bluuebunny/crossref_metadata_2025 huggingface dataset:
Torsional Properties of Distal Femoral Cortical Defects
Authors: Amanatullah Derek F. , Williams Joel C. , Fyhrie David P. , Tamurian Robert M.
Published: August 2014

The optimal management of pathologic long bone lesions remains a challenge in orthopedic surgery. The goal of the current study was to investigate the effect of defect depth on the torsional properties of the distal femur. A laterally placed distal metaphyseal cylindrical defect was milled in the cortex of the distal femur in 20 composite models. The proximal extent of the defects was constant. By decreasing the radius of the cylinder that intersected this predefined cord, 4 different radii defining 4 different depths of resection of the distal femur were created for testing: 17%, 33%, 50%, and 67% cortical defects, when normalized to the width of the femur at the level of resection. Each femur was mounted into a hydraulic axial/torsion materials testing machine and each specimen underwent torsional stiffness testing and torsional failure in external rotation. The specimens with less than a 33% cortical loss consistently demonstrated a superiorly oriented spiral fracture pattern, while the specimens with greater than a 50% cortical loss consistently demonstrated an inferiorly oriented transverse fracture pattern. The cortical defects were all statistically (
P
<.05) less stiff in torsion as the defect grew larger. There was a strong linear correlation between the mean torsional stiffness and cortical defect size (
r
2
=0.977). This observation is supported by finite element analysis. The amount of femur remaining is crucial to stability. This biomechanical analysis predicts a critical loss of torsional integrity when a cortical defect approaches 50% of the width of the femur. [
Orthopedics.
2014; 37(3):158–162]
Biologic Augmentation of Foot and Ankle Arthrodeses With an Allogeneic Cancellous Sponge
Authors: Protzman Nicole M. , Galli Melissa M. , Bleazey Scott T. , Brigido Stephen A.
Published: August 2014

This case series was conducted to assess the safety and efficacy of using an allogeneic cancellous bone sponge for augmentation of foot and ankle arthrodeses. Twenty-five patients were prospectively enrolled in the study prior to undergoing fusion and were then followed for 12 months postoperatively. There were 45 joints: 7 ankles, 12 subtalars, 12 talonaviculars, 6 calcaneocuboids, 1 naviculocuneiform, 6 first tarsometatarsals, and 1 second tarsometatarsal. Patient-reported outcomes of pain (visual analog scale) and function (American Orthopaedic Foot and Ankle Society score) were obtained preoperatively and postoperatively at 6 and 12 months. No complications were noted intraoperatively or during the follow-up period. Three months postoperatively, radiographic osseous union was noted in 52% (13/25) of patients, which further increased to 96% (24/25) of patients at 6 and 12 months. There was no statistically significant difference in union time between joints [H(6)=11.5;
P
=.08]. Statistically significant improvements in pain (
P
≤.002) and function (
P
<.001) were observed across assessments. This study demonstrated that the cancellous bone sponge appears to be a safe and efficacious product. Randomized controlled trials are warranted to determine if the allogeneic cancellous sponge improves fusion rate, pain, and function.
Safety of Bilateral Total Knee Arthroplasty in Morbidly Obese Patients
Authors: Madsen Adam A. , Taylor Benjamin C. , Dimitris Craig , Hansen Dane C. , Steensen Robert A. , Gaines Stephen T.
Published: August 2014

There has been an increase in the prevalence of morbid obesity and the demand for total knee arthroplasty (TKA). Physicians must help patients with bilateral knee arthritis to make informed decisions regarding whether to undergo staged, sequential, or simultaneous TKA. The purpose of this study was to evaluate the perioperative complications of 2-team simultaneous bilateral TKA in the morbidly obese. The authors performed a retrospective review of the records at a single tertiary hospital from 1997 to 2007 and identified 35 morbidly obese (body mass index [BMI] greater than 40 kg/m
2
) patients who had undergone unilateral TKA, as well as 42 morbidly obese and 79 nonobese (BMI less than 30 kg/m
2
) patients who underwent simultaneous bilateral TKA. Clinical, operative, and postoperative variables and complication rates were recorded. Clinical variables were similar between the morbidly obese TKA patients. The bilateral group had significantly increased operative times (132.4 vs 115.5 minutes;
P
<.01), intravenous fluids (2556.1 vs 2114.7 mL;
P
=.03), percentage transfused (64.2% vs 11.4%;
P
<.01), days in the hospital (3.6 vs 3.2 days;
P
=.03), and discharge rates to rehabilitation facility (72.7% vs 48.6%;
P
=.01). Major and minor complications were few and comparable, with the need for manipulation under anesthesia in unilateral TKA (11.4%;
P
=.04) as the only significant difference between groups, including when comparing bilateral nonobese TKAs with bilateral morbidly obese TKAs. The authors feel that morbidly obese patients may undergo 2-team simultaneous bilateral TKA after careful discussion regarding some of the differences in short-term outcomes.
Civilian Gunshot Injuries of the Humerus
Authors: Vaidya Rahul , Sethi Anil , Oliphant Bryant W. , Gibson Victor , Sethi Sajiv , Meehan Robert
Published: August 2014

An institutional review board-approved retrospective study was performed at a level 1 trauma center to evaluate the adequacy of current treatment guidelines in the management of humerus fractures following civilian gunshot injuries. Fifty-four patients with a humerus shaft fracture from a low-velocity gunshot wound were included in the study. Twenty-nine patients were treated nonoperatively, while 25 patients had operative treatment, with 14 undergoing plate fixation, 6 having application of an external fixator, 3 receiving an intramedullary rod, and 2 having irrigation and debridement with fracture immobilization provided by a brace. Patient demographics and injury data, radiographic analyses, and treatment complications were recorded. Healing of soft tissue and bony injuries, including fracture alignment in patients treated nonoperatively, was also evaluated. Fifty-two of 54 patients had minor soft tissue damage and were treated successfully with minimal local wound care. Two patients with larger wounds required extended wound care with repeated irrigation and debridement. Overall, 47 of 54 fractures healed with the primary mode of treatment, and 7 patients went on to nonunion requiring further intervention. Of the patients treated nonoperatively, the average deformity was 16.5°±7.4° in the coronal plane and 4.4°±4.0° in the sagittal plane. This study supports the view that the majority of humerus fractures following civilian gunshot wounds may be treated nonoperatively, with a select group of patients requiring surgical stabilization.
Intra-articular Nodular Fasciitis of the Knee in a Pediatric Patient
Authors: Gans Itai , Morrison Martin J. , Chikwava Kudakwashe R. , Wells Lawrence
Published: August 2014

The differential diagnosis for an intra-articular lesion in the knee of a pediatric patient is broad. Diagnostic considerations include pigmented villonodular synovitis (PVNS)—the most common intra-articular tumor—and a variety of both benign and malignant tumors, including lipomas, hemangiopericytomas, nodular fasciitis, parosteal osteosarcomas, and fibromyxoid sarcomas. If there is concern over possible malignant lesions, a tumor surgeon should be consulted. Precise pathologic diagnosis is ideal for identifying these enigmatic lesions and for determining the appropriate treatment plan. This article presents the case of a 13-year-old boy who presented with 1-month duration of knee pain and no history of trauma to the extremity. Physical examination revealed pain along the medial and lateral joint lines, pain with range of motion, and limited range of motion of the affected knee. Magnetic resonance imaging revealed a 3×1×3-cm lesion in the posterolateral corner that was believed to be localized PVNS. Arthroscopically, there was no evidence of PVNS, but a posterolateral soft tissue mass was found and removed, which was pathologically diagnosed as a rare, benign, intra-articular nodular fasciitis. When working with intra-articular masses, it is important to assess the likelihood of malignancy and to both consult a tumor surgeon and use the appropriate surgical tumor principles when malignancy is a concern. Additionally, the pathology team should be consulted prior to surgery and be on standby during arthroscopic evaluation of the knee to help with precise diagnosis of the intra-articular mass. Discussing the case with the pathologist with imaging studies present is helpful and often aids in the diagnosis of the lesion.
Tactile Surgical Navigation System for Complex Acetabular Fracture Surgery
Authors: Niikura Takahiro , Sugimoto Maki , Lee Sang Yang , Sakai Yoshitada , Nishida Kotaro , Kuroda Ryosuke , Kurosaka Masahiro
Published: August 2014

The authors describe a tactile surgical navigation system using custom 3-dimensional (3D) models of the bony pelvis for complex acetabular fracture surgery. The bone area of interest was extracted from the Digital Imaging and Communications in Medicine (DICOM) data of computed tomography scans. A standard triangulated language file was used to create 3D models of the bony pelvis by layered manufacturing using a 3D printer and non-cytotoxic, sterilizable, acrylic-based photopolymers. No infections and no toxic or other adverse events were observed. The models were useful for preoperative assessment, planning, and simulation; intraoperative assessment; obtaining informed consent; and education. [
Orthopedics
. 2014; 37(4):237–242.]
Percutaneous Femoral Derotational Osteotomy for Excessive Femoral Torsion
Authors: Mei-Dan Omer , McConkey Mark O. , Bravman Jonathan T. , Young David A. , Pascual-Garrido Cecilia
Published: August 2014

Femoral derotational osteotomy is an acceptable treatment for excessive femoral torsion. The described procedure is a minimally invasive single-incision technique based on an intramedullary saw that enables an inside-out osteotomy, preserving the periosteum and biological activity in the local bone and soft tissue. After the osteotomy is complete and correction is achieved, an expandable intramedullary nail is used to achieve immediate stability, without the need for locking screws. Indications, tips, and pitfalls related to this novel osteotomy technique are discussed. [
Orthopedics.
2014; 37(4):243–249.]
Current Indications for and the Technique of Wrist Arthroscopy
Authors: Wagner Jennifer , Ipaktchi Kyros , Livermore Meryl , Banegas Rodrigo
Published: August 2014

Since its introduction more than 30 years ago, wrist arthroscopy has become an essential diagnostic and therapeutic tool in hand surgery. This procedure minimizes exposures and allows access to otherwise remotely located anatomic regions with minimal morbidity. Advances in anatomic understanding and wrist scope technology have standardized the procedure and expanded indications. Current applications are diagnostic staging of various wrist pathologies where arthroscopy allows for a direct, magnified, and tactile-assisted examination. This includes injuries to the triangular fibrocartilage complex (TFCC), osteochondral lesion of the carpus, and dynamic assessment of carpal instability and radiocarpal arthritis. Therapeutic applications have continued to expand and include arthroscopic-assisted fracture reductions, treatment of radiocarpal synovitis and arthritis, TFCC repairs, and arthroscopic management of soft tissue pathologies such as ganglion excisions and release of contractures. [
Orthopedics.
2014; 37(4):251–256.]
Effect of Chondral Defect Size, Shape, and Location on MRI Diagnostic Performance in the Porcine Knee
Authors: Flanigan David C. , Harris Joshua D. , Jia Guang , Choi Seongjin , Siston Robert A. , Randazzo John L. , Knopp Michael
Published: August 2014

The purpose of this study was to determine the sensitivity and positive predictive value of magnetic resonance imaging (MRI) in the identification of full-thickness articular cartilage defects in the porcine knee. Seventy-two full-thickness chondral defects (small or large; circular, oval, or triangular) were created in 12 porcine knees. The authors used 3.0-T MRI with 3-dimensional gradient echo water-selective/fluid (WATSf) sequences acquired in axial, coronal, and sagittal planes. Sensitivity and positive predictive value parameters were calculated for 2 readers. Magnetic resonance imaging was highly sensitive for detection of full-thickness defects in the knee (85%). The highest sensitivity was observed at the medial femoral condyle (93%), while the lowest was observed at the medial patella (71%). The sensitivities for detecting different shapes were unique to each shape, with oval lesions identified with greatest sensitivity (93%). Small lesions (86%) were detected at a similar sensitivity as large lesions (83%). The positive predictive values for accurate true-positive reads were low for all lesion shapes (18%–57%) and moderate for small (69%) and large (59%) sizes, with significant differences observed between the 2 readers. Magnetic resonance imaging has a high sensitivity in the detection of full-thickness articular cartilage defects in the porcine knee. Variability in defect shape and intra-articular location affects MRI sensitivity, while size does not. Magnetic resonance imaging was not effective in describing lesion shape or size. Further, there was subjectivity in reading defect shape and size between 2 radiologists.
A Meta-analysis of Reamed Versus Unreamed Intramedullary Nailing for the Treatment of Closed Tibial Fractures
Authors: Xia Liheng , Zhou Jian , Zhang Yongtao , Mei Gang , Jin Dan
Published: August 2014

Controversy exists regarding the clinical outcomes of reamed vs unreamed intramedullary nailing in the treatment of closed tibial fractures. This study assessed the effects of reamed vs unreamed intramedullary nailing for closed tibial fractures. The authors searched PubMed, EMBASE, BIOSIS, and the Cochrane Controlled Trials Register for randomized and quasi-randomized controlled clinical trials from January 1980 to June 2012 comparing reamed with unreamed intramedullary nailing for closed tibial fracture in adults. Primary outcomes were nonunion, delayed union, malunion, secondary procedure, failure of implants, compartment syndrome, infection, and knee pain. Eight randomized and 1 quasi-randomized clinical trials (1229 fractures) were included. No statistically significant differences were found between reamed and unreamed nailing groups in delayed union (
P
=.20), malunion (
P
=.28), infection (
P
=.36), compartment syndrome (
P
=.36), and knee pain (
P
=.93). The unreamed group had a higher rate of fracture nonunion than the reamed group (
P
=.02). The subgroup analysis of implant failures (broken screws vs broken nails) indicated that reamed nailing significantly reduced the risk of screw breakage (
P
<.001); however, there was no significant difference between reamed and unreamed intramedullary nailing in nail breakage (
P
=.94). The subgroup analysis of a secondary procedure showed that the reamed intramedullary nailing resulted in significantly lower risks of implant exchange (
P
=.01) and dynamization (
P
=.04); however, there was no significant difference in bone grafting rate (
P
=.73). Evidence comparing reamed with unreamed intramedullary nailing for closed tibial fractures indicates that reamed intramedullary nailing may lead to significantly lower risks of nonunion, screw failure, implant exchange, and dynamization without increasing operative complications.
Complications and Technical Pitfalls of Titanium Elastic Nail Fixation for Midclavicular Fractures
Authors: Lu Cheng-Chang , Liu Ping-Cheng , Huang Shih-Hao , Hsieh Chih-Hsin , Tien Yin-Chun , Chien Song-Hsiung
Published: August 2014

Intramedullary titanium elastic nails have been reported to fix displaced midclavicular fractures with excellent functional outcomes and minor complications. This study reports and analyzes the complications and technical pitfalls associated with titanium elastic nail fixation of displaced midclavicular fractures and describes how to prevent these problems. The authors operated on 27 patients (17 men, 10 women; mean age, 45.8 years; range, 16.5–66.9 years) with marked displaced midclavicular fractures using intramedullary titanium elastic nail fixation. The mean Constant score and Disability of the Arm, Shoulder, and Hand score were 93.58 (range, 66.5–100) and 6.22 (range, 0–35), respectively. The mean length difference compared with the contralateral clavicle was a shortening of 0.3 cm (range, −1.5 to 1 cm). Eight patients (30%) had different levels of difficulty at the medial entry point. Clavicular length shortening of more than 1 cm occurred in 5 patients (19%), and all of these patients experienced medial nail tip prominence/protrusion. One patient had 1-cm lengthening of the injured clavicle caused by distraction of the fracture site during titanium elastic nail insertion. Iatrogenic perforation of the posterolateral cortex occurred in 3 patients. Initial misplaced nail insertion occurred in 1 woman who underwent revision with the mini-open method. In 2 patients it was impossible to remove the full nail under general anesthesia. In conclusion, high patient satisfaction and functional outcomes were achieved after titanium elastic nail fixation of displaced midclavicular fractures. However, some complications and technical pitfalls must be considered before titanium elastic nails are used to fix displaced midclavicular fractures.
Total Hip Arthroplasty With Acetabular Fixation: An Unexpected Complication
Authors: Khoriati Al-Achraf
Published: August 2014

The incidence of vascular injuries associated with total hip arthroplasty (THA) is low. However, several vascular structures are at risk of injury within the pelvis. These include the external iliac, femoral, and obturator vessels. Both reaming of the acetabulum and drilling of the acetabular screw holes may place these structures at risk. If left untreated, injuries to these vessels may be associated with severe morbidity and mortality. In this report, an acute vascular complication that had an unusual presentation is highlighted. A 72-year-old woman presented to the emergency department following a road traffic accident in which she sustained a combined fracture of the right acetabulum and femoral head. Her treatment involved a combination of THA and pelvic open reduction and internal fixation. The immediate perioperative recovery period was uncomplicated. However, the patient developed a deep venous thrombus in her right calf 7 days after surgery. Further investigation revealed a second thrombus, occluding the right common femoral vein. Surgical exploration revealed that a screw placed during the initial surgery was pressing against the vessel and occluding it. The discrepancy in incidence between the development of deep venous thrombosis and vascular compression or injury means that the association between the 2 events is unlikely to be made. The author highlights this unusual presentation to improve early recognition and prompt management of similar cases. The importance of adequate preoperative planning and intraoperative imaging with a C-arm is also stressed.
Elbow Arthrodesis: A Novel Technique and Review of the Literature
Authors: Kovack Thomas J. , Jacob Paul B. , Mighell Mark A.
Published: August 2014

The elbow is a complex joint that is the mechanical link in the upper extremity between the hand and the shoulder. Loss of elbow function can severely affect activities of daily living. Arthrodesis of the elbow results in greater functional disability than arthrodesis of the ankle, hip, or knee joints. Arthrodesis is mainly performed for severe joint destruction most commonly due to posttraumatic arthrosis, instability, or infection. The authors describe a new technique of elbow arthrodesis using a step-cut osteotomy that has not been previously reported. They believe that this can increase the surface area for healing with the outcome of a higher fusion rate. It is most important, however, to achieve good compression with lag screws across the fusion site after the desired angled has been achieved. Elbow arthrodesis is not a common orthopedic procedure, but the authors believe that their novel technique provides a reproducible and reliable way to achieve a high fusion rate and desired fusion angle. [
Orthopedics.
2014; 37(5):313–319.]
Operative Versus Nonoperative Treatment in Complex Proximal Humeral Fractures
Authors: Mao Zhi , Zhang Lihai , Zhang Licheng , Zeng Xiantao , Chen Shuo , Liu Daohong , Zhou Zhirui , Tang Peifu
Published: August 2014

This updated meta-analysis investigated whether operative treatment is superior to nonoperative treatment in complex proximal humeral fractures. The authors searched the Cochrane Central Register of Controlled Trials, PubMed, and EMBASE. Randomized controlled trials that evaluated operative vs nonoperative treatment for exclusively 3- or 4-part proximal humeral fractures were considered. Six studies with a total of 287 patients who had proximal humeral fractures were included. According to the meta-analysis, no statistically significant differences were found between operative and nonoperative treatment in Constant-Murley shoulder scores (Constant scores); Disabilities of the Arm, Shoulder, and Hand scores; total complication events; mortality; infection; nonunion; avascular necrosis; osteoarthritis; redisplacement of fractures; or dislocation or resorption of tuberosity. For health-related quality of life, EuroQol-5D (EQ-5D) favored operative treatment, but 15D scores showed no significant difference. Compared with nonoperative treatment, open reduction and internal fixation required significantly more additional surgeries (risk ratio, 6.50; 95% confidence interval, 1.54–27.50;
P
=.01), and more penetrations into joint space occurred (risk ratio, 9.56; 95% confidence interval, 2.27–40.13;
P
=.002). The limited evidence suggests that no convincing findings support the use of either open reduction and internal fixation or hemiarthroplasty for the treatment of complex proximal humeral fractures. The findings of the current study should be interpreted cautiously because of the modest sample size and the short follow-up period.
Posterior Iliac Crescent Fracture-dislocation: Is It Only Rotationally Unstable?
Authors: Zong Zhaowen , Chen Sixu , Jia Min , Shen Yue , Hua Xiang , Liu Daocheng
Published: August 2014

Posterior iliac crescent fracture-dislocation is generally considered rotationally unstable and vertically stable. The current study (1) investigated whether vertical instability may occur in posterior iliac crescent fracture-dislocation and (2) analyzed the clinical features of vertically unstable iliac crescent fracture-dislocation as well as treatment strategies. Patients with pelvic fracture who were treated in the authors’ department from June 2009 to June 2012 were retrospectively reviewed. This study analyzed the clinical features, including incidence, hemodynamic state, associated injuries, injury severity score, and treatment methods for vertically unstable iliac crescent fracture-dislocation. Four patients had vertically unstable fracture-dislocation, accounting for 12.9% of all iliac crescent fracture-dislocations. All 4 patients were hemodynamically unstable on admission and had complications of associated injuries with a higher injury severity score. In 3 of the 4 patients, iliac crescent fracture-dislocations were reduced via the posterior approach at the initial stage and these patients underwent fixation with a plate. The remaining patient was initially given transcondylar traction because of severe complications and underwent open reduction and internal fixation (ORIF) via a posterior approach at a later stage. The outcomes of all 4 patients were rated as good or excellent by the Kobbe rating system at the last follow-up. Vertical instability may occur in iliac crescent fracture-dislocation. The authors propose ORIF of the fracture-dislocation via a posterior approach. When initial surgery is not possible because of severe associated organ injuries, the authors propose transcondylar traction to allow reduction of the sacroiliac joint and ORIF at a later stage.
Use of a Bipolar Sealer in Total Hip Arthroplasty: Medical Resource Use and Costs Using a Hospital Administrative Database
Authors: Ackerman Stacey J. , Tapia Crisanta I. , Baik Rebecca , Pivec Robert , Mont Michael A.
Published: August 2014

Perioperative blood loss during total hip arthroplasty (THA) increases patient morbidity, length of stay (LOS), medical resource use (MRU), and costs. Minimizing blood loss may reduce postoperative anemia, the need for blood transfusions, and the increased risk of infections and longer hospital stays associated with blood transfusions. Pharmacologic agents and bipolar sealer devices can minimize perioperative bleeding. A retrospective, comparative cohort study in the US hospital setting was conducted to assess MRU and associated costs and the incidence of transfusion and complications among patients undergoing THA with or without the use of a bipolar sealer. Using a nationwide all-payer hospital administrative database, THA procedures from January 1, 2008, to March 31, 2011, were identified using International Classification of Diseases, Ninth Revision, Clinical Modification procedure code 81.51. The bipolar sealer cohort (n=2683) and matched control cohort (n=2683) had a mean age of 65 years from 38 hospitals. The 2 groups had similar incidences of pre-operative anemia and medical comorbidities. Patients in the bipolar sealer group required significantly fewer blood transfusions (21.3% vs 23.8%;P=.0286) and had significantly lower incidence of hematomas (0.2% vs 0.9%;P=.0015) and significantly shorter LOS (2.90 vs 3.31 days;P<.0001) overall. The bipolar sealer group had higher supply costs, which were offset by reduced hospital inpatient room and board and operating room costs; there was no significant difference in total hospital costs between the 2 groups ($18,937 vs $18,734;P=.56). A bipolar sealer decreases postoperative blood transfusions and LOS during primary THA without increasing total hospital costs.
Arthroscopic Treatment of Femoral Nerve Paresthesia Caused by an Acetabular Paralabral Cyst
Authors: Kanauchi Taira , Suganuma Jun , MochizuKi Ryuta , Uchikawa Shinichi
Published: August 2014

This report describes a rare case of femoral nerve paresthesia caused by an acetabular paralabral cyst of the hip joint. A 68-year-old woman presented with a 6-month history of right hip pain and paresthesia along the anterior thigh and radiating down to the anterior aspect of the knee. Radiography showed osteoarthritis with a narrowed joint space in the right hip joint. Magnetic resonance imaging showed a cyst with low T1- and high T2-weighted signal intensity arising from a labral tear at the anterior aspect of the acetabulum. The cyst was connected to the joint space and displaced the femoral nerve to the anteromedial side. The lesion was diagnosed as an acetabular paralabral cyst causing femoral neuropathy. Because the main symptom was femoral nerve paresthesia and the patient desired a less invasive procedure, arthroscopic labral repair was performed to stop synovial fluid flow to the paralabral cyst that was causing the femoral nerve paresthesia. After surgery, the cyst and femoral nerve paresthesia disappeared. At the 18-month follow-up, the patient had no recurrence. There have been several reports of neurovascular compression caused by the cyst around the hip joint. To the authors’ knowledge, only 3 cases of acetabular paralabral cysts causing sciatica have been reported. The current patient appears to represent a rare case of an acetabular paralabral cyst causing femoral nerve paresthesia. The authors suggest that arthroscopic labral repair for an acetabular paralabral cyst causing neuropathy can be an option for patients who desire a less invasive procedure.
A Review of Teaching–Learning Strategies to Be Used With Film for Prelicensure Students
Authors: Oh Jina , De Gagné Jennie Chang , Kang Jeongae
Published: August 2014

The use of film in nursing and medical education has been supported as an effective instructional method. The purpose of this article is to identify and synthesize the available studies on teaching–learning strategies to be used with film for prelicensure students. Electronic databases were searched to identify studies published in the English language between January 1990 and March 2012. Twenty-seven articles met the selection criteria for this review and were analyzed. After in-depth discussion about and investigation of the relevant literature, we narrowed down three teaching–learning strategies: reflective activities, practical activities, and evaluative activities. The synthesis of the identified teaching–learning strategies provides a data point for the development of more effective evidence-based learning activities for prelicensure students. Future studies should focus on the examination of teaching effectiveness and learning outcomes, as well as the evaluation of using film, to achieve nursing competencies appropriate to role preparation.
Nursing and Health Sciences Workforce Diversity Research Using PhotoVoice: A College and High School Student Participatory Project
Authors: Benavides-Vaello Sandra , Katz Janet R. , Peterson Jeffery Chaichana , Allen Carol B. , Paul Robbie , Charette-Bluff Andrea Lelana , Morris Phyllis
Published: August 2014

This participatory study used PhotoVoice and qualitative description to (a) mentor baccalaureate nursing and college students in workforce diversity research; (b) explore barriers and facilitators encountered by rural American Indian, Hispanic, and other high school students when attending college and pursuing careers in nursing or the health sciences; and (c) model a process of social action to help existing and future students. Baccalaureate nursing and graduate students participated in all stages of research, including dissemination. Five themes emerged from analysis of PhotoVoice data: (a) being afraid; (b) believing; (c) taking small steps; (d) facing fears; and (e) using support systems. Findings underscore the importance of helping students participate in efforts to increase work-force diversity through research. Increasing nursing and health sciences workforce diversity may require strategies developed within and tailored to specific cultures and communities. [
J Nurs Educ.
2014;53(4):217–222.]
Perspectives on Statistics Education: Observations From Statistical Consulting in an Academic Nursing Environment
Authors: Hayat Matthew J. , Schmiege Sarah J. , Cook Paul F.
Published: August 2014

Statistics knowledge is essential for understanding the nursing and health care literature, as well as for applying rigorous science in nursing research. Statistical consultants providing services to faculty and students in an academic nursing program have the opportunity to identify gaps and challenges in statistics education for nursing students. This information may be useful to curriculum committees and statistics educators. This article aims to provide perspective on statistics education stemming from the experiences of three experienced statistics educators who regularly collaborate and consult with nurse investigators. The authors share their knowledge and express their views about data management, data screening and manipulation, statistical software, types of scientific investigation, and advanced statistical topics not covered in the usual coursework. The suggestions provided promote a call for data to study these topics. Relevant data about statistics education can assist educators in developing comprehensive statistics coursework for nursing students. [J Nurs Educ.2014;53(4):185–191.]
Early Entry to a Doctoral Degree in Nursing Program: Analysis of Student Experiences
Authors: Nehls Nadine , Rice Elizabeth
Published: August 2014

Educational innovations that encourage younger students to pursue doctoral research training are timely and important. To this end, an evaluation of an early-entry doctoral (PhD) program in nursing was conducted. One component of this evaluation examines qualitative data from students admitted to the PhD program as undergraduates or immediately upon graduation from the undergraduate program. The evaluation included all students (
N
= 29) admitted over a 10-year period, from 2002 to 2011. Eighty-three percent of this population agreed to participate. Transcriptions of individual interviews were analyzed using a qualitative descriptive method. The results are categorized into three general areas: decision making about becoming a nurse and a PhD student, facilitators of admission to and progression in an early-entry PhD program, and the challenges of being an early-entry PhD student. The findings provide the data necessary to guide revisions of existing programs and stimulate the development of new early-entry PhD programs. [
J Nurs Educ.
2014;53(4):223–228.]
Role Modeling Clinical Judgment for an Unfolding Older Adult Simulation
Authors: Lasater Kathie , Johnson Elizabeth A. , Ravert Patricia , Rink Doris
Published: August 2014

Nurse educators must foster development of clinical judgment in students to help them provide the best care for the increasing population of older adult patients. This article reports qualitative findings from a mixed-methods study that focused on clinical judgment in the simulated perioperative care of an older adult. The sample was composed of treatment and control groups of prelicensure students (
N
= 275) at five sites. The treatment group watched a video of an expert nurse role model caring for a patient similar to the simulation patient, whereas the control group did not watch the video. Four weeks after simulation, participants cared for real-life, older adult perioperative patients. After the simulated and real-life care experiences, participants completed questionnaires related to clinical judgment dimensions. These two data sets revealed rich findings about the students’ simulation learning, affirming the value of expert role models. Transferability of simulation learning to practice was also explored. [
J Nurs Educ.
2014;53(5):257–264.]
Reconstructing Marginality: A New Model of Cultural Diversity in Nursing
Authors: Southwick Margaret , Polaschek Nick
Published: August 2014

This article presents a new model of cultural diversity in nursing that critically reconstructs the concept of marginality that underpins other models. Rather than viewing the marginal as “other,” marginality is redefined as the space in between the dominant cultural reality and the cultural realities of minority groups located within a society. Members of a minority cultural group who become skilled in the difficult process of negotiating this in-between space open the possibility of transformation within nursing education and practice. This model has been applied in a study of the experience of nursing students of Pacific ethnicity in New Zealand. Subsequently, an undergraduate Pacific nursing program was developed, with greatly increased success rates in registration of Pacific nurses. This model of cultural diversity can also be used to understand nursing practice involving people from minority cultures or other socially excluded categories. [
J Nurs Educ.
2014;53(5):249–255.]
Determinants of Ocular Deviation in Esotropic Subjects Under General Anesthesia
Authors: Daien Vincent , Turpin Chloé , Lignereux François , Belghobsi Riadh , Le Meur Guylene , Lebranchu Pierre , Pechereau Alain
Published: August 2014

Purpose:

The authors attempted to identify the determinants of ocular deviation in a population of patients with esotropia under general anesthesia.

Methods:

Forty-one patients with esotropia were included. Horizontal ocular deviation was evaluated by the photographic Hirschberg test both in the awakened state and under general anesthesia before surgery. Changes in ocular deviation were measured and a multivariate analysis was used to assess its clinical determinants.

Results:

The mean age (± standard deviation [SD]) of study subjects was 13 ± 11 years and 51% were females. The mean spherical equivalent refraction of the right eye was 2.44 ± 2.50 diopters (D), with no significant difference between eyes (
P
= .26). The mean ocular deviation changed significantly, from 33.5 ± 12.5 prism diopters (PD) at preoperative examination to 8.8 ± 11.4 PD under general anesthesia (
P
= .0001). The changes in ocular deviation positively correlated with the pre-operative ocular deviation (correlation coefficient r = 0.59,
P
= .0001) and negatively correlated with patient age (correlation coefficient r = −0.53,
P
= .0001). These two determinants remained significant after multivariate adjustment of the following variables: preoperative ocular deviation; age; gender; spherical equivalent refraction; and number of previous strabismus surgeries (model r
2
= 0.49,
P
= .0001).

Conclusions:

The ocular position under general anesthesia was reported as a key factor in the surgical treatment of subjects with esotropia; therefore, its clinical determinants were assessed. The authors observed that preoperative ocular deviation and patient age were the main factors that influenced the ocular position under general anesthesia.

[J Pediatr Ophthalmol Strabismus 2013;50(3):155–160.]
Antidepressant Drugs and Infectious Disease
Authors: Howland Robert H.
Published: August 2014

Clostridium difficile
(
C. difficile
) infection (CDI) is a common and clinically significant cause of diarrhea associated with the use of antibiotic drugs. Two observational studies have suggested that antidepressant drug use is associated with an increased risk of developing CDI. Because of the potential public health significance of this finding, this article critically evaluates the methodology of these studies and provides evidence to question the plausibility and validity of this finding. The safety of antidepressant and other psychotropic drugs should not be taken for granted, but studies that receive media attention may cause harm if their findings are not valid and they result in a reluctance to use these drugs for treating serious mental disorders. [
Journal of Psychosocial Nursing and Mental Health Services, 51
(7), 11–14.]
A Qualitative Study on the Use of the Care Programme Approach with Individuals with Borderline Personality Disorder: A Service User Perspective
Authors: Rogers Bertha , Dunne Emma
Published: August 2014

A newly developed specialist personality disorder service in the United Kingdom arranged a focus group with seven service users with a diagnosis of borderline personality disorder (BPD) to explore their experiences of the Care Programme Approach (CPA) while under the care of a community mental health team. A thematic analysis generated seven themes. Understanding Borderline Personality Disorder and Understanding Recovery were highlighted as difficulties service users face, with a lack of staff understanding. They also spoke about the struggle of having a voice in their CPA meetings and the lack of information they received in the CPA process. They discussed the deliberation between progression versus consistency and moving on from services. Service users discussed the challenges of accessing treatment and lack of follow up in the CPA process. Greater service user involvement in the process would help address the dissatisfaction and disempowerment in care planning experienced by individuals diagnosed with BPD. [
Journal of Psychosocial Nursing and Mental Health Services, 51
(10), 38–45.]
College Students With Body Art: Well-Being or High-Risk Behavior?
Authors: Owen Donna C. , Armstrong Myrna L. , Koch Jerome R. , Roberts Alden E.
Published: August 2014

Body art is mainstream, with wearers readily admitting to being risk takers. Yet, are high-risk behaviors (e.g., cigarette, alcohol, and illegal drug use, sexual activity) and emotional distress (e.g., depression, suicide, eating disorders, abuse/forced sexual activity) present in all individuals with body art? Of the 595 college students who were queried, 127 (21%) had tattoos and 195 (33%) had lifetime piercings, with 17 (3%) having intimate (nipple, genital, or both) piercings; they also reported their self-views regarding religion, self-esteem, and Need for Uniqueness. Three consistent self-identity outcomes for their body art were: it helped me (a)
express myself
, (b)
feel unique
, and (c)
be myself
. When quantifying their body art amounts, well-being similar to that of individuals with no body art was present in those with one tattoo and less than four piercings. Individuals with four or more tattoos, seven or more piercings, and/or intimate piercings described higher risk behaviors and emotional distress. Education, monitoring, and non-profiling should continue as body art is only “skin deep.” [
Journal of Psychosocial Nursing and Mental Health Services, 51
(10), 20–28.]
More on Antidepressant Drugs and Infectious Disease
Authors: Howland Robert H.
Published: August 2014

Three observational studies have suggested that depression and/or antidepressant drug use is associated with an increased risk of developing
Clostridium difficile
(
C. difficile
) infection (CDI), which is a clinically significant cause of diarrhea typically associated with the use of antibiotic drugs. Establishing causality from observed associations requires evidence from a variety of different scientific perspectives. The authors of these studies do not consider the complex relationship among depression, immune system function, and infectious disease, nor do they consider the antimicrobial or immune-modulating effects of antidepressant drugs. The methodology of these three CDI studies—and their various sources of bias—make it impossible to assess the causal validity of the association between CDI and depression or antidepressant drug exposure. [
Journal of Psychosocial Nursing and Mental Health Services, 51
(10), 11–13.]
Update on Deep Brain Stimulation
Authors: Howland Robert H.
Published: August 2014

Deep brain stimulation
(DBS) is a commonly used neurosurgical form of therapeutic brain stimulation that has been demonstrated to be safe, well tolerated, and effective for the treatment of essential tremor, Parkinson’s disease, and primary dystonia. These particular uses have been approved by the U.S. Food and Drug Administration (FDA). Investigational studies using DBS have been conducted for refractory epilepsy, obesity, chronic pain, tardive dyskinesia, Tourette syndrome, and other movement disorders, but none of these studies has led to FDA approval for these indications. Although the use of DBS has been approved by the FDA under a Humanitarian Device Exemption for the treatment of treatment-resistant obsessive-compulsive disorder, studies systematically investigating the potential use of DBS for various severe chronic psychiatric disorders are in their earliest stages, and further studies are warranted. [
Journal of Psychosocial Nursing and Mental Health Services, 52
(4), 23–26.]
Long-term Outcomes of Photorefractive Keratectomy for Low to High Myopia: 13 to 19 Years of Follow-Up
Authors: Vestergaard Anders H. , Hjortdal Jesper Ø. , Ivarsen Anders , Work Kresten , Grauslund Jakob , Sjølie Anne Katrin
Published: August 2014

PURPOSE:

To evaluate long-term outcomes after photorefractive keratectomy (PRK).

METHODS:

A retrospective follow-up study of patients who received PRK at 5.0- to 6.5-mm optical zones, using the Summit broad beam excimer laser (Summit Technology, Inc., Waltham, MA) at Odense University Hospital, Odense, Denmark, between 1992 and 1998. One randomly selected eye of each patient was used in the statistical analyses. Re-treated eyes were excluded.

RESULTS:

One hundred sixty eyes were included. Mean follow-up time was 16 years (range: 13 to 19 years). Mean preoperative spherical equivalent was −4.84 ± 2.95 diopters (D) (range: −20.25 to −1.25 D). At last follow-up examination, achieved refraction was −1.00 ± 1.56 D (range: −10.75 to +1.00 D) from attempted refraction, and the change in mean refractive error from 6 months postoperatively was less than 1.00 D. Results from a subgroup of unilateral treated patients indicated that myopic progression was the main reason for the residual refractive error. For eyes with low myopia (n = 124), the proportion of eyes within ±1.0 D of attempted refraction was 72%, and for eyes with high myopia (−6.00 D or more, n = 36) it was 47%. Forty-five percent had uncorrected distance visual acuity of 20/20 or better at last follow-up examination. Three eyes (2%) lost two or more lines and 13 eyes (8%) gained two or more lines of corrected distance visual acuity. Fourteen percent had haze (grade 0.5 to 2). Eighty-one percent were satisfied with the surgery.

CONCLUSION:

PRK for low degrees of myopia seemed safe and effective up to 19 years after surgery with conventional broad beam laser ablation. Refractive predictability was significantly lower and the occurrence of haze was higher in eyes with high myopia.

[
J Refract Surg
. 2013;29(5):312–319.]
Intraocular Straylight After Thin-Flap LASIK With a Femtosecond Laser Versus a Mechanical Microkeratome
Authors: Wang Yan , Li Jing , Liu Yangchen , Xie Lili
Published: August 2014

PURPOSE:

To investigate characteristics of straylight before and after thin-flap LASIK performed with femtosecond laser versus with mechanical microkeratome and assess changes at 1 day, 1 week, 1 month, 6 months, and 1 year postoperatively.

METHODS:

One hundred twenty-eight consecutive eyes from 66 patients were included in this prospective study. Sixty-one eyes of 31 patients had thin-flap LASIK with femtosecond laser. In addition, 67 eyes from 35 patients underwent thin-flap LASIK with mechanical microkeratome were included for comparison. Following flap creation, all eyes were ablated using the VIXS S4 excimer laser system (Visx USA, Inc., Santa Clara, CA). Straylight values were measured using the C-Quant straylight meter (Oculus Optikgeräte GmbH, Wetzlar, Germany) preoperatively and 1 day, 1 week, 1 month, 6 months and 1 year postoperatively.

RESULTS:

Preoperatively, the mean straylight values were 0.93 ± 0.11. After femtosecond laser-assisted thin-flap LASIK, the values were 1.00 ± 0.11, 0.98 ± 0.10, and 0.99 ± 0.12 at 1 day, 1 week, and 1 month, respectively, and significantly increased (F = 7.62,
P
> .0001) compared to preoperative values. However, these values decreased and returned to preoperative levels at 6 months and 1 year postoperatively (0.92 ± 0.09 and 0.89 ± 0.13, respectively;
P
> .05). The postoperative-preoperative increases in straylight were reduced in the femtosecond laser group compared to the mechanical microkeratome group (0.05 ± 0.13 vs 0.10 ± 0.13 at 1 month postoperatively;
P
< .05). This difference was statistically significant at 1 month postoperatively (
P
= .04). A negative significant correlation was also found between preoperative straylight values and postoperative-preoperative increases.

CONCLUSIONS:

Straylight increased significantly in the early stages after femtosecond laser-assisted thin-flap LASIK. However, these values improved over time and gradually returned to preoperative levels, which may be related to the progression of corneal healing.

[
J Refract Surg.
2013;29(8):534–539.]