bluuebunny/crossref_metadata_2025 huggingface dataset:
An Investigation of the Impact of a Continuing Nursing Education Program on a Small Catholic Liberal Arts College
Authors: Fay Patricia A
Published: April 2021

ABSTRACT

The purpose of this investigation was to determine the impact of the nursing continuing education (CE) program at a small Catholic liberal arts college on the college itself as identified by CE participants. Data that validated the CE program did more than provide education to registered nurses were gathered. In fact, the data showed that after first coming to the college for a CE offering, participants engaged in several college-related activities, such as registering for the RN-BSN program, sending family members to the college, and recommending the college to family and friends.
Questioning: An Essential Ingredient in Effective Teaching
Authors: House Beverley M , Chassie Marilyn B , Spohn Betty Bowling
Published: April 2021

ABSTRACT

Questions asked in a teaching session can be used to challenge and stimulate learners, direct thought processes, influence the social and emotional milieu of the teaching environment, and evaluate learning. This article focuses on the mechanics and dynamics of questioning as a teaching technique, specifically addressing the concept of hierarchical levels of questioning, application of probing questions to promote higher levels of cognitive processing, and use of questioning as an instructional tool. Specific examples of eliciting questions, questioning levels, and probing questions are included.
Effective Training of Nursing Staff Enhances Hospital Information System Efficiency
Authors: Tiano Judith J , White Ann H
Published: April 2021

ABSTRACT

As more hospitals use computerized information systems, the need to address related nursing issues and to effectively train nursing personnel has become imperative. This article discusses the challenges met by a hospital's nursing administration to educate its staff members in computer use and evaluates the training program and its outcome after the system was started.
Continuing Education in Brazil
Authors: Angerami Emília Luigia Saporiti , Steagall-Gomes Daisy Leslie , Mendes Iranilde Jose Messias
Published: April 2021

ABSTRACT

In the present study, we discuss some specific aspects of the National Health System of Brazil in terms of nursing practice, education, and investigation, which require further professional training through continuing education. With this objective, we shall report a historic view of how this process occurred and is being transformed in this country in an attempt to meet the social realities of our time.
The Challenge: Developing a Preceptorship Program in the Midst of Organizational Change
Authors: Duff Margaret R , Kirsivali-Farmer Kay R
Published: April 2021

ABSTRACT

The implementation of educational programs during ongoing organizational change is a challenge. Our hospital nursing education department was successful in developing a department-wide preceptorship program during significant institutional change. This article outlines an analysis of the process of implementing such a program from the perspective of the unfreezing, moving, and refreezing components of change theory. An examination of the driving and restraining forces before and after the initiation of the program provides rationale for the success of the program. Factors that contributed to achievement of our goals include effective communication, senior administrative support, and education. From this analysis one could conclude that it is possible to initiate major educational initiatives during concurrent organizational change.
Continuing Education for Nurses That Incorporates Genetics
Authors: Monsen Rita Black , Anderson Gwen
Published: April 2021

ABSTRACT

Background: The discoveries of the Human Genome Project are bringing new knowledge of genetics to health and illness arenas. The nursing profession will need to incorporate these new advances into clinical practice, research, and education.

Method: A survey of 68 nursing specialty organizations was conducted to determine current and future offerings in genetics to members.

Results: Responses from 43 organizations' top administrators who are influential in decisions regarding continuing education offerings revealed that 30% were planning to offer content in genetics in future programming. In contrast, none of the respondents had plans to present consumer perspectives of genetic illnesses.

Conclusion: The results of this survey alert leaders in continuing education to the urgent need for dissemination of genetic advances to inform nurses in basic and advanced roles in health care delivery.
Using Focus Group Methodology in Nursing
Authors: Morrison Ruby Shaw , Peoples Letrell
Published: April 2021

ABSTRACT

Background: The need to obtain quality data in a cost-efficient manner spawned an exploration of research methods. The value of focus group methodology for multiple roles in nursing became evident.

Method: This article describes the purpose, process, and application of focus group methodology for nursing continuing education.

Results: Ideas for use of focus group methodology in nursing continuing education are suggested.

Conclusion: Focus group methodology can enhance the work of nurses in continuing education roles.
Challenging Spanish: Ways for Nurses to Become Bilingual
Authors: Oderkirk Wendell
Published: April 2021

ABSTRACT

A desire to provide culturally competent care to an increasing population of non-English-speakers may lead some nurses to consider learning another language as a way to minimize cross-cultural communication barriers. Nurses wishing to learn a second language may be surprised at the variety of ways to acquire bilingual skills, particularly in Spanish, the most common foreign language encountered in the United States. Reasons to learn Spanish are discussed and ways to do so are reviewed. Learning Spanish or another language can enrich the nurse-patient relationship, enhance nurses' self-esteem, and advance nurses' employment opportunities. Bilingual proficiency in English and Spanish (or another language) should be regarded as an authentic clinical skill supporting nurses' cultural and clinical competencies.
Preparing Staff to Deliver Age-Appropriate Nursing Care to Elderly Patients
Authors: Travis Shirley S , Duer Barbara
Published: April 2021

ABSTRACT

Meeting the Joint Commission on Accreditation of Healthcare Organizations accreditation standard for age-appropriate care cannot be accomplished by a once-a-year inservice educational program. Educational offerings that address the specialty of gerontological nursing require deliberate decision-making regarding the generic and advanced competencies necessary for care of elderly patients. Finding the resources to effectively teach the essential (generic and advanced) content is challenging. This article suggests that a staff development department may use existing resources and personnel from other organizations to prepare nursing staff to deliver age-appropriate care to elderly patients.
Association Between Continuing Education and Job Satisfaction of Nurses Employed in Long-Term Care Facilities
Authors: Robertson Ethel M , Higgins Leslie , Rozmus Cathy , Robinson James P
Published: April 2021

ABSTRACT

Background: The purpose of this descriptive, correlational study was to investigate the relationship between continuing education and job satisfaction among RNs and licensed practical nurses (LPNs) employed in long-term care facilities.

Method: Herzberg's Motivational-Hygiene Theory was used as a framework to guide the design of the study. The Professional Educational Activities Scale and the McCloskey/Mueller Satisfaction Scale were completed by 110 nurses employed in long-term care facilities.

Results: No difference was found between type of employment status (full-time versus part-time) on the level of professional educational activities. However, RNs participated in more continuing education activities than LPNs. Nurses who reported higher family incomes also had greater participation in educational activities. Registered nurses reported greater job satisfaction than LPNs. No significant difference was found between the degree of job satisfaction for Black and White nurses. The results of this study indicated nurses who participated in more continuing education activities scored higher on the job satisfaction scale.

Conclusion: As the elderly population increases, a critical need exists for nurses to be knowledgeable about current research-based information, including the economic and psychosocial effects of illness in later life. To provide the most effective care for the elderly population, nurses in long-term care must be knowledgeable about the complexity and specific characteristics of chronic illnesses. Continuing education activities are an important way to access this information.
Hardiness and Anxiety as Predictors of Academic Success in First-Year, Full-Time and Part-Time RN Students
Authors: Patton Tracey J F , Goldenberg Dolly
Published: April 2021

ABSTRACT

Background: The levels of hardiness and anxiety and their relationship with academic success were examined using the Personal Views Survey and the State-Trait Anxiety Inventory.

Method: The instruments were administered to a nonprobability convenience sample of 41 full-time and part-time RN students enrolled in a BSN completion program.

Results: Participants perceived themselves as possessing moderately high levels of hardiness (mean = 72.90) and low levels of anxiety (state mean = 39.33; trait mean = 40.18), but for some, these characteristics did not relate to academic achievement. Statistical significance was set at .05.

Conclusion: These findings indicate how hardiness and anxiety can affect academic success, particularly in adult students, and provide some direction for educators and administrators in maximizing educational endeavors.
Oncology Nurses' Use of the Internet for Continuing Education: A Survey of Oncology Nursing Society Congress Attendees
Authors: Cobb Susan C , Baird Susan B
Published: April 2021

ABSTRACT

A publication and continuing education company conducted a survey at the 23rd Annual Oncology Nursing Society Congress to determine whether nurses are using the Internet and, if so, for what purposes. Survey results revealed that oncology nurses are using the Internet for a variety of educational purposes, which include drug information, literature searches, academic information, continuing education, and patient education. Continuing education providers should continue to pursue the Internet as a means of meeting the needs of oncology nurses for quick, up-to-date information in their field. There is a need for further documentation on the use of the Internet by nurses for continuing education, including topics and program formats that would be most beneficial.
Developing Collaborative Partnerships in Continuing Nursing Education: Walking the Talk
Authors: Daley Barbara J , Black Mary , Gessner Barbara , Sparks Rita Kisting , Kuramoto Alice M
Published: April 2021

ABSTRACT

The purpose of this article is to describe and analyze a reciprocal partnership developed among four university-based continuing education providers in Wisconsin. Members of this partnership collaborated in developing a statewide program to address the educational needs of nurses moving from acute or long-term care into community nursing. Components of the reciprocal partnership model were applied in developing this program. The partners identified that, despite the initial time investment, the collaborative approach was an advantage. The collaborative approach enhanced the quality of the program developed and reached a wider audience. Continuing nursing educators may want to consider partnership arrangements for program development and implementation.
Substance Abuse Education Liaisons: A Collaborative Continuing Education Program for Nurses in Acute Care Settings
Authors: Marcus Marianne T , Rickman Kathleen A , Sobhan Tanveer
Published: April 2021

ABSTRACT

Background: Alcohol, tobacco, and other drug abuse undermine physical and psychological well-being, contributing to the array of illnesses that necessitate admission to acute care settings. Addictive disorders often are undetected, underreported, or overshadowed by the primary illness. Nurses need continuing education to enhance competence in meeting this challenging problem.

Method: Through a unique collaboration between university faculty and acute care nurses from seven hospitals, the nurses attended 18 monthly workshops designed to meet their learning needs related to substance abuse.

Results: The nurses acquired essential knowledge and skills regarding substance abusing clients. The publication of a substance abuse resource manual and the establishment of a continuing network of professionals committed to improving practice are additional positive outcomes of this endeavor.

Conclusion: Project SAEL (Substance Abuse Education Liaisons) is a model that can be emulated by others.
Competency-Based Education: Maximize the Performance of Your Unlicensed Assistive Personnel
Authors: Barczak Nancy , Spunt Debra
Published: April 2021

ABSTRACT

Background: Providing patient care by using the most cost effective means has compelled skill mix changes in many hospitals. The need for educational programs are crucial to prepare unlicensed assistive personnel (UAP) for their new roles.

Method: Using a competency-based approach, an educational program was designed to develop specific technical skills to target complex competencies and to improve the participants' knowledge and skill performance. The educational program met the five program objectives.

Results: Unlicensed assistive personnel gained knowledge and competency in new skills, as assessed in the education program and when applied in the clinical units. The most important outcome was the participants' expressed eagerness to learn more and their desire to work as contributing members of the health care team.

Conclusion: The educational program adequately trained UAP and created a foundation of relationships and teamwork that enhanced the patient care delivery with cost efficiency.
Using Facilitators in Mock Codes: Recasting the Parts for Success
Authors: Cuda Sally , Doerr Donna , Gonzalez Melissa
Published: April 2021

ABSTRACT

Background: Members of the CHRISTUS Santa Rosa Children's Hospital staff development committee identified a need for a mock code program which would address a range of learning needs for nurses and other caregivers with varying levels of knowledge, skills, and experience.

Method: We implemented a mock code program using experienced caregivers, usually emergency room and pediatric intensive care RNs and respiratory therapists to serve as facilitators to code participants during the mock code drills. Facilitators have dual roles of teaching and guiding the code participant as well as evaluating performance.

Results: Code participants and facilitators benefit from the design of this program. Debriefing session input and written program evaluations show that code participants value the opportunity to practice their skills in a nonthreatening situation in which they receive immediate feedback as needed. Facilitators learn to teach and coach and strengthen their own code knowledge and skills at the same time.

Conclusion: This mock code program serves as a unique way to include novice and experienced nurses in mock codes together. The knowledge, skills, and confidence of the code participants and the facilitators have matured. The design of the program allows for immediate teaching/learning where needed, as well as appropriate evaluation. This program develops stronger, calmer, more efficient, and more confident nurses during codes. Practice and equipment changes can be based on findings from the mock codes. The program is invaluable to patients, staff, and hospital.
A 54-year-old Man With Treatment-resistant Bipolar I Disorder
Authors: Anonymous
Published: April 2021

Management of adverse effects resulting from medications used during maintenance treatment can be an ongoing challenge to the clinician.
Emergency-Room Treatment of Acute Asthma
Authors: Anonymous
Published: April 2021

THE PHILADELPHIA REGIONAL PEDIATRIC PULMONARY DISEASE PROGRAM
DIALYSIS CARPAL TUNNEL SYNDROME
Authors: Kenzora John E
Published: April 2021

ABSTRACT: Twelve carpal tunnel releases were performed in eight out of ten dialysis patients who developed progressive median and ulnar nerve compartment syndromes following side (artery)-toend (vein) f istulae required for vascular access, out of a total population of between 200 and 250 patients (4 to 5%). It is our contention that etiology is directly related to the altered vascular hemodynamics produced by the f istulae. All the patients had rapid relief of their pain and dysesthesias, and were very satisfied despite some residual numbness in a few cases.
MEASUREMENT OF INTERNAL FIXATION DEVICE SUPPORT IN EXPERIMENTALLY PRODUCED FRACTURES OF THE DORSOLUMBAR SPINE
Authors: Pinzur Michael S , Meyer Paul R , Lautenschlager Eugene P , Keller John C , Dobozi William , Lewis Jack
Published: April 2021

ABSTRACT: A reproducible flexion injury was induced in ten fresh cadaver spine preparations via four-point loading with continuous recording of load-deformation characteristics and additional monitoring by high speed photography. Each spine was then stabilized with Weiss springs, Harrington distraction rods and Harrington compression rods, and tested in a same manner.13 The elastic modulus of each instrumented spine system was compared to the preinjured state and to each of the devices tested. Fixation with Harrington compression rods had the highest elastic modulus, ie, was the most stiff, of the devices tested, yet failed with the least amount of displacement. Instrumentation with Weiss springs had the lowest elastic modulus, however, and was noted to best maintain continuity with displacement. Harrington distraction rods were intermediate in both modalities. This study demonstrated that no one internal fixation device was applicable to all flexion injuries involving the dorsolumbar spine. Each of the three devices tested was more applicable in selected injuries. None of the devices appeared successful in restoring the original stiffness of the preinjured spine.
PSOAS ABSCESS: THIRTY-FOUR YEARS AFTER PYOGENIC OSTEOMYELITIS OF THE SPINE
Authors: Mansour Alfred , Nabos John F , Nabos Rudolph F
Published: April 2021

ABSTRACT: Although purulent sequelae are common with pyogenic spinal osteomyelitis, they should not persist as chronic problems unless they are untreated or treated inadequately. In 1943 a man had a spinal fusion for spondylolisthesis and postoperatively had pyogenic osteomyelitis of the spine, a complication that cleared after three years of treatment. Thirty-four years later, and after 30 years of being free of symptoms, the patient had a psoas abscess that was relieved by surgical intervention.
A Systematic Approach to the Surgical Treatment of Chronic Shoulder Pain
Authors: Weaver James K
Published: April 2021

ABSTRACT: A systematic surgical approach for dealing with chronic shoulder pain includes a carefully designed arthrectomy of the acromioclavicular joint, removal of the coracoacromial ligament, cuff repair, biceps tendon transfer, and removal of calcific deposits as indicated. Of 38 patients who have been followed for at least 24 months, 29 were rated as excellent on the basis of achieving a full range of pain-free movement and normal strength. Degenerative arthritis of the acromioclavicular joint was found in all cases, whereas bicipital tendinitis was noted in less than half. Inspection or transfer of the biceps tendon is not thought to be necessary, because adequate decompression will relieve bicipital tendinitis. An additional reward produced by resection of the lateral 1 ½ cm of the clavicle and the acromial portions of the AC joint is an excellent exposure of the lesional portion of the shoulder for performing cuff repairs, biceps tendon transfers, or excision of calcific deposits. A properly designed removal of the acromioclavicular joint provides adequate anterior decompression and eliminates the most commonly diseased tissue in the chronically painful shoulder without compromising function.
Femoral Neuropathy: A Case Report and Topic Review
Authors: Simon Keith J , Goodrich Allan
Published: April 2021

ABSTRACT: Pain in the lower extremity is a complaint frequently evaluated by the orthopedist. When this is localized to the anterior and medial aspect of the thigh and inner side of the leg and foot, peripheral lesions involving the femoral nerve must be included in the differential diagnosis. A case of a femoral neuropathy secondary to a retroperitoneal mass is presented. The anatomy and underlying etiologies of femoral neuropathies are reviewed.
The Use of a Modified V-Y Quadricepsplasty During Total Knee Replacement to Gain Exposure and Improve Flexion in the Ankylosed Knee
Authors: Scott Richard D , Siliski John M
Published: April 2021

ABSTRACT: A modified V-Y quadricepsplasty technique is described that facilitates exposure for prosthetic replacement in the knee with limited preoperative motion. The technique allows increased postoperative flexion without increasing the final postoperative extension lag. Seven patients have undergone knee arthroplasty using this method. The average increase in flexion was 49°. The average ultimate extension lag was 8°.
Multiple Replacements of Major Joints in Rheumatoid Arthritis
Authors: Yoshino Shin-ichi
Published: April 2021

ABSTRACT: Multiple total joint replacements were performed in 51 handicapped rheumatoid patients. Three joints were replaced in 23 patients, four joints in 25 patients, five joints in one patient, and six joints in two patients, for a total of 186 replacements of elbow, hip, knee and ankle joints. By the time of followup, seven of the patients had died due to unrelated causes. Evaluation of the walking ability in the remaining 43 patients revealed that 20 out of 22 nonambulatory patients had become able to walk indoors and outdoors, and 21 patients who had been able to walk only indoors became able to walk outdoors as well. Major complications occurred in 11 patients: femoral neck fracture in three, supracondylar fracture of the femur in three, cervical myelopathy in two, and loosening of the femoral prosthesis in two patients. The factors responsible for poor results in two patients were cervical problems and loss of motivation.
Irreducible Palmar Dislocation of the Proximal Interphalangeal Joint: A Case Report
Authors: Ostrowski David M , Neimkin Ronald J
Published: April 2021

ABSTRACT: Irreducible palmar dislocation of the proximal interphalangeal joint in which the central slip remains intact is a rare injury. A noose formed by the extensor mechanism traps the condyle of the proximal phalanx. The collateral ligament is avulsed and the volar plate is disrupted. Closed reduction was unsuccessful in this case. Open reduction achieved a good result. Key indexing terms: Extensor tendon injuries; Volar PIP dislocation.
Infrapatellar Tendon Ruptures
Authors: Burgess Ronald C , Guise Edwin R
Published: April 2021

ABSTRACT: This is a retrospective study of 23 infrapatellar tendon ruptures in 22 patients seen at Henry Ford Hospital from 1969 to 1980. Two of the patients had a systemic disease known to predispose to tendon ruptures, while the remainder of the tendon ruptures occurred in otherwise normal individuals as the result of either repetitive or isolated trauma.
Anterior Shoulder Dislocation with Posterior Displacement of the Long Head of the Biceps Tendon: Arthrographic Findings A Case Report
Authors: Freeland Alan E , Higgins Robert W
Published: April 2021

ABSTRACT: An acute anterior dislocation of the shoulder was accompanied by disruption and posterior displacement of the long head of the biceps tendon. This prevented concentric reduction of the humeral head into the glenoid and restricted shoulder motion. The diagnosis was confirmed by arthrogram.
TRAUMA
Authors: Wiss Donald A , Missakian Maylene
Published: April 2021

Supracondylar Fracture of the Femur
Innominate Osteotomy and Varus Derotational Osteotomy in the Treatment of Congenital Dysplasia of the Hip
Authors: Lehman William L , Grogan Dennis P
Published: April 2021

ABSTRACT: The long-term functional and radiographic outcome of congenital hip dysplasia in patients previously diagnosed and nonoperatively treated, who subsequently underwent operative treatment after walking age was retrospectively reviewed in 94 patients (87% return).

Innominate osteotomy (75 hips, 15.2 years mean follow up) yielded satisfactory late radiographic results in 33% of the subluxated hips and 50% of the dislocated hips, despite more encouraging results at one year (56% and 63.6% respectively).

Varus derotational femoral osteotomy (35 hips, 10.8 years mean follow up) yielded a satisfactory radiographic outcome in 55.6% of the subluxated hips and 38.5% of the dislocated hips, with little change from the results at one year.

Late diagnosis, late operative treatment, and complications of treatment, particularly ischemic necrosis of the femoral head, were predictive of poor outcome. Combined procedures (10 hips, 12 years mean follow up) or secondary open procedures were ineffective.

Although Severin radiographic grade varied with time, functional status remained virtually the same throughout individual follow up. Those patients followed beyond skeletal maturity who developed gross articular incongruity or osteoarthritis, showed a decline in functional status.
Posterior Tibial Artery Pseudoaneurysm Following Tibial Fracture: A Case Report
Authors: Breen Thomas , Brumback Robert
Published: April 2021

ABSTRACT: The presence of distal pulses is oftentimes misleading and the severity of the fracture roentgenographically is frequently unrelated to the possibility of a vascular injury. Pseudoaneurysms following long bone injuries, although not as commonly seen in blunt as in penetrating trauma, are potentially limb threatening injuries requiring a high index of suspicion and the liberal use of angiography for early diagnosis and repair. A case of a pseudoaneurysm of the posterior tibial artery associated with a grade I open fracture following blunt trauma and a review of the literature concerning arterial injury in blunt trauma are presented.
Intrapelvic Migration of Knowles Pin Through External Iliac Vein
Authors: Buch Richard G , Kernek Clyde B , Madura James A , Province William D
Published: April 2021

ABSTRACT: Intrapelvic migration of a Knowles pin is rare. A case is reported of Knowles pin migration into the pelvis and through the external iliac vein. This was caused by a combination of excessive motion of the femoral neck nonunion and osteoporosis of the femoral head which allowed forward migration of the pin.
Reduction of Pain Inhibition on Voluntary Muscle Activation by Epidural Analgesia
Authors: Arvidsson Inga , Eriksson Enjar , Knutsson E , Arnér S
Published: April 2021

ABSTRACT: The influence of postoperative pain on muscle function, and the possible effect of local anesthetics on the normal muscle function are discussed. The integrated EMG (EMG) during maximum voluntary contraction of the quadriceps muscle was registered in ten patients the day after undergoing reconstruction of the anterior cruciate ligament. Recordings were taken before, 5, 12, and 20 min to 25 min after epidural injection of 20 ml of 0.25% lidocaine with adrenaline (2.5 µg/ml). As pain gradually subsided, IEMG increased a mean of 2,728% 20 min to 25 min after injection (range 425% to 10,068%), compared to initial recordings before anesthesia. This indicates that pain relief plays a significant role in the ability to normally activate the quadriceps muscle after open knee surgery.

Neither the Hoffman (H-)reflex, nor maximum voluntary isokinetic muscle torque was appreciably affected by epidural injection of dilute local anesthetics, as tested on two healthy volunteers.

Infiltrations of local anesthetics info the distal part of the quadriceps muscle did not affect maximum voluntary isokinetic knee extension torque. From the experiments performed we conclude that it is possible to selectively block pain by injections of local anesthetics into the epidural space, without interfering with normal muscle function. It might thus be possible to prevent some of the postoperative muscle atrophy by using a continuous epidural analgesia for two to three days following surgery, and starting an early active physical therapy program.
A Modular Femur-Tibia Reconstruction System
Authors: Kotz R , Ritschl P , Trachtenbrodt J
Published: April 2021

ABSTRACT: A 26 piece modular system for the reconstruction of the bones of the lower extremity from the femoral head to the distal third of the tibia is described. This modular system can be implanted without cement and allows for the intraoperative determination of the amount of resection necessary. The implant material is the well-known cast, Co-Cr-Mo alloy Vitallium.®

From 1982 to the end of 1985, 52 patients were treated with this cementless tumor endoprosthesis of the Kotz Modular Femur-Tibia Reconstruction System (KMFTR) at the University of Vienna, Department of Orthopedics. The locations of the tumors were: proximal femur (28), distal femur (17), and proximal tibia (7). In two cases a total femur was implanted and in another patient a total knee.

Indications for the resection of the bone segments and joints concerned included primary bone tumors, metastases, and loosening of conventional endoprostheses and tumor resection endoprostheses.

Twenty-one patients with an average follow up of 20.4 months and a minimum follow up of 1 year were evaluated according to Enneking's criteria. Eight patients had proximal femoral replacement. The results were excellent in two, good in five, and fair in one. Eleven patients had undergone replacement surgery in the knee joint area. The overall rating showed five excellent results, four good and two fair. One patient with a total femoral replacement had multiple bone metastases with polytopic pain and was no longer available for regular assessment. Another patient with a total knee replacement suffered a rupture of the patellar ligament after 10 months and had to be revised.

Radiologically we have observed excellent bone incorporation of the prosthesis in 15 of 25 evaluated patients. Ten cases showed no changes in radiologic features as compared to the initial findings. These were patients with short follow up periods.

Although complications did occur in these major surgical interventions, the final results were very satisfactory and the patients were subjectively content with the operation.
Conservative Management of Metatarsal and Heel Pain in the Adult Foot
Authors: D'Ambrosia Robert D
Published: April 2021

ABSTRACT: The Louisiana State University (LSU) Affiliated Hospitals foot clinic has had good success in the treatment of metatarsal and heel pain using the following five modalities. 1) Muscle strengthening and muscle stretching of the intrinsic muscles and the muscles about the ankfe joint, especially the gastrocnemius-soleus complex. 2) Contrast baths in the acute condition to decrease the edema and inflammatory process. 3) Nonsteroidal agents with the acute condition to decrease the inflammatory response. 4) Shoe modifications. 5) Orthotic devices.

Orthotic devices seem to be the most useful in the treatment of both conditions. It has been found necessary to prescribe orthotics in almost all cases of chronic problems to institute permanent relief.1,2

Opposition remains to multiple steroid injections into either area, although there is no great objection to one or possibly two injections into a particular area to decrease the inflammatory process. It has been observed that a general worsening of the condition occurs from multiple injections. After repeated steroid injections one sets the stage for increased atrophy of the fat pad, which results in a more prominent bony surface and increased pain. Cases have been documented on many occasions showing indented areas over the heel or metatarsals or complete loss of the metatarsal fat pad of patients who have received multiple injections of steroids.
The Natural History of Unfused Scoliosis
Authors: Edgar Michael A
Published: April 2021

ABSTRACT: Seventy-eight unfused patients with idiopathic scoliosis were followed from skeletal maturity over a mean period of 17 years (range 10 to 27 years) with a mean age at follow up of 33.7 years. The following aspects were investigated: curve deterioration, back pain incidence, and psychosocial details.

There was considerable variation in the progression rate of similar deformities but on average significant deterioration occurred when the Cobb angle was over 55° with a maximum deterioration approaching 1 .5° per year in the thoracic curves between 90° and 100° mature Cobb angle. Thoracolumbar and lumbar curves were slightly more benign with a maximum progression rate of about 1° when the mature angle was 80° to 90°. The thoracic component of double curves progressed least.

Rotation increased in proportion to the Cobb angle progression except in some lumbar curves where lateral subluxation occurred with a disproportionate amount of rotation. The incidence of back pain in relation to pain in the general population and in fused patients remains uncertain. Eighty-two percent of patients had married and 87% had job satisfaction; 10% received treatment for depression.
Mechanical and Histological Studies of Acute Joint Hemorrhage
Authors: Parsons John R , Zingler Barry M , McKeon John J
Published: April 2021

ABSTRACT: In this study, a simple animal model has been used to gather data on the mechanical and histologic changes in cartilage and the histologic changes in synovium attendant to acute joint hemorrhage. The continuous presence of autologous blood in the experimental joints for 10 days results in cartilage which is significantly more compliant than normal. These changes are attributed to loss of proteoglycan. Further, the study demonstrates a consistent pathology of the synovial tissues. Elaboration of degenerative enzymes from iron-laden synovial or subsynovial macrophages must be considered a primary mechanism of cartilage damage.
Review of the Brachial Plexus Part I: Acute Injuries
Authors: Ferenz Clint C
Published: April 2021

ABSTRACT: Acute injuries of the brachial plexus are open or closed, and occur by compression, traction, sharp laceration, or missile injuries. Following initial resuscitation, a proper evaluation and treatment plan must be formulated. A review of the literature showed an obvious trend away from conservative treatment of many brachial plexus lesion toward an early, aggressive surgical approach to these injuries. An extensive literature review also provided the opportunity to devise a rational classification of brachial plexus injuries, which allows for a treatment regimen that reflects the trend of the recent literature.
The Musculoskeletal Manifestations of Progeria: A Literature Review
Authors: Hamer Louis , Kaplan Frederick , Fallon Michael
Published: April 2021

ABSTRACT: Although a superficial similarity exists between the musculoskeletal disorders associated with natural aging and those of progeria, an in-depth analysis reveals profound differences in the pathophysiology between the two processes. The protean manifestations of progeria can best be explained on the basis of the vascular changes found at autopsy. A disorder of the vascular endothelium may predispose progeric vessels to atherosclerotic changes. The unique musculoskeletal manifestations of progeria arise from the effects of premature atherosclerosis on the vascularized connective tissues.
Controlling Anterior Tibial Displacement Under Static Load: A Comparison of Two Braces
Authors: Branch Thomas , Hunter Robert , Reynolds Peter
Published: April 2021

ABSTRACT: This article presents data comparing the restraining effect of the Lenox Hill® and the CTi brace to static loading using the KT-1000 Knee Ligament Arthrometer. Testing was performed at 25° and 90° in 15 patients with documented single ligament injuries involving the anterior cruciate. The opposite knee was determined to be normal by subjective and objective testing and was used as the control.

Results showed that the anterior drawer was more sensitive at 25° than at 90°, in differentiating the ACL deficient knee from the control leg. At 25°, using passive and active drawer tests, both the Lenox Hill and the CTi brace improved the ACL deficient knee significantly. With 15 Ib of passive loading, both the Lenox Hill and the CTi brace improved the drawer to within normal limits. However, only the CTi brace was able to return the drawer to within the normal range at the 20 Ib force level. Neither brace improved the drawer to norma! when subjected to the higher loads created by an active drawer test. At 90°, 15 Ib of passive loading could not discriminate between the braced and the unbraced knee or between the normal and ACL deficient knee. When 20 Ib of force was applied, only the CTi brace improved the drawer significantly, which placed the drawer into the normal range.

Under static testing conditions, the CTi brace proved to be better than the Lenox Hill in controlling the anterior drawer in flexion and at 20 Ib of passive loads; however, when higher loading forces were used in the active anterior drawer test, neither brace was effective in controlling anterior tibial translation.
Subacute Osteomyelitis Presenting as Bone Tumors
Authors: Juhn Amir , Healey John H , Ghelman Bernard , Lane Joseph M
Published: April 2021

ABSTRACT: The problem of the differential diagnosis between subacute osteomyelitis and primary bone tumors is a difficult one. Presenting symptoms, duration of disease, laboratory data, and location of the pathologic process are of little assistance. The authors reviewed eight typical cases. Preoperative diagnosis included benign and malignant bone tumors, as well as osteomyelitis; but the final diagnosis of osteomyelitis was made only after open biopsy and culture. The presenting symptoms and signs included: pain, usually dull; soft tissue mass; and, rarely, low grade fever. The radiographic features were usually a lytic area with various degrees of sclerotic reaction. White blood count and sedimentation rate were not helpful. The treatment, including surgical curettage and appropriate antibiotic therapy, resulted in resolution of the process and healing of the bony defects.
The RGO Generation II: Muscle Stimulation Powered Orthosis as a Practical Walking System for Thoracic Paraplegics
Authors: Solomonow M , Baratta R , Hirokawa S , Rightor N , Walker W , Beaudette P , Shoji H , D'Ambrosia R
Published: April 2021

ABSTRACT: The RGO Generation Il reciprocating gait orthosis was jointly developed by Louisiana State University Medical Center and Durr-Fillauer Medical, lnc, to overcome four problems encountered with the existing model: 1) The high energy cost of locomotion; 2) the great arm strength required for patients to stand up from the seated position without assistance; 3) difficulty (especially for patients with hamstring contracture) in remaining standing owing to failure of the knee latch to lock except in full extension; and 4) problems in balancing when ambulating on an incline. The RGO Generation Il employs concurrent electrostimulation of the rectus femoris and hamstrings to assist in rising and balancing and a ratchet-type latching device to improve safety and stability in standing. Alternating stimulation of the rectus femoris and contralateral hamstrings are used for locomotion. Testing in six patients with thoracic paraplegia demonstrated an average 30+% reduction in energy expenditure at a walking speed of .05 m/s and a 15+% reduction at .37 m/s; improved mobility and better balance on inclines; and unassisted rising in all patients. Walking range was increased from an average of 100 m to an average of 800 m. More research is needed to provide stairclimbing ability and to further reduce energy expenditure.
Vancomycin Prophylaxis and Elective Total Joint Arthroplasty
Authors: Ritter Merrill A , Barzilauskas Cathi D , Faris Philip M , Keating E Michael
Published: April 2021

ABSTRACT: A series of 201 consecutive patients treated with unilateral or bilateral total joint arthroplasty were given a single-dose prophylactic antibiotic regimen consisting of 1 g vancomycin infused over 1 hour on the morning of surgery and 80 g gentamicin given upon arrival in the operating room. Bactericidal blood levels were maintained during and for 24 hours after surgery. Elevated serum creatinine levels developed postsurgical Iy in 8 patients but returned to normal. No serious hypersensitivity reactions occurred; minor reactions responded to antihistamine therapy. No postoperative infections were reported. Cost of administration compared favorably with 24- and 48-hour regimens employing cephalosporins. The investigators concluded that a combined single dose vancomycin/gentamicin regimen is a safe, effective, and cost efficient method of orthopedic implant prophylaxis.
Sacrococcygeal Pain Syndromes: Diagnosis and Treatment
Authors: Traycoff Roger B , Crayton Hulon , Dodson Rebekah
Published: April 2021

ABSTRACT: Sacrococcygeal pain can arise from the sacrococcygeal joint, from contiguous structures sharing the same innervation, or from distant sites. True coccygodynia consists of pain arising from the sacrococcygeal joint, whereas pseudococcygodynia consists of pain referred to but not arising from the coccyx. Coccygodynia can usually be distinguished from pseudococcygodynia by physical examination with the diagnosis being confirmed by injection of local anesthetic into the sacrococcygeal joint. The etiology of pain not relieved by intraarticular injection can be further defined by selective neuroblockade. A method for defining the anatomic basis for sacrococcygeal pain is presented as well as a discussion of the relevant anatomy and differential diagnosis of sacrococcygeal pain.
The Significance of Intracompartmental Pressures in the Diagnosis of Chronic Exertional Compartment Syndrome
Authors: Mannarino Frank , Sexson Steve
Published: April 2021

ABSTRACT: Chronic exertional compartment syndrome is one cause of pain in the tower extremity, a common disability in athletes. The significance of intracompartmental pressures in the diagnosis of chronic exertional compartment syndrome is somewhat controversial. The goal of this study was to review the compartment pressure tests in a group of patients that underwent fasciotomy for refractory exertional compartment syndrome and to compare these pressures with an asymptomatic control group. The results are presented and compared with those of previous studies.
Revision of Painful Distal Tip Amputations
Authors: Gross Stewart C , Watson H Kirk
Published: April 2021

ABSTRACT:From 1 968 to 1 987, 22 patients were diagnosed with dysfunctioning digits after complete distal digital amputations. Each patient had the proximal portion of the partially amputated phalanx left within the injured digit. On average, 21 months after the initial injury, each patient underwent an excision of the remnant portion of the phalanx which averaged 6 mm (range 1 to 17 mm). All 22 patients reported excellent postoperative results of full function and no residual pain with an average follow up of 9 months. We theorized that localized synovitis produces joint pain related to: 1 ) nontolerated joint stress loading due to a change in the lever arm length of the amputated phalanx, or 2) inadequate cartilage nutrition owing to lack of stress applied to this joint. Maintaining digital length must be rethought with emphasis placed on painless function. Considering the losses to these patients in terms of time, employment, and money, a distal remnant measuring 4 mm or less should be excised, regardless of the digit, at the time of the injury.
Leg Length Equalization During Total Hip Replacement
Authors: Woolson Steven T
Published: April 2021

ABSTRACT: A method of equalization of leg lengths during total hip replacement surgery was developed which utilizes the concept of equalizing the vertical dimensions of the resected femoral head and neck segment and the remaining hip joint cartilage space, which are removed during the procedure, with the vertical dimensions of the femoral and acetabular prostheses, which are implanted into that void. This was accomplished by determining the dimensions of the prostheses from careful preoperative templating technique and by using a simple arithmetic formula to determine the level of the femoral neck osteotomy. The level of the osteotomy was made by a measurement from the top of the dislocated head of the femur to the medial femoral neck calcar.

The radiologic postoperative leg length differences of a consecutive series of 84 patients undergoing primary total hip replacement using this method were determined. The average discrepancy was 2.8 mm. Seventy-five patients (89%) were found to have a postoperative leg length discrepancy of 6 mm (1/4 inch) or less. Six patients (7%) had a discrepancy of 7 to 13 mm, and only three patients (4%) had more than 13 mm (1/2 inch) leg length difference. Using this technique only two patients (2.5%) with unilateral hip replacements had leg lengthening of more then 6 mm.
CT-GUIDED BIOPSY OF METASTATIC SACRAL TUMORS
Authors: Settle William J , Ebraheim Nabil A , Coombs Robert , Saunders R Craig , Jackson W Thomas
Published: April 2021

ABSTRACT

Between June 8, 1985 and January 29, 1986, the authors performed five CT-guided needle biopsies of suspicious sacral lesions. In each of the five cases, these biopsies allowed the acquisition of specimens suitable for definitive pathologic diagnosis. Three cases of metastatic adenocarcinoma, one case of desmoplastic fibroma, and one case of chronic inflammatory changes were noted. In the case involving chronic inflammatory changes, subsequent open biopsy was performed, confirming the inflammatory changes and absence of neoplasm. The authors conclude that percutaneous CT-guided biopsy of sacral lesion can be performed safely and rapidly, and allows accurate diagnosis and treatment of sacral lesions.
THE RELATIONSHIP BETWEEN THE TREATMENT OF CONGENITAL DISLOCATION OF THE HIP AND AVASCULAR NECROSIS
Authors: Binnet Mehmet S , Chakirgil Gungor S , Adiyaman Sinan , Ates Yalim
Published: April 2021

ABSTRACT

The most important complication following the treatment of congenital dislocation of the hip is avascular necrosis. The potential sequelae that may arise after the onset of avascular necrosis are worse than if the hip remained dislocated. We evaluated 38 hips in which avascular necrosis developed after reduction. The average patient age at the time of reduction was 4.3 years, with a follow up of 6 to 15 years. Twelve hips had closed reduction and 26 had open reduction. Following reduction, 8 hips had Type I, 6 had Type II, 9 had Type III, and 15 had Type IV avascular necrosis. In this article, we evaluate our cases and review current literature on the subject. Close follow up and timely interventions can reduce potential sequelae to a minimum.
THE USEFULNESS OF MRI IN EVALUATING MENISCI AFTER MENISCUS REPAIR
Authors: Bronstein Robert , Kirk Patrick , Hurley John
Published: April 2021

ABSTRACT

We reviewed magnetic resonance imaging (MRI) scans of 15 asymptomatic patients at 6 months to 1 year following meniscal repair procedures. All of the patients were found to have persistent MRI signals in the region of the repair. Nine of the 17 meniscal repairs in the 15 patients had persistent grade 3 signals. Arthrograms were performed on six patients (eight meniscal repairs). Seven of these postoperative menisci showed grade 3 signals on MJRI. Only one meniscus was shown to have a complete tear by arthrogram. There were no false negative scans. The overall accuracy, defined as the percentage of postoperative menisci correctly diagnosed by MRI, was 38% (3/8). MRI is a useful preoperative diagnostic study following knee injury. This report demonstrates, however, that present MRI modalities are unable to distinguish between scar tissue of healed meniscal repairs and meniscal tears. Therefore, it is not a useful diagnostic tool in evaluating reinjury following successful meniscal repair.