bluuebunny/crossref_metadata_2025 huggingface dataset:
Internet self-efficacy does not predict student use of Internet-mediated educational technology
Authors: Buchanan Tom , Joban Sanjay , Porter Alan
Published: August 2014

Two studies tested the hypothesis that use of learning technologies among undergraduate psychology students was associated with higher Internet self-efficacy (ISE). In Study 1, the ISE scores of 86 students were found not to be associated with either attitudes towards, or measured use of, blogs and wikis as part of an IT skills course. ISE was associated with time spent online, and positive attitudes to wikis were associated with higher use. Study 2 measured 163 students’ ISE scores at the beginning and end of the same course. ISE was again not correlated with attitudes towards, or actual measured use of, learning technologies used in the course. However, ISE was shown to increase during the course. Positive attitudes towards wikis and discussion boards were associated with higher use of each. Overall, ISE scores did not influence measured use of a Virtual Learning Environment (VLE, including blogs, wikis and a discussion board), or attitudes towards those technologies. This implies that while ISE is linked to aspects of online behaviour (time spent online) and can be modified by online activity or training, it does not predict student use of educational Internet technologies.Keywords: Internet self-efficacy; student; blog; wiki; VLE(Published: 19 August 2014)Citation: Research in Learning Technology 2014, 22: 19585 - http://dx.doi.org/10.3402/rlt.v22.19585
Reaction of selected carbohydrate aldehydes with benzylmagnesium halides: benzyl versus o-tolyl rearrangement
Authors: Bella Maroš , Steiner Bohumil , Langer Vratislav , Koóš Miroslav
Published: August 2014

The Grignard reaction of 2,3-O-isopropylidene-α-D-lyxo-pentodialdo-1,4-furanoside and benzylmagnesium chloride (or bromide) afforded a non-separable mixture of diastereomeric benzyl carbinols and diastereomeric o-tolyl carbinols. The latter resulted from an unexpected benzyl to o-tolyl rearrangement. The proportion of benzyl versus o-tolyl derivatives depended on the reaction conditions. Benzylmagnesium chloride afforded predominantly o-tolyl carbinols while the application of benzylmagnesium bromide led preferably to the o-tolyl carbinols only when used in excess or at higher temperatures. The structures of the benzyl and o-tolyl derivatives were confirmed unambiguously by NMR spectral data and X-ray crystallographic analysis of their 5-ketone analogues obtained by oxidation of the corresponding mixture of diastereomeric carbinols. A possible mechanism for the Grignard reaction leading to the benzyl→o-tolyl rearrangement is also proposed.
The Accreditation Process: A Virtual Visit Experience
Authors: DeSilets Lynore D.
Published: August 2014

This column provides an overview of the 2013 American Nurses Credentialing Center accreditation process by relaying one university provider unit’s experience with accreditation. Various components of the re-accreditation process are described.

J Contin Educ Nurs
2013;44(8):336–337.
Assuring Content Integrity
Authors: Dickerson Pamela S.
Published: August 2014

It is important to assure that content integrity is maintained for the educational activities you provide. This column addresses the key components of content integrity and how to be sure they are implemented in your planning process.

J Contin Educ Nurs
2013;44(9):385–386.
Developing Confidence Decreases Guessing and Increases Competency
Authors: Center Deborah L. , Adams Timothy M.
Published: August 2014

Validating competency to meet accreditation and safety demands is a major challenge many organizations face. Traditional testing methods may only reflect guessing and may not capture the amount of misinformation nurses are using for critical decision making. Using a confidence-based learning methodology allows learners to correct misinformation and gain confidence and competency.

J Contin Educ Nurs
2013;44(9):389–390.
End-of-Life Experiential Learning for Newly Licensed Nurses
Authors: Warnke JoEllen , Thirlwell Sarah
Published: August 2014

Many newly licensed nurses begin their careers with limited knowledge and experience in end-of-life care. Findings from a literature review and a learning needs assessment of newly licensed nurses at a comprehensive cancer center guided the development of an 8-hour educational program on end-of-life care. An experiential learning approach was used to foster confidence and develop knowledge and skills in delivery of end-of-life care by newly licensed nurses.
J Contin Educ Nurs.
2014;45(3):106–107.
Repurposing Traditional Instructor-Led Lectures for Continuing Education: Rewarding Instructors as Authors and Maximizing Return on Investment
Authors: Rushinek Avi , Rushinek Sara , Lippincott Christine , Ambrosia Todd
Published: August 2014

The aim of this article is to describe the repurposing of classroom video surveillance and on-screen archives (RCVSOSA) model, which is an innovative, technology-enabled approach to continuing education in nursing. The RCVSOSA model leverages network Internet-protocol, high-definition surveillance cameras to record videos of classroom lectures that can be automatically uploaded to the Internet or converted to DVD, either in their entirety or as content-specific modules, with the production work embedded in the technology. The proposed model supports health care continuing education through the use of online assessments for focused education modules, access to archived online recordings and DVD training courses, voice-to-text transcripts, and possibly continuing education modules that may be translated into multiple languages. Potential benefits of this model include increased access to educational modules for students, instant authorship, and financial compensation for instructors and their respective organizations.
J Contin Educ Nurs.
2014;45(4):188–192.
Developing Leaders as Systems Thinkers—Part I
Authors: Bleich Michael R.
Published: August 2014

There is an increased demand for leaders to become systems thinkers. This article explains how thinking and acting systematically differs from thinking and acting in a systems-oriented manner.

J Contin Educ Nurs.
2014;45(4):158–159.
Polytraumatic TBI: Perspectives from Military Medicine
Authors: Tepe Victoria , Cernich Alison , Kelly James
Published: August 2014

CME Educational Objectives

1.

Review diagnostic challenges and risks associated with traumatic brain injury (TBI), related injury processes, comorbidities, and persistent symptoms and sequelae.

2.

Review the evidence related to undiagnosed neurotrauma, and particularly mild TBI, as a potential contributor to physical, cognitive, emotional, and behavioral dysfunction.

3.

Discuss the incidence and risks of multiple injury scenarios, especially those involving sensory system injuries, and related efforts to advance the integrated study and management of polytrauma/TBI.

What prepared us? … Almost every hospital has a surgeon or nurse or medic with battlefield experience, sometimes several. … We’ve learned, and we’ve absorbed.

Atul Gawande, MD, “Why Boston’s Hospitals Were Ready” (
The New Yorker
, April 17, 2013).

Traumatic brain injury (TBI) has been described as “the beginning of an ongoing, perhaps lifelong process.”
1
Even when classified as mild, TBI can pose significant long-term challenges to health, well-being, and functionality. TBI also increases the risk for psychiatric disturbance such as depression and stress-related disorder.
2
The inherent complexity of TBI is complicated further in the context of multiple injuries (polytrauma) to other body structures, organs, and systems including vision, hearing, and mental health. Although unfortunately common in combat and blast exposure (see Figure
1
, page 309), polytraumatic scenarios are by no means limited to the military environment.
Mental Disorders Comorbid with Vestibular Pathology
Authors: Lawson Ben D. , Rupert Angus H. , Kelley Amanda M.
Published: August 2014

CME Educational Objectives

1.

Review the evidence for the presence of mental disorders among patients with vestibular deficits caused by head acceleration or barotraumas.

2.

Consider evidence indicating that unusual vestibular stimulation acts as a temporary vestibular insult to healthy people, causing measurable, reversible cognitive deficits.

3.

Make clinicians aware that vestibular injury is a potential contributor to observed psychological effects they see during treatment of injuries arising from concussion and/or blast.

Military clinicians regularly examine personnel with posttraumatic stress (PTS), concussion, and/or mild traumatic brain injury (mTBI). For example, when a service member has suffered head injury and the loss of a comrade due to an explosive device, it may be difficult to determine which of the patient’s problems originate from psychological reaction to traumatic stress versus organic medical conditions arising from head injury.
Deep Brain Stimulation for Treatment-Resistant Depression
Authors: Kaur Navneet , Chou Tina , Corse Andrew K. , Arulpragasam Amanda R. , Deckersbach Thilo , Evans Karleyton C.
Published: August 2014

CME Educational Objectives

1.

Describe the role of deep brain stimulation (DBS) in treatment-resistant depression (TRD).

2.

Identify the current primary brain targets used in DBS for TRD and describe the major clinical findings.

3.

Explain the potential future direction of DBS for TRD.

Major depressive disorder (MDD) is a psychiatric disorder characterized by depressed mood, anhedonia, insomnia, weight loss or gain, agitation or psychomotor retardation, fatigue, feelings of worthlessness or excessive guilt, diminished concentration, and suicidal ideation/behavior (
Diagnostic and Statistical Manual of Mental Disorders
, fourth edition, text revision [
DSM-IV-TR
]).
1
MDD is one of the leading causes of disability in the world, affecting approximately 14.8 million American adults with a lifetime prevalence rate of 19.2%.
2
A 28-Year-Old Man with Depression, PTSD, and Anabolic-Androgenic Steroid and Amphetamine Use
Authors: Hegazy Belal , Sanda Corneliu
Published: August 2014

CME Educational Objectives

1.

Develop an understanding of anabolic-androgenic steroid (AAS) abuse, including risk factors, signs and symptoms of abuse, and other psychiatric comorbidities.

2.

Identify different tools of assessments to diagnose AAS abuse and different options for treatment.

3.

Describe factors associated with relapse for AAS abuse.

The patient is a 28-year-old man who was referred to a psychiatric clinic for the evaluation of polysubstance dependence, depression, and posttraumatic stress disorder (PTSD). He reported that for the last 2 years he had been abusing “Tina,” the street name for methamphetamine; anabolic steroids, opioid narcotics; and occasionally alcohol. He reported that he started taking different steroids at the encouragement of his friends at the local gym. He reported that using amphetamine and anabolic steroids together in a binge pattern would give him energy; improve his physical exercise endurance; build up muscles; and, ultimately, improve his physical appearance.
Impulsivity, Aggression, and Suicide Risk in Patients with Schizophrenia
Authors: Pompili Maurizio , Serafini Gianluca , Innamorati Marco , Biondi Massimo , Girardi Nicoletta , Murri Martino Belvederi , Amore Mario , Lester David , Girardi Paolo
Published: August 2014

CME Educational Objectives

1.

Recognize the threat for impulsivity, aggression and suicide in patients with schizophrenia.

2.

Assess the risk for aggressive and suicidal behaviors in patients with schizophrenia with detailed anamnestic assessment and self-report questionnaires or specific psychometric instruments.

3.

Incorporate targeted and evidence-based therapies into treatment of patients with schizophrenia.

The potential of impulsivity/aggression in subjects with schizophrenia may be investigated with a detailed anamnestic assessment, and carefully measured using self-report questionnaires or specific psychometric instruments. Clinicians not only have to pay particular attention to the assessment but also to the management of patients with schizophrenia to prevent suicide and social impairment related to impulsivity/aggression. Both short-term and long-term risk of impulsivity/aggression may be managed using behavioral strategies and engaging patients in a therapeutic alliance.
Cognitive Impairment in Depressed Older Adults: Implications for Prognosis and Treatment
Authors: Morimoto Sarah Shizuko , Kanellopoulos Theodora , Alexopoulos George S.
Published: August 2014

Late-life depression is often accompanied by cognitive impairment. In some cases, the syndromes of depression and cognitive impairment may be related to the same underlying disorder (eg, vascular dementia, hypothyroidism), whereas in other cases, they may be relatively independent and simply coexist. Cognitive deficits in late-life depression span multiple domains; however, deficits in executive functions may be particularly important as their presence predicts poor clinical outcomes. Cognitive impairment, when mild, does not appear to progress to dementia in most cases, but variability in the course of elders with depression and cognitive impairment suggests the need for careful follow-up, particularly in cases where executive dysfunction is suspected. The Expert Consensus Guideline recommends antidepressant drug therapy combined with a psychosocial intervention as the treatment of choice for geriatric depression. New treatments including computerized cognitive remediation and problem-solving therapy may be particularly effective in treating both affective and cognitive symptoms.
Pediatric Polysomnography for Sleep-Disordered Breathing Prior to Tonsillectomy: A Guideline Review
Authors: Walz Patrick C. , Schroeder James W.
Published: August 2014

CME Educational Objectives

1.

Review the most recent American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) guidelines for perioperative management of patients with sleep-disordered breathing (SDB).

2.

Highlight perioperative challenges in management of patients with SDB.

3.

Discuss significant updates in the SDB literature since the AAO-HNS guideline publication.

Snoring and other signs of sleep-disordered breathing (SDB) represent a common management challenge for the pediatrician, pulmonologist, anesthesiologist, and otolaryngologist. In 2011, the American Academy of Otolaryngology–Head and Neck Surgery published a clinical practice guideline for the treatment of patients with SDB. This guideline provides indications for polysomnography use in patients with SDB. In this article, we discuss the management of SDB in pediatric patients, which relies on the accurate assessment of symptoms of SDB, identification of comorbidities known to increase the severity of SDB, and appropriate preoperative assessment of the patient.
Pediatric Obesity, Metabolic Syndrome, and Obstructive Sleep Apnea Syndrome
Authors: Nevin Mary A.
Published: August 2014

CME Educational Objectives

1.

Illuminate the relationship between childhood obesity and obstructive sleep apnea syndrome (OSA).

2.

Determine the complications associated with obesity and sleep-disordered breathing (SDB).

3.

Discuss currently recommended management options for OSA in the obese child or adolescent.

The prevalence of obesity in the pediatric population has dramatically increased in the last 30 years. While the adverse health effects of obesity have long been recognized in adults, many of these complications are now understood to begin in early childhood. Obese children and adolescents are significantly more likely than their peers of healthy weight to suffer from obstructive sleep apnea and metabolic syndrome. In turn, affected individuals may experience myriad serious clinical sequelae; neuro-cognitive, psychiatric, cardiovascular, and endocrinologic complications have each been extensively documented. Thus, the spectrum of obesity-related disease represents a serious but preventable threat to personal and family wellness; additionally, it is a source of considerable health care expenditure and represents a national and international health crisis. The optimal care of these patients will be best achieved through the pediatric health care provider’s timely recognition of these clinical problems and knowledge of appropriate intervention strategies.
Children with Autism Spectrum Disorder and Epilepsy
Authors: Francis Amy , Msall Michael , Obringer Emily , Kelley Kent
Published: August 2014

CME Educational Objectives

1.

To review the prevalence of epilepsy in children with autism spectrum disorder (ASD), the types of seizures associated with ASD, common electroencephalogram (EEG) findings, and common MRI findings.

2.

To understand the current treatment approaches and the evidence based strategies for intervention.

3.

To recognize that that care coordination and implementation of the medical home principle is of great importance for children with autism and epilepsy.

Autism spectrum disorder (ASD) is a biologically based neurodevelopmental disability characterized by qualitative and persistent deficits in social communication and social interaction and by the presence of restricted, repetitive, and stereotyped patterns of behavior. Symptoms must be present in early childhood and they must limit and impair everyday functioning. There is an increased prevalence of epilepsy and/or epileptiform electroencephalography (EEG) abnormalities in children with ASD. It is estimated that approximately one-third of children and adolescents with ASD experience seizures, but the relationship between epilepsy and autism is controversial. This article reviews the types of seizures associated with ASD, the EEG findings, and current treatment strategies. The article also describes syndromes associated with the autism phenotype and epilepsy.
Henoch-Schöenlein Purpura and Diabetes Mellitus in a 9-Year-Old African-American Male
Authors: D’Souza Shalome , Hageman Joseph R. , Patel Payal , Littlejohn Elizabeth
Published: August 2014

A 9-year-old boy with a past medical history of asthma was admitted from the emergency department (ED) for evaluation of a rash, polyarthralgia, and hyperglycemia noted at the referring hospital. The rash was reported as purpuric “bumps,” which started 3 days prior to presentation. The rash had initially presented on the lower extremities and had progressively worsened as well as spread to both upper extremities. He also complained of pain in his right knee and lower extremity swelling with limited flexion bilaterally. There was no history of polyphagia, polydipsia, nausea, vomiting, diarrhea, abdominal pain, headache, or fever. The patient mentioned that he had lost approximately 10 lbs during the past year, but he had been trying to lose weight.
An Adolescent with Graves’ Disease and Thymic Hyperplasia
Authors: D’Souza Shalome , Patel Payal , Hageman Joseph R. , Deplewski Dianne
Published: August 2014

A 14-year-old female presented to our hospital for a second opinion regarding a recent diagnosis of Graves’ disease and a mediastinal mass.

Four months prior to presentation, the patient developed difficulty with concentration. Historically she had been an A/B student; however, her school performance worsened suddenly, and she almost failed the eighth grade. One month later, she began complaining of increased sweating, diarrhea, difficulty with balance, jitteriness, and difficulty sitting still. During the previous 2 months, she had an increased appetite along with a 10-lb weight gain, increased hair loss, fatigue, and dry skin. Two weeks prior to her presentation, her mother noted that she had a “large neck mass.” At that time, the patient complained of dysphagia and tenderness of the anterior neck on palpation, but she had no respiratory difficulties. In addition, she had no symptoms of fever or night sweats.
A 12-Week-Old Male with a 10-Day History of Fever
Authors: Bhatt Sima Thakkar , Hageman Joseph R. , Bartlett Allison , Trivedi Kalyani
Published: August 2014

Kawasaki disease (KD) is a self-limited vasculitis that can have significant morbidity and even mortality if not identified and treated early. The purpose of this case study is to highlight the importance of keeping KD in the differential diagnosis, even if all clinical criteria are not met. This is especially true in children younger than 1 year of age, who are more likely to have an incomplete or atypical presentation. The patient in this study is a 12-week-old African-American male with no significant past medical history who presented with a 10-day history of fever up to 105° F. An echocardiogram shortly after admission demonstrated normal cardiac structure and function with evidence of coronary artery abnormalities. Diagnosis of KD (treatment with intravenous immunoglobulin, aspirin, and a tumor necrosis factor-alpha inhibitor) and follow-up imaging are detailed. Treatment of KD in the acute phase is aimed at preventing coronary thrombosis and aneurysm formation.
Transitional Care Management Services: Optimizing Medication Reconciliation to Improve the Care of Older Adults
Authors: Pincus Kathleen
Published: August 2014

Recent establishment of Transitional Care Management (TCM) services by the Centers for Medicare & Medicaid Services demonstrates the shift in emphasis toward interventions that reduce hospital and emergency department utilization. Older adults are especially vulnerable during these transitions in care due to the increased risk of medication-related problems. Thorough medication reconciliation can preemptively identify potential medication-related problems such as medication errors, high-risk medications, and adverse effects. [
Journal of Gerontological Nursing, 39
(10), 10–15.]
Nurse Entrepreneurs, Arise!: Improving Lives of Older Adults by Bringing Your Ideas to Market
Authors: Rowe Meredeth A.
Published: August 2014

Many functions that nurses carry out require the use of various technologies, yet nurses are rarely involved in the development and/or testing of technology. The purpose of this article is to provide an introduction to the world of technology development to help nurses understand how to become involved in this endeavor. An illustration of a newly developed technology will be used to further clarify the steps. [
Journal of Gerontological Nursing, 39
(10), 16–21.]
When Nurses Lead
Authors: Bonner Alice
Published: August 2014

In Fall 2011, the Centers for Medicare and Medicaid Services (CMS) began a major initiative to improve dementia care in nursing homes. The initial goal was to reduce the prevalence of antipsychotic medication use in long-stay nursing home residents with dementia by 15%. Through a new, public-private collaboration, the National Partnership to Improve Dementia Care established coalitions in every state. After 18 months, a 15.1% reduction was achieved nationally. Throughout the initiative, many nurses played key roles in leading the process for change. This article describes the roles of nurse leaders in this national policy work. [
Journal of Gerontological Nursing, 40
(6), 17–21.]
Ilizarov External Fixator for Stump Salvage in Infected Nonunions
Authors: Onyekwelu Ikemefuna , Hasan Saqib , Chapman Cary B.
Published: August 2014

Infected nonunions are potentially difficult complications to treat in the context of complex tibial fractures. Often, such complications necessitate amputation to prevent further sequelae, such as fulminant sepsis and complete loss of the limb. As such, the eradication of infection, the decision regarding when to amputate, and the length of the residual stump are important factors to optimize patient outcome. The authors present a unique scenario whereby an Ilizarov external fixation device was used to treat an infected tibial nonunion while simultaneously salvaging stump length to enable fitting for a below-knee prostheses. The use of the Ilizarov device can prevent abrupt dissemination of infection, stabilize the fracture, and bridge nonunion gaps. This is augmented by the unique ability of the construct to be periodically readjusted and realigned where needed to permit osteogenesis and proper alignment. The result in this case was complete eradication of infection, with the use of continuous antibiotics as a pharmacological adjunct, union of the tibial fragments, and a below-knee amputation with adequate stump length and prosthetic fit. The success of this treatment strategy was predicated on the above factors, with an emphasis on amputation level and its effect on function. The Ilizarov external fixator is a device that has been widely used to treat limb-length discrepancies, correct deformities, and induce osseous growth in bony nonunion. The authors present the Ilizarov device as a viable option for the treatment of infected tibial nonunions and stump length salvage.
Isolated Subtalar Dislocation
Authors: Byrd Zackary O. , Ebraheim Miranda , Weston John T. , Liu Jiayong , Ebraheim Nabil A.
Published: August 2014

Educational Objectives

As a result of reading this article, physicians should be able to:

1.

Understand the etiology, epidemiology, and importance of treatment of isolated subtalar dislocation.

2.

Understand the most common management practices when treating isolated subtalar dislocation and identify variations in management that may affect prognosis.

3.

Consolidate reported patient outcomes as they pertain to variations in management strategies to explore which practices may provide the best prognosis after treatment of isolated subtalar dislocation.

4.

Highlight the importance of further study to determine the best course of management for isolated subtalar dislocation regarding variables in treatment.

This study reviews the literature on isolated subtalar dislocation published within the past 5 years. Variation in management existed mostly in the categories of treatment choice, immobilizer type, and period of immobilization, with closed reduction, closed reduction and percutaneous pinning, below-knee casting, less than 4 weeks of immobilization, and 6 weeks of immobilization reporting good results. The good results described after the addition of percutaneous K-wire fixation to the initial treatment method of isolated subtalar dislocation, immobilization via below-knee casting, and shorter periods of immobilization suggest that these practices may be useful for the treatment of this rare injury.
Cadaver Training Module for Teaching Thoracic Pedicle Screw Placement to Residents
Authors: Tortolani P. Justin , Moatz Bradley W. , Parks Brent G. , Cunningham Bryan W. , Sefter John , Kretzer Ryan M.
Published: August 2014

Surgical training using simulators has been shown to be highly effective but is not available for some applications and is too expensive for many programs. The authors piloted a cadaver-based module with the goal of objectively measuring and significantly improving orthopedic residents’ surgical skills in placing thoracic pedicle screws, an advanced procedure. An experienced spine surgeon placed thoracic pedicle screws in 7 cadavers (T1–T12) to establish the skilled accuracy rate. For this pilot study, 3 orthopedic residents unfamiliar with the procedure were given didactic training for safe thoracic pedicle screw insertion. Each resident instrumented alternating sides of 5 consecutive cadavers (T1–T12). Screw positions were graded by computed tomography in a blinded fashion, with accuracy defined as no shank breach of the pedicle or vertebral body. Results were reviewed with the residents, instruction was repeated, and alternating sides of 5 cadavers were instrumented by the residents. The experienced surgeon accurately placed 67 (82%) of 82 pedicle screws. Residents accurately placed 80 (44%) of 180 pedicle screws in the initial set of specimens and 105 (58%) of 180 pedicle screws in the second set of specimens (
P
=.01). Accuracy varied significantly among residents before but not after computed tomography review.

The study’s results show that a cadaver-based training module that resembles the clinical setting can be used to teach complex surgical skills to orthopedic residents.
Mechanical Assessment of Local Bone Quality to Predict Failure of Locked Plating in a Proximal Humerus Fracture Model
Authors: Röderer Götz , Brianza Stefano , Schiuma Damiano , Schwyn Ronald , Scola Alexander , Gueorguiev Boyko , Gebhard Florian , Tami Andrea
Published: August 2014

The importance of osteoporosis in proximal humerus fractures is well recognized. However, the local distribution of bone quality in the humeral head may also have a significant effect because it remains unclear in what quality of bone screws of standard implants purchase. The goal of this study was to investigate whether the failure of proximal humerus locked plating can be predicted by the DensiProbe (ARI, Davos, Switzerland). A 2-part fracture with metaphyseal impaction was simulated in 12 fresh-frozen human cadaveric humeri. Using the DensiProbe, local bone quality was determined in the humeral head in the course of 6 proximal screws of a standard locking plate (Philos; Synthes GmbH, Solothurn, Switzerland). Cyclic mechanical testing with increasing axial loading until failure was performed. Bone mineral density (BMD) significantly correlated with cycles until failure.

Head migration significantly increased between 1000 and 2000 loading cycles and significantly correlated with BMD after 3000 cycles. DensiProbe peak torque in all screw positions and their respective mean torque correlated significantly with the BMD values. In 3 positions, the peak torque significantly correlated with cycles to failure; here BMD significantly influenced mechanical stability. The validity of the DensiProbe was proven by the correlation between its peak torque measurements and BMD. The correlation between the peak torque and cycles to failure revealed the potential of the DensiProbe to predict the failure of locked plating in vitro. This method provides information about local bone quality, potentially making it suitable for intraoperative use by allowing the surgeon to take measures to improve stability.
Adductor Tenotomy as a Treatment for Groin Pain in Professional Soccer Players
Authors: Mei-Dan Omer , Lopez Vicente , Carmont Michael R. , MCConkey Mark O. , Steinbacher Gilbert , Alvarez Pedro D. , Cugat Ramon B.
Published: August 2014

Chronic, exercise-related groin pain is a debilitating condition. Nonoperative treatment has limited efficacy, but surgical intervention on the adductor-abdomino complex may be used to alleviate symptoms and allow return to play (RTP). The purpose of this study was to report the outcome of adductor tenotomy and hernioplasty for professional soccer players with groin pain.

Between 2000 and 2006, a total of 155 professional and recreational soccer players with recalcitrant groin pain (with or without lower abdominal pain) and resistance to conservative treatment were included in this retrospective analysis. Ninety-six patients were treated with adductor tenotomy and 59 patients were treated with combined adductor tenotomy and hernioplasty. No difference in pre- or postoperative parameters was detected between groups, apart from abdominal wall muscle defects revealed during ultrasound for patients in the combined group. The RTP time and subjective and objective outcome measures were compared. A combined score was developed to evaluate outcomes that consisted of overall satisfaction (50%), RTP time (15%), and Tegner scores (35%). Mean RTP was 11 weeks (range, 4–36 weeks). Postoperative Tegner score remained 8.2 (same as the preinjury Tegner score). Subjective outcome was rated 4.3 of 5. The combined score indicated 80% of good or excellent results for both groups.

Surgical intervention allows RTP at the same level in professional soccer players following failure of nonoperative treatments. Athletes with adductor syndrome and accompanying sportsman’s hernia may benefit from adductor tenotomy alone.
Treatment of Spinal Fractures in Ankylosing Spondylitis
Authors: Mathews Michael , Bolesta Michael J.
Published: August 2014

Ankylosing spondylitis (AS) is a chronic inflammatory spondyloarthropathy with the potential for progressive spinal stiffness that ultimately makes patients susceptible to spinal fractures with traumatic spinal cord injury from even low-energy trauma. Treatment of patients with AS and spinal fractures (AS+FX) is controversial because, although these patients need especially rigorous stabilization, surgery has been associated with an increased risk of complications and persistent neurological deficits. The purpose of this retrospective case series was to profile patients with AS+FX from a 19-year period within the authors’ county hospital system, including differences of neurological status in patients treated operatively vs nonoperatively.

The study group comprised 11 patients with AS+FX (9 men and 2 women; mean age, 63 years [range, 38–91 years]). The authors reviewed available clinical notes and imaging reports. Six patients had posterior operative fixation, and 5 were stabilized nonoperatively. By the time of either discharge or final follow-up, 3 of the patients treated operatively deteriorated neurologically (2 of them preoperatively) and 3 remained stable. Of the patients treated nonoperatively, 3 remained neurologically intact, 1 deteriorated, and 1 recovered completely. The most common complications in all patients were pneumonia and urinary tract infection. Operative and nonoperative management produced acceptable outcomes in most patients. The authors recommend individualized treatment, accounting for patient preferences and comorbidities.
Extra-abdominal Periosteal Desmoid Tumor of the Third Toe
Authors: Saleem Omar , Sayres Stephanie , O’Malley Martin
Published: August 2014

Extra-abdominal periosteal desmoid tumors are uncommon nonmetastatic tumors of the extremities with a propensity for local recurrence. Lesions in the distal extremities are rare; a majority of extra-abdominal lesions occur in more proximal portions of the upper and lower extremities. This article reports a patient with an extra-abdominal periosteal desmoid tumor in the toe.

A 37-year-old woman had a mass in her left third distal phalanx that was originally noted 3 years prior to presenting to the authors’ institution. She reported the mass expanded during pregnancy. The toe was red and elongated and had expanded to approximately the same size as her great toe. The plantar aspect of the toe was thick and callused, and the toenail was slightly elevated. Marginal excision with retention of the nail was performed without complication. The mass was determined to be an extra-abdominal periosteal desmoid tumor and was successfully removed without recurrence. To date, the patient remains asymptomatic, with no pain and complete sensation in her third toe.

Although extra-abdominal periosteal desmoid tumors have been identified in the extremities, to the authors’ knowledge none have been reported as far distal as the toe. Identifying this lesion in the distal extremity will allow a hasty diagnosis and treatment in future cases of similar presentation. Knowledge of the existence of this type of tumor in the distal extremity may also assist in narrowing differential diagnoses.
Matching Osteochondritis Dissecans Lesions in Identical Twin Brothers
Authors: Richie Lucas B. , Sytsma Mark J.
Published: August 2014

Osteochondritis dissecans is a disorder of unknown etiology that can result in fragmentation of osteochondral surfaces, most commonly of the knee, shoulder, elbow, and ankle. This may lead to sequelae of pain and an inability to participate in desired activities. Multiple theories exist as to the true cause of the disorder, but none have been fully proven. One such proposed etiology is genetic causation.

Familial cases of osteochondritis dissecans are rare, yet these cases offer support to growing evidence that may support a genetic link. This article describes osteochondritis dissecans lesions of the femoral trochlea in monozygotic (identical) twins. Both twins presented with similar symptoms 1 year apart. Neither twin had any clear inciting trauma. Magnetic resonance imaging revealed osteochondral lesions in similar positions of the lateral trochlear of the same knee in both brothers. Osteochondral autograft transfer and tibial tubercle anteromedialization were performed on both patients. An identical postoperative protocol was followed, and recovery with full return to sport was comparable for the brothers. To the authors’ knowledge, only 1 other case report exists of osteochondritis dissecans lesions in monozygotic twins.

Although debate continues regarding the true etiology of this disorder, cases of identical twins presenting with a similar disease process are highly suggestive of a genetic component and may lead to early identification and treatment of these lesions. Continued research in the area of osteochondritis dissecans and its genetic basis is needed to completely understand this disorder.
Resection of Soft Tissue Tumors Extending Through the Obturator Ring
Authors: Starks Alexandria , Guo Lifei , Abraham John A.
Published: August 2014

Pelvic soft tissue sarcomas are rare tumors often presenting larger than other soft tissue sarcomas and can extend into the thigh through various anatomic routes. Surgical resection is the main modality of curative treatment. En bloc tumor excision with wide, negative margins may reduce the risk of local recurrence. Soft tissue sarcomas extending through the obturator foramen create unique challenges to operative management.

This case report describes 2 cases of lipomatous lesions that extend through the obturator foramen, presenting as dumbbell-shaped lesions with large intra- and extrapelvis portions. One possible surgical approach performed in both patients is detailed with long-term follow-up. Postoperatively, 1 incidence of infection was reported. Functional outcomes were acceptable, with full restoration of ambulation without assistive devices in both cases and no hernia observed. Oncologic outcomes included locoregional recurrence in 1 patient at 24 months outside the radiation field.

The ideal primary treatment for all localized soft tissue sarcomas, including those extending through the obturator foramen, is resection. However, the unique subgroup of obturator ring soft tissue sarcomas has undefined outcomes and complications. The authors’ goal was to achieve en bloc resection with wide negative margins while preserving ipsilateral limb function. The surgical approach described in this case study offers a description of feasibility and discussion of theoretical and observed complications.
Short Stem Option for Total Hip Arthroplasty With Retained Hardware
Authors: Mont Michael A. , Pivec Robert , Issa Kimona , Harwin Steven F.
Published: August 2014

The presence of retained femoral hardware, usually as a consequence of prior orthopedic trauma, has been classically presented as something that must be removed prior to total hip arthroplasty. However, hardware removal is not without risks, including pain, creation of stress risers, and refracture. The authors report a patient with a retained retrograde femoral nail who underwent total hip arthroplasty with a short, neck-preserving femoral stem used to avoid the need for hardware removal. Clinical results at short-term follow-up have been excellent. In the setting of retained hardware, the use of short stems may be a viable treatment option for a well-selected subgroup of patients who require total hip arthroplasty and when the surgeon cannot use standard implants.
Osteoid Osteoma
Authors: Boscainos Petros J. , Cousins Gerard R. , Kulshreshtha Rajiv , Oliver T. Barry , Papagelopoulos Panayiotis J.
Published: August 2014

Educational Objectives

As a result of reading this article, physicians should be able to:

1.

Discuss the clinical presentation of and different imaging modality options for suspected osteoid osteomas.

2.

Develop an insight into the histopathology and histochemistry of osteoid osteomas.

3.

Use diagnostic processes in the differential diagnosis of suspected osteoid osteomas.

4.

Apply current treatment depending on the location and accessibility of the lesion.

Osteoid osteoma is the third most common benign bone tumor. The authors describe the clinical presentation, diagnostic investigations, differential diagnosis, histopathology, and treatment options for this condition, including a comprehensive review of the literature. Osteoid osteomas have wide variations in presentation and tend to present in the second decade of life, with pain that is worse at night and is relieved by salicylates. Plain radiographs and computed tomography scans are the mainstay of imaging; however, bone scintigraphy, single-photon emission computed tomography, magnetic resonance imaging, and sonography are also used. Osteoid osteomas consist of a nidus with surrounding sclerotic bone. The differential diagnosis covers a wide range of conditions due to the variable presentation of osteoid osteoma. The natural history is for regression to occur within 6 to 15 years with no treatment; however, this can be reduced to 2 to 3 years with the use of aspirin and non-steroidal anti-inflammatory drugs. Computed tomography–guided percutaneous techniques, including trephine excision, cryoablation, radiofrequency ablation, and laser thermocoagulation, are described.
Bibliometric Analysis of the Orthopedic Literature
Authors: Hui Zhaoyang , Yi Zhongmei , Peng Jun
Published: August 2014

Bibliometric indicators are used to assess research performance. The goal of this study was to explore publication output to construct a picture of orthopedics that may be beneficial to researchers and orthopedic specialists. All orthopedics articles published in 61 journals from 2000 to 2011 were retrieved from the Science Citation Index Expanded database. The numbers of articles, citations, authors, institutions, and journals were analyzed and subjected to quantitative and qualitative comparisons. The number of published orthopedics articles increased between 2000 and 2011. Articles published by authors from the United States always ranked first in number, although the United States’ share is decreasing in the world literature. Authors from the United States published the most-cited articles and the most articles in journals with top-10 impact factors; moreover, the United States also had the greatest share of experts and highly ranked institutions. The United Kingdom, Germany, and Japan were always within the world’s top 4 in terms of numbers of articles and citations. The shares of Germany, South Korea, and China among total orthopedics articles increased, especially that of China. In 2011, China ranked the fifth in the world, with its world share increasing from 0.64% in 2000 to 5.05% in 2011. However, China lags behind in average citations per article, top research institutions, and most prolific authors. According to the total citations per article, the University of Pittsburgh, Harvard University, and the Hospital for Special Surgery were the most prolific institutions.
Comparison of Clinical Results After Pisiformectomy in Patients With Rheumatic Versus Posttraumatic Osteoarthritis
Authors: Lautenbach Martin , Eisenschenk Andreas , Langner Inga , Arntz Ulrike , Millrose Michael
Published: August 2014

Pisotriquetral osteoarthritis is important to consider in the differential diagnosis of chronic ulnar-sided wrist pain. It can develop following traumatic injury to the pisiform or in rheumatic diseases, such as rheumatoid arthritis or psoriatic arthritis. It has been shown that pisiformectomy can relieve symptoms in cases that have not responded to nonoperative treatment, and the excision does not compromise the function or strength of the wrist. Most studies focus on posttraumatic causes of pisotriquetral osteoarthritis. In the current study, rheumatic causes are also considered and the outcomes are compared.

This retrospective study included 35 patients who underwent pisiformectomy for pisotriquetral osteoarthritis. All patients underwent a thorough diagnostic evaluation to exclude other etiologies for ulnar-sided wrist pain. Radiological examinations including posteroanterior and lateral views of the wrist and a tangential view of the pisotriquetral joint were analyzed. All patients had excellent or very good results after pisiformectomy, with a significant reduction in pain. No significant difference was found in the outcomes for patients with rheumatic vs posttraumatic osteoarthritis.

Patients with rheumatic causes of pisotriquetral osteoarthritis can be successfully treated with pisiformectomy. With respect to idiopathic causes, these patients need a longer postoperative period to gain full pain relief. It is important to consider the possibility of pisotriquetral osteoarthritis after excluding other diagnoses in patients with rheumatic osteoarthritis.
Incidence of Syndesmotic Injury
Authors: Vosseller J. Turner , Karl John W. , Greisberg Justin K.
Published: August 2014

Injury to the tibiofibular syndesmosis can occur with ankle sprain or fracture. The incidence of syndesmotic injury has not been specifically studied at a population level. Data on syndesmotic injury were obtained from the Healthcare Cost and Utilization Project (HCUP), a federal-state-private partnership. It is administered by the Agency for Healthcare Research and Quality, a division of the US Department of Health and Human Services. Two HCUP databases were queried for 8 states: the State Inpatient Database and the State Emergency Department Database. The first 6 International Classification of Diseases, Ninth Edition (ICD-9) code diagnoses were searched for codes that are used for syndesmotic injury (ie, 845.03). These data, along with data from the 2010 US census, were used to yield incidence rates for syndesmosis injury, as well as for various demographic groups. National estimates of injury totals were also calculated. In the 8 states, there were a total of 1821 syndesmotic injuries. Given the population of these states, the incidence rate of syndesmotic injury was 2.09 syndesmotic injuries per 100,000 person-years. This incidence correlates to an estimated 6445 syndesmotic injuries per year in the United States. These data provide some baseline numbers as to the incidence of syndesmotic injury in the United States. Although the incidence was low relative to some other injuries, the fact that syndesmotic injuries tend to occur in younger patients may have a greater effect in terms of productive years of life lost.