bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical Evaluation and Cost Effectiveness of Preoperative Laboratory Assessment on Patients Undergoing Total Hip Arthroplasty
Authors: Sanders Don P , McKinney Frederick W , Harris William H
Published: April 2021

ABSTRACT: By examining the records of 101 admissions (86 patients) undergoing total hip replacement for osteoarthritis, we studied the impact of 24 preoperative laboratory assessments on the postoperative course. Four patients had their procedures postponed or canceled because of laboratory abnormalities; three of these patients had abnormal urinalyses and one had abnormal liver function tests. No other patients had alterations In their perioperative course as a result of the tests. No subsequent postoperative complications were attributable to either an abnormal or deficient preoperative assessment. Two patients with postoperative hepatitis had normal preoperative liver function studies. One patient had a postoperative bleeding episode but had had normal preoperative PT and PTT values. The economic implications are discussed in a costeffectiveness model. On the basis of these results, we recommend that only a minimal set of preoperative laboratory tests be added to the detailed medical history and physical examination in otherwise healthy patients about to undergo total hip replacement surgery.
Diagnostic Arthroscopy of the Knee in Children and Adolescents
Authors: Harvell James C , Fu Freddie H , Stanitski Carl L
Published: April 2021

ABSTRACT: There is a definite role for arthroscopy in the diagnosis and treatment of problem knees in children and adolescents. In this series, the largest reported to date, significant intraarticular pathology frequently existed in both préadolescent and adolescent groups. Three hundred ten knee arthroscopies in 285 children were reviewed. Preoperative clinical diagnoses were correlated with arthroscopic findings. In préadolescents (12 years old and younger), only 55% of preoperative clinical diagnoses were confirmed at surgery. Thirty-five percent of this group were found to have additional pathology not anticipated preoperative^. In adolescents (13 to 18 years old), 70% of clinical diagnoses were confirmed arthroscopically. Additional pathology was also found on arthroscopic examination in 25% of this group.
Treatment Options in Unicameral Bone Cysts
Authors: Farber Jeffrey M , Stanton Robert P
Published: April 2021

ABSTRACT: Curettage and bone grafting has been the traditional treatment for unicameral bone cysts. Aspiration followed by injection of methylprednisolone acetate has been successfully used by Scaglietti et al. We reviewed 59 patients treated for unicameral bone cysts. The patients were subsequently evaluated for healing with regard to age, activity of cyst, and bone graft origin. The healing rate for curettage and bone graft was 53%. For patients with methylprednisolone acetate injection after aspiration, the healing rate was 70%. This difference was not statistically significant. The methylprednisolone acetate injection method has comparable efficacy to that of the more traditional curettage and bone graft method, and it is safe and cost-effective.
GROSS POLYETHYLENE FAILURE IN TOTAL KNEE ARTHROPLASTY
Authors: Heck David A , Clingman Jeffrey K , Kettelkamp Donald G
Published: April 2021

ABSTRACT

A total of 12 total knee replacements in nine patients with evidence of gross polyethylene failure at the time of revision surgery were identified. There were nine tibial and three patellar component failures. The average time from index to revision arthroplasty was 6 years (range: 0.75 to 9.63). A retrospective cohort group was identified based on date of operation. The average patient weight of the initial group was 89.6 kg (range: 76 to 104 kg), compared with 74.8 kg (range: 47 to 108 kg) (P = .04) in the control group. There was a male sex preponderance in the failure group (F = .045). The average height of the study group was 176 cm, compared to 161 cm for the control group (P = .003). Using the modified OASDI scale, the failure group had a higher activity level (P =.023). Pre-revision limb alignment in patients with failed TKA was statistically different from controls and served as an indication of polyethylene failure (P = .04). The selection of modular prosthetic component systems that allow for easy polyethylene revision is indicated in the high risk patient group identified. Close follow up is needed to minimize the sequela of polyethylene failure.
OPERATIVE TREATMENT OF BICONDYLAR INTRAARTICULAR FRACTURES OF THE DISTAL HUMERUS
Authors: Sanders Richard A , Raney Ellen M , Pipkin Stuart P
Published: April 2021

ABSTRACT

Orthopedists' lack of consensus on treatment regimens for bicondylar fractures of the distal humerus warrants further review of this uncommon fracture. We present a series of 17 bicondylar fractures of the distal humerus that had a minimum follow up of 2 years. Of these fractures, the 13 that were treated exclusively with internal fixation had 92% excellent or good results. The operative technique we describe is modified from the technique recommended by the AO group. We have found it helpful to use the radial column as the site of primary fixation with a 3.5 mm dynamic compression plate in the sagittal plane. Additional fixation is provided by a reconstruction plate placed posteriorly on the ulnar column in the coronal plane. This system of dual plates in perpendicular planes provides rigidity for early motion which, when supervised, is beneficial to a satisfactory outcome.
POSTTRAUMATIC TIBIAL OSTEOMYELITIS: A COMPARISON OF THREE TREATMENT APPROACHES
Authors: Koval Kenneth J , Meadows Steve E , Rosen Howard , Silver Lester , Zuckerman Joseph D
Published: April 2021

ABSTRACT

The treatment of 25 tibias in 25 patients with posttraumatic chronic osteomyelitis was reviewed. The approaches to soft tissue management fell into three groups: 1) muscle flap coverage; 2) primary closure with suction irrigation; and 3) open cancellous bone grafting. Treatment success was judged by the presence or absence of drainage and the local signs or symptoms of infection, and by the status of the tibial nonunion. Overall, 19 of 25 tibias (76%) had successful treatment. We found flap coverage to have a higher success rate (80%) than either primary closure with suction irrigation (45.5%) or open cancellous bone grafting (40%), These results further attest to the refractory nature of chronic osteomyelitis.
SEGMENTAL BLOOD PRESSURE AFTER TOTAL HIP REPLACEMENT
Authors: Gebuhr Peter , Soelberg Michael , Henriksen Jens H
Published: April 2021

ABSTRACT

Twenty-nine patients due to have a total hip replacement had their systemic systolic and segmental blood pressures measured prior to operation and 1 and 6 weeks postoperatively. No patients had signs of ischemia. The segmental blood pressure was measured at the ankle and at the toes. A significant drop was found in all pressures 1 week postoperatively. The decrease followed the systemic pressure and was restored to normal after 6 weeks. In a group of six patients with preoperatively decreased ankle pressure, a significant transient further decrease in the ankle-toe gradient pressure was found on the operated side. None of the patients had symptoms from the lowered pressure. We conclude that in patients without signs of ischemia, the postoperative segmental pressure decrease is reversible and therefore not dangerous.
BOTH-BONE FOREARM FRACTURES IN CHILDREN
Authors: Carey Patrick J , Alburger Philip D , Betz Randal R , Clancy Michael , Steel Howard H
Published: April 2021

ABSTRACT

Treatment of both-bone forearm fractures remains a difficult dilemma for the orthopedist. We assessed the results of 33 children treated with closed reduction and a long-arm cast using traction with finger traps in neutral rotation. Patients were grouped according to age and analyzed for residual angulation and range of motion (ROM). Despite some residual angulation and loss of rotation, all patients were fully active with no functional restriction at follow up. For patients 10 years old or younger with less than 30° of post-casting angulation, full ROM and minimal residual angulation on radiograph can be expected. For patients ages 11 to 15 years (the oldest patient in this series was 15), residual angulation is likely and approximately 60% of patients will have residual loss of less than or equal to 30° of rotation. In spite of this, we found no evidence of functional loss at follow up. Our series supports the continued use of closed manipulation as an effective treatment in children with both-bone forearm fractures.
QUADRICEPSPLASTY: THE JUDET TECHNIQUE AND RESULTS OF 21 POSTTRAUMATIC CASES
Authors: Merchan E C R , Myong Chong
Published: April 2021

ABSTRACT

Twenty-one quadricepsplasty procedures were carried out on 21 patients over a 14-year period due to posttraumatic stiffness of the knee joint. Three patients (14.2%) required mobilization under anesthesia in the early postoperative period. The average interval between injury and quadricepsplasty was 18 months (range: 5 to 49 months). Preoperatively, all cases showed less than 90° knee flexion. At follow up, 12 cases (57.2% ) achieved more than 90° flexion, while nine patients (42.8%) exhibited under 90° flexion. Flexion gain was between 60° and 90° in six cases (28.5%) and less than 60° in 15 cases (71.5%). Results were assessed according to Judet et al. There were 14 excellent and good (66.6%) and seven fair (33.3%) results. No poor results were found in this series.
DEEP VENOUS THROMBOSIS FOLLOWING LUMBAR LAMINOTOMY AND LAMINECTOMY
Authors: Ferree Bret A
Published: April 2021

ABSTRACT

Sixty consecutive patients undergoing lumbar laminotomy or laminectomy underwent preoperative and postoperative compression ultrasonography of the lower extremities to detect acute deep venous thrombosis (DVT). Compression stockings were the only method of prophylaxis. Three patients (5%) developed postoperative calf DVT. Despite continued treatment with only compression stockings, serial scanning failed to detect propagation of the thrombus proximal to the knee in any patient. The average age of patients who developed DVT, 62 years, was significantly greater (P<.05) than the age of patients who did not, 45 years. There were no statistically significant differences in DVT rates when compared by: sex, addition of one- or twolevel fusion, length of procedure, or number of days of bedrest.
THE USE OF KETOROLAC IN THE MANAGEMENT OF POSTOPERATIVE PAIN
Authors: DeAndrade J Robin , Maslanka Marc , Maneatis Thomas , Bynum Lincoln , Burchmore Michael
Published: April 2021

ABSTRACT

Ketorolac tromethamine (Toradol) is a nonsteroidal antiinflammatory drug (NSAID) available in intramuscular (IM) and oral formulations for the management of acute pain. Intramuscular ketorolac is the only parenteral NSAID available for analgesic use in the US. The clinical profile is reviewed, and clinical studies most applicable to a postoperative patient are discussed in detail. The results of a clinical study performed at Emory University School of Medicine are presented. In this single-dose study, 176 patients received either 10 ntg of oral ketorolac, 5 mg or 10 mg of IM morphine, or placebo after orthopedic surgery. The analgesic efficacy of ketorolac was comparable to both doses of morphine and significantly superior to placebo. Ketorolac, when administered intramuscularly or orally, is a safe and effective analgesic agent for the short-term management of acute postoperative pain and can be used as an alternative to opioid therapy.
ANTERIOR PARAMEDIAN RETROPERITONEAL SURGICAL APPROACH TO THE LUMBAR SPINE
Authors: Crofts Kim M , Wong David A , Murr Peter C
Published: April 2021

ABSTRACT

While routinely used in pediatric general surgery, the extraperitoneal paramedian approach to the spine and retroperitoneum has been employed infrequently in the adult population. We have utilized this technique successfully in 15 adult patients with pathologic conditions of the spine requiring radical vertebral body resection, dura decompression, and/or spine reconstruction. The anterior paramedian retroperitoneal dissection has definite advantages over the traditional transperitoneal or sympathectomy approaches. Wide exposure of the spine is obtained with minimal risk of contamination of the peritoneal cavity. Ease of orientation for identification of anatomic structures and radiographs is greatly enhanced.
TRANSCRANIAL MAGNETIC MOTOR-EVOKED POTENTIALS IN SCOLIOSIS SURGERY
Authors: Glassman Steven D , Zhang Y Ping , Shields Christopher B , Johnson John R , Linden R Dean
Published: April 2021

ABSTRACT

Spinal cord monitoring using SSEPs is an accepted adjunct in the surgical correction of spinal deformities, but does not directly assess motor function. Motor-evoked potentials have been introduced in an effort to meet this important need. In this series of 18 patients, the feasibility of intraoperative monitoring using transcranial magnetic motor-evoked potentials is documented. The potential value of this neurophysiologic monitoring technique, as well as the pitfalls in interpretation, are reviewed.
FREE VASCULARIZED TEMPORAL PARIETAL FLAP IN HAND SURGERY
Authors: Seradge Houshang , Adham Mehdi Navid , Seradge Espanta , Hunter David
Published: April 2021

ABSTRACT

Free vascularized temporo-parietal fascia (TPF) flap is a flap of thin, pliable and vascularized tissue which can cover an area measuring up to 12 cm × 14 cm. The flap is harvested based on temporal vessels, which provide a smooth, gliding surface for tendon function and eliminates the need for secondary procedures usually required by the pedicled or bulky free vascularized myocutaneous flaps. The donor pedicle is long and consistent with an average diameter of 3 mm in adults. This flap is versatile. In 12 resurfacings for traumatic wounds of hand and wrist, no flaps were lost. Donor site morbidity, except for a transient sideburn hair loss in one case, was not encountered. We recommend this flap as a viable one-stage procedure for coverage of complex hand wounds.
SPLINT IMMOBILIZATION OF GAMEKEEPER'S THUMB
Authors: Landsman Jonathan C , Seitz William H , Froimson Avrum I , Leb Robert B , Bacher Evan J
Published: April 2021

ABSTRACT

Thirty-nine patients diagnosed with 40 acute complete ruptures of the ulnar collateral ligament of the thumb metacarpophalangeal joint were treated primarily with thumb spica splint immobilization. Duration of splinting ranged from 8 to 12 weeks. Thirtyfour of these injuries (85%) followed for 1 to 5 years (average 2.4 years) healed without significant instability, arthrosis, pain, or stiffness (range of motion within 80% of the contralateral hand). Six ruptures (15%) demonstrated persistent instability and pain at 12 weeks and were treated with surgical reconstruction. Currently accepted guidelines for surgical intervention as primary treatment for ligamentous disruption at the thumb metacarpophalangeal joint may need revision. This study suggests that splint immobilization is an effective primary treatment modality. The minority of patients who demonstrate persistent laxity can be successfully treated surgically with excellent results.
RESULTS OF CFV TOTAL WRIST ARTHROPLASTY: REVIEW AND EARLY REPORT
Authors: Ferlic Donald C , Clayton Mack L
Published: April 2021

ABSTRACT

Articulated total wrist arthroplasties have been used in the United States since 1974. In the 1980s the CFV wrist was developed in an attempt to reduce the incidence of imbalance, loosening, and bone resorption that has been seen in the early implants, and also to eliminate the use of bone cement. Since 1988, we have implanted 15 of these wrists. To date, nine patients are satisfied because of pain relief and motion; however, there have been 6 failures: 2 for infection, 3 because of a loose distal component, and 1 because of balance. Other problems that have been observed are flexor tenosynovitis, carpal tunnel syndrome, and a balancing problem.
The Risk of Venous Thromboembolism in the Orthopedic Patient: Epidemiological and Physiological Data
Authors: Paiement Guy D , Mendelsohn Cerrah
Published: April 2021

ABSTRACT

Venous thromboembolism is responsible for 500,000 deaths annually in industrialized countries. It is probably the most common preventable cause of death in elective orthopedic surgery patients. Rates of deep vein thrombosis (DVT) and fatal pulmonary embolism (PE) in unprotected orthopedic patient populations are high. The overall DVT rate is >40% in patients undergoing hip or knee arthroplasty or suffering from multiple injuries. The proximal DVT rate for these patients is ≥15%, and the fatal PE rate is ≥1%. Risk factors associated with venous thromboembolism are related to the vascular injury, activation of blood coagulation, and venous stasis. Lower extremity orthopedic procedures carry a risk greater than that of surgery itself. Thus, orthopedic patients are at high risk for venous thromboembolic conditions. A systematic assessment of this risk should be performed in every patient, and an appropriate management plan should be implemented.
The Post-Hospital Discharge Venous Thrombosis Risk of the Orthopedic Patient
Authors: Planes André , Vochelle Nicole
Published: April 2021

ABSTRACT

A prospective, randomized, double-blind trial was performed in total hip replacement patients to document the risk of deep vein thrombosis (DVT) after hospital discharge, and to assess the efficacy of sustained antithrombotic prophylaxis. In a total of 179 patients receiving enoxaparin 40 mg/day during hospitalization, those without venogram-proven DVT at discharge were randomly assigned to continue prophylaxis with enoxaparin (N=90) or receive placebo (N=89). At the end of 21 days' treatment, intention-to-treat analysis in 173 evaluable patients demonstrated a significantly lower incidence (P=0.018) of DVT in the enoxaparin group (7.1%; N=6) compared with the placebo group (19.3%; N=17). These findings were confirmed by perprotocol analysis in 155 patients. Minor bleeding episodes occurred in three patients in the enoxaparin group and one in the placebo group. Thus, total hip replacement patients have a significant risk of developing DVT after hospital discharge. Continued prophylaxis with enoxaparin is effective in reducing this risk.
Decrease in Knee Joint Pain and Increase in Function in Patients With Medial Compartment Arthrosis: A Prospective Analysis of Valgus Bracing
Authors: Hewett Timothy E , Noyes Frank R , Barber-Westin Sue D , Hedcmann Timothy P
Published: April 2021

ABSTRACT

We studied a brace designed to decrease loads on the medial tibiofemoral compartment in knees with chronic pain and arthrosis to determine if pain symptoms decreased, function improved, and dynamic gait characteristics altered during walking. Eighteen patients with symptomatic medial compartment arthrosis were fitted with a commercially available brace. All were evaluated after an average of 9 weeks of brace wear, and 13 patients were evaluated after 1 year of brace wear. The Cincinnati Knee Rating System and additional pain scales were used to analyze symptoms and functional limitations. Nine subjects underwent a dynamic gait analysis and were compared with a control group of 11 normal subjects matched for age and walking speed.

The brace was worn an average of 7 hours a day, 5 days a week. Following 9 weeks of brace wear, statistically significant improvements were found for all pain parameters, and these improvements continued at the 1 year evaluation. Before brace wear, 78% had pain with activities of daily living, but after the first evaluation, only 39% continued to have such pain, and at the second evaluation, only 31% were so affected. Before brace wear, patients had a walking tolerance of 51 minutes prior to the onset of pain symptoms. At the first evaluation, patients could walk 138 minutes without pain, and after 1 year, they could walk 107 minutes without pain. Before brace wear, 78% rated their overall knee condition as fair or poor whereas at the first evaluation, only 33% continued to provide this rating. No differences were found in the dynamic gait parameters measured with and without the brace.

While this brace did not provide the dramatic improvements in symptoms, function, and patient satisfaction obtainable after high tibial osteotomy, it did help the majority of patients. If the goal of brace use is to buy a short amount of time for patients who cannot undergo or wish to avoid osteotomy or knee arthroplasty, then bracing appears to offer a reasonable alternative for short-term pain relief and improved function.
Functional Distal Interphalangeal Joint Splinting for Trigger Finger in Laborers: A Review and Cadaver Investigation
Authors: Rodgers Jeffrey A , McCarthy Jack A , Tiedeman Jeffrey J
Published: April 2021

ABSTRACT

This two-part study evaluates the efficacy of functional distal interphalangeal joint (DIP) splinting for the treatment of trigger finger. Thirty-one fingers from 21 meat packing plant workers were treated with DIP splinting. A single corticosteroid injection was offered if triggering was stage 4 or greater. All workers returned to work immediately. Eighty-one percent of the digits were treated successfully (mean follow-up: 1 year). Treatment failure correlated with duration of symptoms and stage of triggering but did not correlate with age, race, sex, disease in multiple digits, or prior treatment. For the second part of the study, the effect of DIP splinting on flexor digitorum profundus (FDP) tendon excursion was studied in 16 fingers from 4 fresh cadavers. Excursion decreased 4.8 mm for the Stax splint and 4.2 mm for the dorsal Alumafoam splint. We conclude that DIP splinting provides a reliable and functional means of treating work-related trigger finger without lost time from work. Our cadaver investigation supports our theory that DIP splinting significantly decreases FDP excursion.
Cortical Strut Grafting for Enigmatic Thigh Pain Following Total Hip Arthroplasty
Authors: Domb Benjamin , Hostin Emmanuel , Mont Michael A , Hungerford David S
Published: April 2021

ABSTRACT

Enigmatic thigh pain remains a difficult problem to treat after total hip arthroplasty. This article reports on the use of strut cortical allografting for the treatment of recalcitrant enigmatic thigh pain following total hip arthroplasty in patients with a well-fixed cemented or cementless femoral component.
Variation in Hospital Charges for Total Joint Arthroplasty: An Investigation of Physician Efficiency
Authors: Lester D Kevin , Linn Lawrence S
Published: April 2021

ABSTRACT

Total joint arthroplasty' is a common procedure for which consistent, clinically satisfactory outcomes are expected. Data from 796 total joint procedures performed by 20 surgeons at one center were evaluated to identify sources of variability in costs (as measured by hospital charges) where clinical outcome is expected to remain constant. Stepwise multivariate regression characterized the contribution of six variables to hospital charges listed in order of explanatory power: postoperative length of stay, surgical time, patient preoperative morbidity, units of blood transfused, perioperative complications, and procedure type (hip or knee) accounted for 46% of variability in hospital charges (multiple R
p 2
). In a subsequent analysis, after statistical adjustment for preoperative comorbid diagnoses, the sampling distribution of mean values for surgical time, total units of blood transfused, and total hospital charges were summarized and compared among surgeons. Despite adjustment for comorbid diagnoses, substantial variation and significant differences remained between surgeons in markers of resource utilization and "surgical efficiency." These findings suggest there is substantial variability in hospital charges not attributable to patient characteristics or category of procedure - a distinct and economically significant portion of this variability Is practitioner specific.
Iliac Crest Bone-Muscle Transfer in Periacetabular Osteotomy
Authors: Santore Richard , Nelson Fred R T , Muldoon Michael
Published: April 2021

ABSTRACT

Ganz et al1 reported acetabular osteotomy for extensive acetabular reorientation without changing the acetabular diameter. This article reports our modification of this surgical technique, which preserves the integrity of the tensor fascia latea muscle as well as providing viable bone for bone graft at the anterior iliac osteotomy site. The interval between the sartorius and tensor fascia lata is developed distal to the anterosuperior iliac spine. After iliac osteotomy through the anterosuperior iliac spine, the distal portion of the anterosuperior iliac spine (acetabular segment), along with its slip of tensor fascia lata (1 -2 cm), is separated and shaped to fit the anterior bone gap. Two small holes are drilled into that segment and also into the distal cut surface in the anterior portion of the remaining crest so that when the sutures are tightened, the tensor muscle is preserved anatomically and bone grafting is achieved.
Computed Tomography in the Determination of Transarticular C1-C2 Screw Length
Authors: Nadim Yasser , Sabry Fady , Xu Rongming , Ebraheim Nabil
Published: April 2021

ABSTRACT

This study evaluated the significance of computed tomographic (CT) measurements of the upper cervical vertebrae and their clinical implications in transarticular C1-C2 screw placement. In the first part of the study, analysis of axial CT scans of the atlas of 46 patients who had a normal C1-C2 region was performed. Measurements included the vertical distance between the middle of the ventral cortex of the lateral mass and the anterior-most point of the anterior tubercle, and the angle of the anterior ring of C1 relative to the frontal plane.

In the second part, axial CT scans of the upper cervical spine were performed in seven cadaveric cervical spines and analyzed using the same criteria. Using the Magerl technique of transarticular Cl -C2 screw placement, one screw was placed in each cervical spine. Following each placement, a strict lateral radiograph was taken and the distance between the tip of the screw and the anteriormost point of the anterior tubercle of Cl was measured. Analysis of the cervical cadaveric specimens showed the vertical distance between the middle of the ventral cortex and the anterior-most part of the anterior tubercle when measured on CT scan corresponded to the distance measured on lateral radiographs after placement of the Cl -C2 transarticular screw.

The study of the 46 patients with normal Cl -C2 region had shown the mean values of linear and angular measurements to be greater in males than in females, although no significant difference was found between the two groups (P>.05). The mean distance between the anterior-most point of the anterior tubercle and the middle of the ventral cortex of the lateral mass was 6.5±1 mm, and the mean transverse angle of the anterior ring relative to the frontal plane was 22°±3.G.

Axial CT evaluation of the individual anatomic relationships of the atlas is simple and may be a useful guide in the determination of the length of the transarticular screw when performed during surgery under lateral fluoroscopic control.
Postoperative Pain Control in Total Joint Arthroplasty: A Prospective, Randomized Study of a Fixed-Dose, Around-the-Clock, Oral Regimen
Authors: Flory Douglas A , Fankhauser Richard A , McShane Michael A
Published: April 2021

ABSTRACT

This randomized, prospective study assessed postoperative pain control in 119 patients undergoing total joint arthroplasty. Croup 1 (59 patients) received scheduled, around-the-clock, oral opioids and group 2 (60 patients) received oral opioids on an as-needed basis. Both groups had parenteral opioids available for breakthrough pain. The average scores for group 1 were lower than group 2. Differences were significant in sensory scores (AM day 1; AM and PM day 2), affective scores (PM day 2), total pain (PM day 2), visual analog scale (PM day 2), and present pain intensity index (AM day 1; PM day 2). Group 1 averaged 2.05 breakthrough pain doses and group 2 averaged 3.47 doses (P=.003), an average savings of 17.2% of the cost of pain medications during the first 2 postoperative days. The results indicate that scheduled, around-the-clock, oral opioids are an effective treatment regimen for postoperative pain control in total joint arthroplasty patients.
Preoperative Duplex Ultrasonography Evaluation for Deep Venous Thrombosis in Revision Hip Arthroplasty Patients
Authors: Wallace Buck , Jeffrey R Brooke , Goodman Stuart B
Published: April 2021

ABSTRACT

In a prospective consecutive series, 53 revision hip arthroplasties were performed in 51 patients. Pre- and postoperative Duplex ultrasonography examinations were reviewed by an independent, experienced radiologist. Three of 51 patients (53 procedures) had evidence of chronic deep venous thrombosis (DVT) or other venous abnormality preoperatively, yielding an incidence of 5.6%. One (1.9%) patient developed an acute DVT postoperatively despite pharmacological and mechanical preventative measures. These results indicate the use of preoperative ultrasonography as a screening tool prior to revision hip arthroplasty is not warranted based on the low incidence of acute or chronic DVT detected preoperatively. Long-term anticoagulation, when necessary, can be based on the findings of a postoperative scan.
Factors in Academia and Service That Influence Baccalaureate Graduates' Membership in the American Nurses' Association
Authors: Bailey Patricia A
Published: April 2021

ABSTRACT

The intent of this study was to explore relationships among models of influence, association experiences, attitudes toward the American Nurses' Association (ANA), attitudes toward professionalism, and first-year baccalaureate nurse graduates joining the American Nurses' Association. One hundred sixty-three baccalaureate nurses from programs in three northeastern states returned a mailed questionnaire. Analysis of the data showed that graduates identified deans and faculty as more favorably disposed toward the ANA as compared to supervisors, head nurses, and peers. Faculty were identified more often as influencing subjects to join the ANA. Respondents saw the ANA as valuable for the profession, representing nursing, and promoting standards but they generally did not hold membership. Professionalism content in the curriculum had no relationship to scores on either of the two scales or to ANA membership. Having had ANA content was positively related to seeing the ANA as promoter of human rights and as a voice for nursing. There were significant differences between ANA members and non-members and use of the professional organization as a major referent and seeing the ANA as an accreditor. It was concluded that faculty and deans were positive models of influence for new graduates regarding the Association but did not affect membership for those graduates. Further study of curriculum content and professional role model behavior in the work setting is urgently needed.
Participation of Nursing Faculty in University Governance
Authors: Bahrawy Aida A
Published: April 2021

ABSTRACT

It has been suggested that faculty participation in governance in American colleges is low, and that faculty in schools of nursing are particularly unlikely to be involved in governance activities. This study was designed to determine actual and ideal levels of nursing faculty participation in five areas of governance: academic, student, personnel, public, and financial affairs. A survey of nursing faculty suggested that they were involved substantially in academic affairs, but less involved in the other areas of governance. Generally, the faculty indicated satisfaction with their high level of participation in academic affairs, and with their lower level of participation in student affairs, personnel affairs, and public affairs; the faculty did indicate dissatisfaction with their low level of participation in financial affairs.
The NCLEX-RN and Nurse Educators
Authors: Washburn Jane , Short Lois
Published: April 2021

ABSTRACT

The involvement of nurse educators with recent NCLEX-RN changes was studied. One hundred and twenty administrators from associate (ADN) and baccalaureate (BSN) degree programs across the country responded to a questionnaire regarding educator knowledge about, involvement in, and opinion of the change process. Findings revealed that administrators from both program types felt ill-informed regarding NCLEX-RN changes prior to their implementation, and they expressed a desire to have had input in the change process. While administrators had varied opinions regarding the passing standard change and the content change, they were strongly opposed to the manner in which change occurred.
Ways of Knowing Among Beginning Students in Nursing
Authors: Eyres Sandra J , Loustau Anne , Ersek Mary
Published: April 2021

ABSTRACT

Twenty-one students in their first quarter of nursing school were interviewed to determine the utility of the typology for ways of knowing developed by Belenky, Clinchy, Goldberger, and Tarale (1986) for understanding the cognitive development of nursing students; the differences in epistemological perspectives by gender, age, and ethnicity; and the forces in nursing school that encourage developmental transitions. The typology was found to be applicable for Caucasian women and provided important insights on differences among groups of students. Some of the implications for providing supportive educational environments are presented.
An Immodest Proposal: Pay Equity for Nursing Faculty Who Do Clinical Teaching
Authors: Boughn Susan
Published: April 2021

ABSTRACT

Pay equity, the concept of equal pay for equal or comparable work, will continue to be of paramount importance to women as the 20th century draws to a close. While it might have been anticipated that women in academic settings would enjoy pay equity, clinical teaching in nursing education provides a model for gender discrimination as related to women's work. Elements of proposal development and a case study for contesting pay inequity are presented.
Comparison of Learning Outcomes Between Graduate Students in Telecourses and Those in Traditional Classrooms
Authors: Feel Juanita Fogel
Published: April 2021

ABSTRACT

The shortage of master's-prepared nurses has led to the practice of providing educational opportunities to such students through courses taught by live television. This study compared learning outcomes between students taught by TV and those taking the classes in a traditional classroom. Eight traditional and seven telecourse classes were included. No significant differences were found for all comparisons of telecourse students between those at remote sites and those in the studio. No significant differences were found for four of seven comparisons between traditional and telecourse students. For three comparisons, the traditional students performed somewhat better but the differences, although statistically significant, were minimal. The study provides support for the efficacy of teaching master's-level courses by television.
Alternatives in Nursing Education Funding
Authors: Webber Pamela Bayliss
Published: April 2021

ABSTRACT

Contracting between private educational institutions and state governments or agencies is developing as a cost-effective method for meeting nursing education demands in an era of scarce resources. This article explores relevant literature and current status of this type of contracting.
New Nurse Faculty: Core Competencies for Role Development
Authors: Choudhry U K
Published: April 2021

ABSTRACT

This study originated from the need to define the role competencies for a beginning nurse educator. A survey of full-time faculty and heads of university and community college nursing programs in Ontario showed a high degree of agreement between the two sets of faculty for teacher role, practice, service, personal and professional growth competencies. Significant differences were noted on competencies involving student evaluation, facilitating student's practice, acting as student's advocate, and research. Agreement was noted on the problems created by role ambiguity and role incompetence, particularly for new faculty. This suggests the need for educational preparation and socialization of nurse faculty.
Developing Analytic Thinking Skills in Early Undergraduate Education
Authors: Bowers Barbara , McCarthy Donna
Published: April 2021

ABSTRACT

This article describes how a required prenursing health issues course was substantially restructured to increase the opportunities for students to develop analytic skills and for faculty to gain greater insight into how the students processed course content. Using writing-to-learn (WTL) strategies based on theories of adult cognitive development (Kinneavy, McCIeary, & Nakadate, 1985; Kohlberg, 1978; Perry 1978), course readings, writing assignments, and exam questions were revised continuously over five semesters. This article describes the purpose and process of redesigning the course and some reflections on the outcome.
What High School Students Think of a Nursing Career: A Survey of Dade County Senior High Schools
Authors: Grossman Divina Gracia S , Northrop Celeste
Published: April 2021

ABSTRACT

Using a cross-sectional design, we surveyed 700 10th and llth-grade students in Dade County, Florida, to examine high school students' opinions of a nursing career and the relationships among students' opinions and several variables. Of a possible range of opinion scores from 14 to 56, the mean opinion score for the sample was 40.92 (SD= 7.8). While age had no significant correlation with nursing opinion scores, they were influenced significantly by gender, the students' desired occupation, and the opinions of parents, friends, and guidance counselors. Although only 28 (7%) of the students selected nursing as their desired occupation, 119 (24.5%) considered nursing one of their alternatives prior to making a decision. These findings have important implications for the recruitment of high school graduates into nursing.
Preferred Learning Styles and Study Strategies in a Linguistically Diverse Baccalaureate Nursing Student Population
Authors: Keane Mary
Published: April 2021

ABSTRACT

This study examined learning styles, learning and study strategies, and specific background variables (primary language, ethnic background, and length of time in the United States) in a multicultural and linguistically diverse baccalaureate nursing student population. Results revealed positive associations between English as a primary language and the learning strategy of self-study and negative associations with high anxiety levels. Length of time in the United States was positively correlated with the learning strategy of information-processing. Lower GPA scores reflected lower mean ratings on the composite scales of the Learning Styles Inventory (LSI) and Learning and Study Strategies Inventory (LASSI). The main predictor variables for GPA were English as a primary language, the learning strategies of information-processing and selecting main ideas, and the learning style of group study.
A Comparison of International Learning Experiences for Baccalaureate Nursing Students: Developed and Developing Countries
Authors: Haloburdo Esther P , Thompson Mary Ann
Published: April 2021

ABSTRACT

As faculty seek creative learning opportunities for students in a changing social, political, and health care environment, knowledge about international learning experiences can provide critical information for decision making. Thia study sought the answer to two questions: What are the learning outcomes of an international experience for baccalaureate nursing students and what are the similarities and differences in what students learn in developed and developing countries? Using grounded theory methodology, 14 students who had participated in international learning experiences were interviewed. Three major categories emerged from the data analysis: personal and professional growth, empirical knowledge, and the learning experience. More similarities than differences were identified among the students who had traveled to developing versus developed countries. The findings suggest that international experiences need to include the opportunity to provide direct nursing care. A proposed model for such experiences is presented.
Community Partnerships: Redirecting the Education of Undergraduate Nursing Students
Authors: Oneha Mary Frances , Sloat Ann , Shoultz Jan , Tse Alice
Published: April 2021

ABSTRACT

Consistent with the goal of reforming nursing education to support nursing's agenda for health care reform, a community-based, multiprofessional initiative supported by the W.K Kellogg Foundation began in Hawaii in 1991. This initiative created a partnership among the University of Hawaii Schools of Medicine, Nursing, Social Work, and Public Health, three community health centers, and their communities to provide a communitybased, integrated system of health care, education, and research. In response to this initiative, the School of Nursing developed an integrated undergraduate curriculum consisting of: a discipline-specific tutorial using an inquiry-based learning strategy; a multiprofessional tutorial; and a 1-year clinical experience providing culturally competent primary care. Community-based education has stimulated changes in the philosophy, mission, and curriculum of the School of Nursing. The outcomes achieved as a result of this initiative have had a favorable impact on clients using the community health centers, the communities, the School of Nursing, and the students.
Students' Philosophical Assumptions and Psychology in the Classroom
Authors: Dowds Barbara Noel , Marcel Barbara B
Published: April 2021

ABSTRACT

The current study investigated the underlying philosophical assumptions, or world views, that undergraduate nursing students bring to the psychology classroom. It was hypothesized that studente would most prefer mechanistic explanations of behavior, explanations derived from an analytical, linear, cause-and-effect model. It was aleo hypothesized that they would least prefer contextualistic explanations of behavior, i.e., explanations derived from a synthetic, subjective, and relational model. Forty female hospital-based RN students completed a modified version of the World Hypothesis Scale. As predicted, they were significantly more likely to endorse mechanistic explanations and less likely to endorse contextualietic explanations. Because teaching psychology lends itself to a contextualistic approach in which a variety of models for understanding behavior are explored, the study of psychology can be one way to increase nursing students' critical thinking skills.
A Comprehensive Approach to Clinical Evaluation
Authors: Woolley Gale R , Bryan Martha S , Davis Jean W
Published: April 2021

ABSTRACT

Historically, the summative clinical evaluation of nursing students has been problematic. Tools of measurement for clinical performance have been subjective and, at times, biased at several levels. With these thoughts and past experiences in mind, the faculty in an associate degree nursing program developed a comprehensive approach to summative clinical evaluation.

The process began with the development and implementation of a Clinical Performance Manual (CPM) describing five components of the summative evaluation process. These included the: ability to consistently exhibit professional behaviors; random skills performance examination; plan of care examination; critical situations examination; and required course assignments. These components were developed with the intent of objectifying the measurement of cognitive, affective, and psychomotor skills of students.

After 1 year of implementing this process with 250 students, feedback received from faculty and students was reviewed and discussed. Reliability and validity studies have been conducted. A decision was made to continue with this new method of evaluation. Recommendations include piloting and implementing the process in others schools and programs.
The Cloutterbuck Minimum Data Matrix: A Teaching Mechanism for the New Millennium
Authors: Cloutterbuck Jane C , Cherry Brenda S
Published: April 2021

ABSTRACT

The demands of the United States' rapidly changing health care system and society signal the need to design and implement health professions programs which prepare students for practice within a health care paradigm that will be very different from the one existing today and for work with an increasingly diverse and independent consumer population. The Cloutterbuck Minimum Data Matrix (CMDM) is a teaching mechanism designed to generate a comprehensive base of consumer information prerequisite to the indepth level of critical analysis and synthesis needed to produce quality health care outcomes in the 21st century. The CMDM assumes an interdisciplinary perspective and educates students to recognize and incorporate consumer diversity into strategies for care.
Tobacco-Related Instruction in Undergraduate Nursing Education in Illinois
Authors: Kraatz Elizabeth Santas , Dudas Susan , Frerichs Marian , Paice Judith , Swenson Carol
Published: April 2021

ABSTRACT

Tobacco use is responsible for more deaths in the United States than any other factor. Nurses are in a unique position to convey life-saving messages to clients regarding tobacco use. To gauge the type and extent of tobacco-related background knowledge acquired by nurses in tbe course of their education, the Nurses' Committee of the Illinois Division of the American Cancer Society (ACS) surveyed 70 nursing programs in the state of Illinois. The number of lecture hours spent on tobacco-related issues was greater in LPN programs than in either associate or baccalaureate degree programs, and instruction was scattered throughout the curriculum of each program. Most schools reported heavy reliance on adult medicalsurgical textbooks to convey tobacco-related content. The most recent editions of the textbooks used by the schools were reviewed, and they also were found te adopt a scattered approach, with a disappointing lack of depth regarding the hazards of tobacco. It is recommended a single course be identified as responsible for relaying tobacco-related content and information supplied by general medical-surgical textbooks be supplemented by materials drawn from other sources.
An Introduction to the Partial Credit Model for Developing Nursing Assessments
Authors: Fox Christine
Published: April 2021

Abstract

The partial credit model, which is a special case of the Rasch measurement model, was presented as a useful way to develop and refine complex nursing assessments. The advantages of the Rasch model over the classical psychometric model were presented including the lack of bias in the measurement process, the ability to highlight those items in need of refinement, the provision of information on congruence between the data and the model, and feedback on the usefulness of the response categories. The partial credit model was introduced as a way to develop complex nursing assessments such as performance-based assessments, because of the model's ability to accommodate a variety of scoring procedures. Finally, an application of the partial credit model was illustrated using the Practical Knowledge Inventory for Nurses, a paper-and-pencil instrument that measures on-the-job decision-making for nurses.
Research Utilization: A Challenge for Nursing Graduate Education to Improve Patient Care
Authors: Quinn Christina
Published: April 2021

ABSTRACT

To improve patient care, hospitals and other health care facilities are looking to improve patient outcomes through examining how nursing care can be changed or modified based on research. The process of applying research results into clinical practice is called research utilization (RU). In this article, a master's level research utilization course is described. The process of research utilization is highlighted along with specifics regarding course development and evaluation methods. Graduate level research courses such as this one can assist students to demonstrate competency in research utilization including: synthesis of research literature, development of practice guidelines based on research, and identification of strategies to carry out RU protocols and evaluate outcomes.