for Adult Learners
Authors: Lewis Donna J , Saydak Susan J , Mierzwa Irene P , Robinson Janice A
Published: April 2021

ABSTRACT

Developing stimulating and innovative educational episodes poses a challenge to nurse educators. The technique of gaming is making a comeback on the educational scene as it facilitates internalization of concepts and promotes affective learning and the application of psychomotor skills. The theoretical use of gaming strategies, development, implementation, and applicability in staff development is discussed.
The Nursing Assessment Decision Grid: Tool for Delegation Decision
Authors: Conger Margaret M
Published: April 2021

ABSTRACT

The ability of registered nurses to delegate patient care to nurse extenders has become an important skill. This study measures the effectiveness of the Nursing Assessment Decision Grid to teach RNs delegation skills. The ability of 93 staff nurses to analyze tasks and problems found in two patient vignettes and then delegate some care to an LVN working in a dyad was measured before and after exposure to the Nursing Assessment Decision Grid. A paired sample t test was used to compare mean pretest and posttest scores for the three parameters. Analysis of variance was used to examine the effect of professional and personal experiences on this decision making ability.

RNs showed a statistically significant increase in their ability to identify nursing tasks and patient problems embedded in two vignettes. They were then able to make delegation decisions about the care of the patients in the vignettes. Primary language of the study subject may have had an effect on the ability to perform patient problem analysis.
Nurses' Perceptions of Usefulness of Laboratory Data for Nursing Practice
Authors: Corbett Jane Vincent , LaBorde Ann
Published: April 2021

ABSTRACT

The purpose of this study was to examine nurses' perceptions about the usefulness and barriers to the use of laboratory tests. An investigator-developed questionnaire was given to participants in 20 continuing education workshops. The sample consisted of 536 registered nurses and 40 licensed vocational nurses. Descriptive statistics and content analysis were performed. No significant differences existed in the nurses' reported uses or barriers to using laboratory data by area of practice or length of time since graduation. A significant difference (Fisher's exact P = 0.02) found was the educational level in the reported major usefulness of laboratory data.
The Impact of Continuing Education on Patient Outcomes in the Elderly Hip Fracture Population
Authors: Gill Kelly P , Ursic Pauline
Published: April 2021

ABSTRACT

As the health care system is oriented to provide service with finite dollars, nursing educators are being asked to demonstrate how continuing education for staff improves patient outcomes. The purpose of this study was to evaluate the impact of an orthopedic-geriatric continuing education program for nurses on the elderly patient who had sustained a hip fracture. A significant difference was found between the control and experimental unit patients with respect to time to first ambulation and length of stay on the orthopedic unit.
Distance Education Programs: Defining Issues of Assessment, Accessibility, and Accommodation
Authors: Sherwood Gwen D , Armstrong Myrna L , Bond Mary Lou
Published: April 2021

ABSTRACT

Identification and resolution of a variety of issues is imperative to establishing effective distance education via telecommunications. In this first-hand experience, the authors describe selected issues and possible responses inherent in the development and implementation of a new teaching modality. The decision to pursue distance education by telecommunications should be made only after a thorough examination of the needs, the required resources, and the changes to be expected. Advance planning is essential for problem solving.
Meeting the Basic and Educational Needs of Foreign Nurses
Authors: Dijkhuizen Sheila Rutherford
Published: April 2021

ABSTRACT

Foreign nurses are arriving in the United States in large numbers. It is important for educators and recruiters to understand what motivates foreign nurses and to have some awareness of their educational and cultural backgrounds. This knowledge enables the educator to meet the foreign nurses' needs, facilitate their orientation, and promote their integration into the practice of American nursing. Research (Rutherford, 1989) indicates a direct relationship between job satisfaction and the nationality of the foreign nurse. This relationship is influenced by their ethnic, cultural, religious, and educational background. All must be taken into consideration as these factors will affect recruitment and retention of foreign nurses. Research has shown that, when basic needs are met, job satisfaction is more likely to be attained, and the organization benefits in the areas of cost containment and improved quality of care.
Health Care Reform: Initial Implications for Continuing Education in Nursing
Authors: Camin Linda R
Published: April 2021

ABSTRACT

Continuing education coordinators and interested others met statewide to consider the educational needs of nurses emerging with health care reform. It was agreed that continuing nursing education must aggressively pursue its mission and activities to lead, promote, and enhance the education of our profession on health care reform.
Developing a Teaching Video on Mechanical Ventilation Weaning to Facilitate Effective Nursing Research
Authors: Birdsall Carole , Barker Kathleen , Setti Karen
Published: April 2021

ABSTRACT

This article describes the process of developing a teaching video associated with conducting a nursing research study and directed at educating critical care staff nurses about the process of successfully weaning patients from mechanical ventilation. Techniques on developing the script and filming and editing the video are presented. The results of this process included staff empowerment and a teaching video used by 10 hospitals in a multi-site research project.
Reducing Restraints: Where to Start
Authors: Terpstra Terry L , Terpstra Tammy L , Van Doren Elaine
Published: April 2021

ABSTRACT

To begin a restraint reduction program at a large neuropsychiatric Veterans Affairs medical center, nursing educators examined perceptions of and knowledge about restraint use among 113 nursing staff members employed on one acute, two intermediate, and five long-term care units. Strumpf and Evans' (1988) Perceptions of Restraint Use Questionnaire, a knowledge test, and questions about personal characteristics were used. Top reasons for restraint use identified were to prevent pulling on an intravenous line, to prevent breaking open sutures, and to protect from a fall. Although knowledge scores were high, they did not correlate significantly with ability to suggest alternatives. Respondents viewed restraint use as a somewhat important intervention. Statistically significant differences were found between level of practice and number of alternatives listed, knowledge score, and personal perception score. Implications for nursing educators embarking on a restraint reduction program are discussed including myths and quality-of-life issues.
Using Role Theory Concepts to Understand Transitions From Hospital-Based Nursing Practice to Home Care Nursing
Authors: Murray Teri A
Published: April 2021

ABSTRACT

Background: The phenomena experienced by professional nurses who make practice-based career changes are seldom addressed in the literature. Nurses changing from a hospital-based practice to a home health care setting report feelings of anxiety, incompetency, and lack of the necessary skills to care for clients in the home.

Method: An integrative review of the literature on role theory can provide the conceptual understanding of the transitional experience of nurses whose roles change when they move from hospital-based practice to a home health care setting.

Results: A model of the role transition process is helpful in identifying the transition experienced by nurses new to the home health care setting. Experiences during the initial transition period are critical in shaping the nurse's understanding of the role.

Conclusion: Educators can play a key part in assisting novice home health care nurses with role enactment by developing comprehensive orientation and education programs aimed at minimizing role strain.
Preceptorship: A Model to Empower Nurses in Rural Health Settings
Authors: Dusmohamed Haroon , Guscott Anthony
Published: April 2021

ABSTRACT

Continuing education and staff development help nurses meet new needs and demands caused by rapid changes in society, demography, technology, politicoeconomic structure, and disease patterns. Rural nurses have a unique, generalist role within their practice but are disadvantaged in accessing professional development because of geographical and professional isolation. A preceptorship program was developed to empower individual nurses in rural health units in South Australia. This program equipped them with the knowledge, skills, and attitudes necessary to make changes in their health units. At the same time, it enabled participants to act as mentors to colleagues in collaborative partnerships designed to meet the complex health needs of their rural clients.
THE BATEMAN UPF PROSTHESIS: A 48-MONTH EXPERIENCE
Authors: Lestrange Nile R
Published: April 2021

ABSTRACT: One hundred fifty Bateman Universal Proximal Femur prostheses performed in a single orthopedic practice over a period of 48 months were reviewed. The prosthesis was primarily used to treat fractures, however, hip replacement arthroplasties for degenerative arthritis, failed Austin Moore prostheses and failed nails are included included as well. A Harris hip rating system was used to evaluate the results. The prosthesis was felt to offer definite advantages over the Austin Moore and Thompson prostheses, and the results were felt to approximate the customary total hip replacement arthroplasties.
TOTAL HIP REVISION: INDICATIONS AND SURGICAL TECHNIQUE
Authors: Stillwell William Thomas , Hamati Yousif I , Drinker Henry , Turner Roderick H
Published: April 2021

ABSTRACT: Specialized techniques for evaluation and treatment of failed total hip arthroplasties were developed in the management of 171 patients from 1972 through 1978, using an integrated, interdisciplinary approach. Various surgical techniques were tailored to the individual and directed at the specific etiology of failure. Intraoperative biplanar fluoroscopic monitoring of a high-speed, low-torque pneumatic drill facilitated removal of femoral acrylic and reaming of the distal shaft. Coordinated use of instrumentation for autotransfusion, cement fragmentation, bone debridement and acetabuloplasty, together with new advances in the diagnosis and management of various intraoperative complications are described.

An average follow-up of 36 months was obtained in 91 cases. Good to excellent hip ratings were seen in 83%.
THE PERCUTANEOUS LATERAL RETINACULAR RELEASE
Authors: Betz Randal R , Lonergan Robert , Patterson Richard , Litton Jason , Yucha Thomas , Boal Richard
Published: April 2021

ABSTRACT: A lateral retinacular release performed through a 2 ½-3 cm lateral parapatella incision can give rewarding results for patients with chondromalacia, degenerative joint disease, recurrent subluxation or recurrent dislocation of the patella. A retrospective review from August 1978 to December 1980 of 37 patients (42 knees) shows 83% excellent or satisfactory results, 17% unsatisfactory results with an average postoperative follow-up of 12.3 months. Preoperative pain was reduced in all but two patients; no patient was made worse by the procedure with respect to pain or function. In 17 knees with recurrent dislocation of the patella there were no recurrences of dislocation. Patients having Class IV chondromalacia, considered degenerative joint disease of the patellofemoral joint, and those patients over 35 years of age had the poorest results. One hemarthrosis was the only immediate postoperative complication. Four patellectomies and one recurrent medial subluxation were the long-term failures. Comparison with the results of other treatment methods - including patella shaving, patella curettage and drilling, patellectomy, patellar prosthesis, and realignment procedures- shows the results of the percutaneous lateral retinacular release to compare favorably within the limitations of short-term follow-up.
Palpable Pathology
Authors: Hadesman William , Trotter David , Ibrahim Kamal
Published: April 2021

ABSTRACT: A case of a 14-year-old male with a history, physical exam, and x-rays compatible with an epiphyseal injury of the proximal right clavicle is presented. Typical symptoms, physical examination findings, and special roentgenographic views are discussed along with conservative and operative modes of treatment.
A Technique of Arthroscopic Meniscoplasty
Authors: DiStefano Vincent J , Bizzle Paul
Published: April 2021

ABSTRACT: Indications and technique are discussed for arthroscopic repair of meniscal tears by means of mattress sutures delivered by Kirschner wire. Short term results in eight cases are summarized.
Ankle Arthroscopy: Approaches and Technique
Authors: Gollehon Douglas L , Drez David
Published: April 2021

ABSTRACT; Arthroscopic visualization of the ankle is outlined, with particular attention to establishment of portals.
Bilateral Simultaneous Rupture of the Infrapatellar Tendon: A Case Report and Literature Review
Authors: Goodrich Allan , Difiore Ralph J , Tippens Jack K
Published: April 2021

ABSTRACT: Bilateral simultaneous patellar tendon rupture is a rare entity. Most case studies in the literature have been reported in patients with an underlying systemic condition, i.e. systemic lupus erythematosus, rheumatoid arthritis, or associated with a history of steroid injections about the infrapatellar tendon. A recent case report treated at Dwight David Eisenhower Army Medical Center without a predisposing underlying systemic condition or history of injection is presented. Our patient is the youngest to be reported in the literature. The literature is reviewed on this subject, and the mechanism of injury presented.
Knee Arthroscopy With Local Anesthesia in Ambulatory Patients: Methods, Results and Patient Compliance
Authors: Eriksson Ejnar , Häggmark Tom , Saartok Tönu , Sebik Ahmed , Ortengren Börje
Published: April 2021

ABSTRACT: Knee arthroscopy in locally anesthetized ambulatory patients has been performed by filling the knee joint with 50 ml to 60 ml of 0.5% prilocaine, with adrenaline and with additional local infiltration at the sites of puncture. During the arthroscopic procedure the joint cavity is further distended with a mixture of the same local anesthetic diluted 1:10 with physiological saline or Ringer's acetate. During a normal arthroscopy of the knee joint about 500 mg of the local anesthetic is used.

In 17 patients the blood concentrations of the local anesthetic used was measured 2.5 min to 135 min after instillation. The highest plasma levels found (after 60 min to 120 min) were stitl 1 0 to 1 5 times lower than an acceptable upper plasma level. These low blood levels probably depend on a slow absorption and that a considerable amount of the local anesthetic is washed out after the arthroscopy.

A questionnaire was sent to 278 patients who during a two year period had undergone arthroscopy as an outpatient procedure. The degree Of satisfaction for the anesthetic procedure was highest for general anesthesia where 97% were completely satisfied. Sixty-four percent were satisfied when given spinal anesthesia. However, 11% had to be put to sleep due to insufficient spinai block and 12% had headaches more than one day after outpatient spinal anesthesia. Seventy-seven percent were satisfied with local anesthesia. There was no statistical difference between the degree of satisfaction after local or spinal anesthesia

Although general anesthesia has a higher patient acceptance than spinal or local anesthesia, the latter simplifies and expedites the technique of knee arthroscopy in ambulatory patients and allows them to retu rn home immediately. Local anesthesia can also be performed with a good safety margin.
Stalked Patellar Tendon Graft in Reconstruction of the Anterior Cruciate Ligament
Authors: Eriksson Ejnar
Published: April 2021

ABSTRACT: A careful description of the surgical technique in reconstruction of the anterior cruciate using the medial third of the patellar tendon is given. It is pointed out that it is a technical advantage if the drill hole for the patellar tendon enters the knee joint into or just behind the remnants of the normal anterior cruciate ligament. It is also emphasized how important it is that the ligament is anchored to its normal anatomic insertion far back posterolaterally. With the technique suggested about 90% stable knees can be expected at an early follow up. The most common complication was an extension lag and recommendations for how this should be treated are given.
DECREASED PAIN WITH LOWER FLEXURAL RIGIDITY OF UNCEMENTED FEMORAL PROSTHESES
Authors: Skinner Harry B , Curlin Frederick J
Published: April 2021

ABSTRACT

One hundred one consecutive uncemented hip arthroplasties (87 patients) were analyzed radiographically at 1-year follow up to relate mechanical factors to hip pain as determined by clinical pain scores. The average area moment of inertia and flexural rigidity were greater for the bone than the metal prosthesis for each type of prosthesis (AML, HG, PCA). Normalization of the flexural rigidity ratio (bone to prosthesis) for patient weight yielded a Spearman correlation coefficient of 0.232, significant at P =.02, suggesting that both applied stress and bending stiffness have an effect on pain. No relationship was seen between pain and AP, or average gap between prostheses and bone.
EXTRAPERIOSTEAL TOE PHALANX TRANSFER FOR CONGENITAL APHALANGIA: REFINEMENT OF TECHNIQUE
Authors: Toby E Bruce , Koman L Andrew , Poehling Gary G
Published: April 2021

ABSTRACT

Toe phalanges with attached periosteum can be transferred to hands with congenital aphalangia, constructing rudimentary digits with growth potential. Using a volar technique, rather than the traditional dorsal method, allows stabilization of the constructed metacarpophalangeal joint and maximizes flexor function.
Management of Osteolysis Around Total Hip Arthroplasty
Authors: Berry Daniel J
Published: April 2021

UHMWPE: The Good, Bad, & Ugly
Fixation and Bearing Surfaces for the Next Millennium
Authors: Bobyn J Dennis
Published: April 2021

UHMWPE: The Good, Bad, & Ugly
Morselized Allografting in Revision TKA
Authors: Hofmann Aaron A
Published: April 2021

Problems After Knee Arthroplasty: 'Things That Go Bump In the Night"
TKA Salvage: The End Game When Reimplantation Won't Work
Authors: Rosenberg Aaron G
Published: April 2021

Problems After Knee Arthroplasty: "Things That Go Bump in the Night"
Avoiding "Misteaks" in Knee Arthroplasty: Five Easy Pieces
Authors: Booth Robert E
Published: April 2021

Optimizing Knee Arthroplasty
Mechanical Strength and Wear of Used EBI External Fixators
Authors: Dirschl Douglas R , Obremskey William T
Published: April 2021

Abstract

Thirty-one EBI external fixators (Dynafix; EBI, Parsippany, NJ) subjected to one or two clinical uses underwent static mechanical testing identical to that performed on new devices prior to market approval. No fixator exhibited catastrophic mechanical failure. For all fixators tested, the mean load to failure was not significantly different from that of identical testing of new devices. Although loss of material from serrated joints was observed in some joints, mechanical strength was not affected. Additional testing of fixators of a variety of designs is necessary to expand on the results of this investigation. The results of this study represent a first step in validating the safety of external fixator component reuse.
Evaluation of 70/30 D,L-PLa for Use as a Resorbable Interbody Fusion Cage
Authors: Toth Jeffrey M , Wang Mei , Scifert Jeffrey L , Cornwall G Bryan , Estes Bradley T , Seim Howard B , Turner A Simon
Published: April 2021

Abstract

Titanium lumbar interbody spinal fusion devices are reported to be 90% effective for single-level lumbar interbody fusion, although radiographic determination of fusion has been debated. Using blinded radiographic, biomechanic, histologic, and statistical measures, researchers in the present study evaluated a radiolucent 70/30 poly(L-lactide-co-D,L-lactide) (70/30 D,L-PLa) interbody fusion device packed with autograft or rhBMP-2 on a collagen sponge in 25 sheep at 3, 6, 12, 18, and 24 months. A trend of increased fusion stiffness, radiographic fusion, and histologic fusion was demonstrated from 3 months to 24 months. Device degradation was associated with a mild to moderate chronic inflammatory response at all postoperative sacrifice times.
Correlation of the Change in the International Normalized Ratio and Decreasing the Coumadin Dosage Following Total Joint Arthroplasty
Authors: Rosenbaum Cathy Creger , Woods Scott E , Hasselfeld Kimberly A
Published: April 2021

Abstract

This retrospective pilot study determined whether a change in the daily International Normalized Ratio (INR) correlates with a decrease in Coumadin (DuPont Pharma, Wilmington, Del) dosage. Four hundred seventeen patients yielded 1167 pairs of INR values and Coumadin doses. An increase in INR >0.4 units correlated 81% with a decrease in the Coumadin dose (P<.05). In patients aged ≥70 years, the correlation fell to 70% compared to an 89% correlation in patients aged <70 years (P<.05). The correlation fell to 78% in women, while men exhibited an increase to 87% (P<.05).

Although this is a pilot study, when managing postoperative Coumadin anticoagulation for orthopedic patients, an increase in INR >0.4 units correlates highly with the need to decrease the Coumadin dose. A prospective study is needed to test the usefulness of this parameter.
Osteoinduction by a Collagen Mineral Composite Combined With Isologous Bone Marrow in a Subcutaneous Rat Model
Authors: Alvis Mark , Lalor Peggy , Brown Melissa K C , Thorn Malahki R , Block Jon E , Hornby Samantha , Berg Richard , Reddi A Hari
Published: April 2021

Abstract

In a subcutaneous implant rat model, Collagraft alone (n=8), Collagraft plus isologous bone marrow (n=8), and marrow alone (n=8) were evaluated. Twelve rats were euthanized at 11 days and 12 at 21 days. Explants were evaluated histologically for evidence of bone formation, and osteogenic activity was determined by an assay for alkaline phosphatase. Histological bone formation was absent in all groups at 11 days. At 21 days, in the Collagraft alone and bone marrow alone groups, no bone induction was noted. In contrast, 21-day specimens from the Collagraft plus bone marrow group showed newly formed bone. Alkaline phosphatase activity was negligible (<0.05 units/mg) in all 11-day specimens. Activity in Collagraft plus bone marrow specimens at 21 days (0.38 units/mg) was significantly higher than any other group (P<.001 for all comparisons). This study demonstrates that Collagraft plus bone marrow is an osteoinductive matrix.
Suture V Technique: A Method for Supplementing Soft-Tissue Interference Fixation of Anterior Cruciate Ligament Grafts
Authors: Bernstein Joseph , Tan Virak
Published: April 2021

The Suture V technique, a modification of traditional bioabsorbable interference screw fixation methods, is used for attaching a son-tissue anterior cruciate ligament gran in the tibia. This technique adds trivial length to the tibial skin incision and the overall time of the surgical case, and may provide valuable reinforcement to the tibial tunnel fixation.
Extended Thromboprophylaxis after Hip or Knee Replacement
Authors: Friedman Richard J
Published: April 2021

Abstract

Early discharge from the hospital after total joint arthroplasty has increased the need for extended outpatient thromboprophylaxis. Multiple controlled clinical trials and several meta-analyses of these data have examined various agents in different regimens. These data indicate that extended prophylaxis with a low-molecular-weight heparin after knee or hip arthroplasty significantly reduces the number of venous thromboembolic episodes with no increases in major bleeding. The data also show that >98% of patients given long-term low-molecular-weight heparin prophylaxis remain free from symptomatic deep venous thrombosis and pulmonary embolism. Therefore, to minimize patient risk safely and cost-effectively, extended prophylaxis with low-molecular-weight heparin oncedaily for 4 weeks after surgery should be considered for patients undergoing total joint arthroplasty.
Bleeding Associated with Thromboprophylaxis: A Multifactorial Issue
Authors: Cushner Fred D
Published: April 2021

Abstract

Although postoperative bleeding is a legitimate concern when anticoagulant agents are used in thromboprophylaxis during total joint arthroplasty, the incidence of bleeding reported in clinical trials must be evaluated. Postoperative bleeding is a multifactorial effect that may be influenced by variables such as preoperative risk factors; the protocol, timing, and dose of the anticoagulant; and the surgical procedure and technique, as well as by the specific anticoagulant used. Because the reported rates of bleeding associated with various anticoagulants are low and the risks of venous thromboembolism in the absence of prophylaxis are high, thromboprophylaxis is a safe and effective strategy for reducing morbidity and mortality in patients undergoing total joint arthroplasty.
Intraoperative Closed Reduction and Percutaneus Fixation of Displaced Femoral Neck Fractures With the Trochanteric Gamma Nail
Authors: Garnavos Christos
Published: April 2021

A technique for dosed intraoperative reduction of comminuted displaced femoral neck fractures with the trochanteric gamma nail is described. The procedure is performed through a 2- to 3 -cm incision, while the lag screw and distal screw are inserted via stab wounds on the thigh, making the entire procedure percutaneous.
The Effect of Delayed Autogenous Bone Grafting on the Healing of Diaphyseal Defects in a Canine Model
Authors: Box Gloria G , Lindsey Ronald W , Curylo Lukas , Miclau Theodore , Alexander Jerry W , Perren Stephan M
Published: April 2021

Abstract

Bone grafting of osseous defects is often delayed to minimize the risk of infection, however, the effect of this delay on defect healing is not clear. Unilateral oblong unicortical diaphyseal femoral defects (30x4.5 mm) were created in 3 groups of 1 8 adult canines that were grafted with autogenous bone immediately, at 2 weeks, and at 6 weeks. After an 8-week healing period, paired femurs, which consisted of defect versus intact specimens, were assessed by biomechanical testing and microradiography. No differences were demonstrated biomechanically or radiographically between the healing defects with immediate versus delayed bone grafting. This study suggests that within the first 6 weeks postoperatively osseous defects can be grafted with autologous bone without adversely affecting bone graft incorporation.
Modified Retro-Tubercle Opening-Wedge Versus Conventional High Tibial Osteotomy
Authors: Keyhani Sohrab , Abbasian Mohammad Reza , Kazemi Seyed Morteza , Esmailiejah Ali Akbar , Seyed Hosseinzadeh Hamid Reza , Shahi Ali Sina , Firouzi Farzad
Published: April 2021

Despite the fact that common surgical techniques for the treatment of genu varum usually correct the malalignment in the affected knee, these methods have significant complications and cause problems in the long term. Retro-tubercle opening-wedge high tibial osteotomy is among the newer techniques for the treatment of genu varum. The goal of this study was to compare the results of retro-tubercle opening-wedge high tibial osteotomy with those of medial opening-wedge osteotomy.

In a randomized, controlled trial, 72 patients with varus knees who were scheduled for surgery were assigned into either the retro-tubercle opening-wedge high tibial osteotomy (n=34) or medial opening-wedge osteotomy groups (n=38). Groups were matched for age and sex. The position of the patella was compared with respect to the tuberosity and the upper tibial slope pre- and postoperatively. Patients were followed for an average of 13 months (range, 10–21 months). In the retro-tubercle opening-wedge high tibial osteotomy group, the length of the patellar tendon did not significantly differ pre- and postoperatively (
P
≥.5); however, in the medial opening-wedge osteotomy group, a statistically significant shortening was noted in patellar tendon postoperatively (
P
≤.05). Similarly, the tibial plateau inclination showed a statistically significant difference postoperatively in the medial opening-wedge osteotomy group, while the difference in the retro-tubercle opening-wedge high tibial osteotomy group did not reach statistical significance.