bluuebunny/crossref_metadata_2025 huggingface dataset:
Brexit et discours de politique étrangère.
Authors: Deschaux-Dutard Delphine
Published: April 2021

Cet article vise à démontrer comment le Brexit exerce un impact sur les discours de politique étrangère français et allemand en matière de défense européenne depuis 2016. En croisant l’institutionnalisme discursif et le concept d’entrepreneurs politiques tel qu’il est proposé par Kingdon dans sa théorie des courants multiples, l’article analyse la dimension discursive et symbolique du changement impulsé dans la PSDC à la suite du Brexit. L’article permet de mettre en lumière l’existence de deux types de discours déployés par les entrepreneurs gouvernementaux français et allemands : des discours de coordination visant à apporter du changement qualitatif à la défense européenne, et des discours communicationnels visant à légitimer les propositions ainsi que le retour d’un leadership franco-allemand en matière de PSDC après le Brexit. L’intérêt de cette approche est de saisir comment se déploient ces discours au niveau européen alors même que des divergences normatives de fond persistent entre les acteurs.
Same Challenge, Different Answers? Mapping out Brexit Challenges for Czech and Slovak EU Policy-Making
Authors: Brusenbauch Meislová Monika
Published: April 2021

Cet article analyse les défis que suscite le Brexit pour les politiques européennes de la République tchèque et de la Slovaquie. En se basant sur la littérature relative aux défis (attendus) du Brexit pour les politiques européennes des États de petite et moyenne taille, l'article se concentre principalement sur les défis posés par le Brexit dans deux dimensions des politiques européennes : 1) les secteurs de politique publique et 2) les capacités à défendre une cause. Le principal argument mis en avant dans cet article est que les défis découlant du Brexit pour les politiques européennes des États membres sont influencés par deux facteurs : 1) la politique européenne du pays et 2) les liens du pays avec le Royaume-Uni dans le cadre de l'élaboration des politiques européennes. Parmi les deux pays examinés ici, c'est surtout la République tchèque dont les politiques européennes sont remises en cause par le Brexit.
L’addiction est une pratique sociale soluble dans la coopération
Authors: Morel Alain
Published: April 2021

Comprendre les addictions, et donc les prévenir et les soigner, nécessite de s’entendre collectivement sur une définition qui intègre à la fois une délibération transdisciplinaire pour réunir les données scientifiques et la prise en compte des expériences vécues dans leur diversité. Partager une définition commune est la meilleure façon de restituer à toutes les composantes de la société et à chacun son pouvoir d’agir et d’éviter la captation de l’expertise par telle ou telle corporation. Dans le monde d’aujourd’hui, l’usage de drogues et l’addiction ne peuvent plus être considérés comme une faute, une faiblesse de la volonté ou une maladie de quelques-uns. C’est un fait social massif, une pratique quasi universelle directement en interaction avec le monde social dans lequel elle s’origine et prend sens. L’addictologie ne peut donc se réduire à une discipline, neuro-médicale ou autre. Elle doit se concevoir à travers un prisme fondamentalement intégratif. Un modèle « bio-psycho-social » qui prenne en compte le caractère humain, fondamentalement culturel et social, donc politique des consommations de drogues et des addictions. Elles n’ont cessé de se répandre dans le monde entier ces dernières décennies, attisées par des politiques plus centrées sur la répression que sur les droits humains. Pour relever ce défi, pour prévenir, aider, soigner, avec éthique et efficacité, les politiques des États et des institutions doivent avant tout recueillir les savoirs, mobiliser les ressources collectives, les relations sociales et la solidarité entre leurs membres. Les protocoles technologiques, pharmacologiques ou autres n’ont de portée qu’au service de la relation d’entraide et de sollicitude, et s’ils facilitent l’association des savoirs entre professionnels et usagers. Tout comme notre société, l’addictologie est au seuil d’une « transition ». Elle doit contribuer à la prédominance de nouveaux liens sociaux fondés sur la coopération, l’égalité, le renforcement du pouvoir d’agir, l’inclusion sociale, le partage expérientiel et la coéducation. Pour qu’une telle transition soit « durable », il est nécessaire de fédérer les acteurs, de soutenir les expériences innovantes et de consolider cette dynamique par une politique de santé qui favorise à tous les niveaux l’implication et la coopération avec les usagers dans les champs éducationnel, clinique et institutionnel.
Une certification Patient-Expert Addictions au carrefour du savoir expérientiel du patient rétabli de ses conduites addictives et des activités des acteurs des soins
Authors: Dejour Alain
Published: April 2021

Exercer une activité de patient-expert dans le champ des conduites addictives, au-delà des seuls programmes d’éducation thérapeutiques du patient, vaut bien une certification de patient-expert addictions (PEA). Il s’agit de légitimer une pratique existante, de développer et sécuriser son pouvoir d’agir de concert avec les acteurs des structures de soins et d’accompagnement, de créer un environnement d’échanges sur les pratiques. Le parcours de certification, individualisé, respectueux et professionnalisant, s’appuie sur un travail réflexif sur son savoir expérientiel au regard d’un référentiel d’activités et de compétences qui prend en compte tous les domaines d’activités du PEA.
Du contrat de poids au contrat moral
Authors: Dumont Pierre , Terral Daniel , Fénéon Dominique
Published: April 2021

Cet article décrit le fonctionnement d’une équipe pluridisciplinaire de pédopsychiatrie dans l’accompagnement d’adolescents hospitalisés pour anorexie mentale sévère. Laissant tomber le contrat de poids au profit d’un « contrat moral », notre modèle de prise en charge invite le patient et le soignant à faire l’expérience d’une rencontre intersubjective hédoniste nécessaire pour dépasser les illusions et les dénis communs. Nous verrons comment notre positionnement, libéré de certaines « contraintes » et « privations », permet aux adolescents dits anorexiques d’accepter un retour de l’ordre naturel des choses dans la sécurité et le plaisir.
Mandatory Continuing Education: What the Research Tells Us
Authors: Thurston Hester I
Published: April 2021

ABSTRACT

The development of continuing education in nursing closely parallels that of adult education (Table). The primary models researchers have used in studying nursing have been the paradigms of adult education. In today's society, rapid development of technology and expansion of knowledge have made necessary a frequent update of nursing skills. This need in turn has led to mandatory continuing education (CE).
Field-Dependence/Independence: Considerations in Staff Development
Authors: Ismeurt Jennifer , Ismeurt Robert , Miller Barbara K
Published: April 2021

ABSTRACT

Clinical nurse preceptors, staff development specialists, and staff nurses are becoming more involved with the clinical learning experiences of new graduates, nursing school students, and the highly mobile, experienced nurse. Assessment of learning styles and the cognitive process is necessary for the implementation of successful orientation programs. Consideration of the bipolar learning style of field-dependence/independence can be useful for preceptors involved with teaching in the clinical setting. This article reviews the development of the concept of field-dependence/independence, identifies associated characteristics, and discusses assessment of learning style. Specific teaching strategies for both field-dependent and field-independent learners are discussed.
Nurses' Knowledge About and Attitudes Toward Patients With AIDS
Authors: Rae Donna , Brown Yvonne , Calder Barbara
Published: April 2021

ABSTRACT

With the increasing incidence of AIDS, it is probably inevitable that most nurses working in acute care settings will at some time come in contact with a patient who has AIDS. Nurses must be prepared to give safe, competent, and compassionate care to patients with AIDS. This article reports the results of a survey of registered nurses' knowledge and attitudes related to AIDS and AIDS patients. The respondents displayed moderate scores on the knowledge questions, high scores on transmission and treatment, but low scores on epidemiology and pathophysiology. On the attitude subscales, scores were above three on a five-point scale, indicating a lack of negative attitudes. Recommendations for educational programming are included.
Baccalaureate Nurse Graduates' Perception of Barriers to the Use of Physical Assessment Skills in the Clinical Setting
Authors: Sony S D
Published: April 2021

ABSTRACT

This study examined the perceived barriers to the use of physical assessment skills (PAS) in the clinical setting by 148 baccalaureate-prepared nurses who graduated between 1982 and 1988. Data were collected by means of self-administered, mailed questionnaires, and a 42-item PAS tool, using a five-point scale. Graduates were asked to identify specific barriers to not using, or seldom using, PAS. Of the 42 PAS, 10 were used most frequently, and 12 were "never" or "seldom" used in the clinical setting. Numerous barriers were listed: performance by physician ranked first; inappropriate to clinical setting ranked second.
The Provision and Evaluation of a Neonatal Resuscitation Program
Authors: Dunn Sandra , Niday Patricia , Watters Nancy E , McGrath Patrick , Alcock Denise
Published: April 2021

ABSTRACT

The need to train perinatal staff in neonatal resuscitation is widely accepted; however, standardized educational programs have not been available. This study used a randomized control trial to evaluate a one-day neonatal resuscitation education program with 190 nurses. Experimental subjects receiving the program had significantly improved knowledge and skill performance. Knowledge, but not skill performance, was maintained at six months for the experimental group. There was a significant relationship between subjects' self-rating of knowledge and performance, suggesting that this method could be used to prioritize staff for basic or refresher training. An effective format and evaluation instruments for neonatal resuscitation training have been developed. Strategies to maintain skills should be addressed in future research.
What Happens to Learning When the Workshop is Over?
Authors: Kiener Mary Elaine , Hentschel Doe
Published: April 2021

ABSTRACT

This article presents findings from a study conducted to identify factors that facilitate and hinder the process by which professionals incorporate learning into practice. While a majority of learners identified their new knowledge as a facilitative factor for the incorporation process, nearly a third acknowledged that a knowledge deficit or the task's complexity would hinder the incorporation process. References to administrative support more frequently identified hindrances rather than facilitators.
Inservice Education: Calculating the Cost
Authors: Bethel Patricia L
Published: April 2021

ABSTRACT

Cost effectiveness is the mandate in health care today. Nursing staff development especially has needed to rethink its methodologies because of the significant cost of programs. The Department of Nursing Education and Resources of Miami Valley Hospital in Dayton, Ohio adopted an "All-Day" concept in an effort to achieve maximum efficiency from its resources for inservice education. To comprehensively and accurately determine how efficient the all-day method was in terms of cost in comparison with the previous "unit-based" process, a detailed cost analysis was undertaken. Each method was studied for one year, and the comparison revealed the all-day method was more viable from a cost perspective, as well as more beneficial from the participants' perspective.
Who Pays for Continuing Education in Nursing?
Authors: Schoen Delores C , Morgan Ann P
Published: April 2021

ABSTRACT

This study examines the determinants of employer support for attendance at nursing continuing education (CE) offerings. The experience of 1,171 nurses was examined in relation to their age, educational background, present job characteristics, and annual income. Position level and income were positively related to the extent of employer support. The findings were consistent with the view that employers support attendance at CB offerings based on professional status rather than the needs of nurses.
Teaching Family/Significant Other Nursing
Authors: Mayo Ann M
Published: April 2021

ABSTRACT

A family/significant other nursing education program for staff nurses can benefit staff, patients, families, and the organization. Recent Joint Commission on Accreditation of Healthcare Organizations (JCAHO) focus survey processes attempt to evaluate how nursing departments operationalize the JCAHO nursing standards. Nurses must be able to articulate and document their organization's policies and procedures regarding the nursing care standards, including those standards that address family and significant other needs.
Career Ladder Program
Authors: Guerrero Jann H , Hansen Mary Lou
Published: April 2021

ABSTRACT

In June 1990, Santa Rosa Children's Hospital instituted a multitrack career ladder program for registered nurses, in response to the issues of retention of expert nursing staff and development of professional nursing practice. The program incorporates clinical, education, and management tracks, providing vertical and lateral mobility to the registered nurse. Performance evaluation criteria complement the promotional process, and the registered nurse has a menu of requirements to fulfill each year upon promotion to or maintenance of career ladder level. Through incorporation of a graduated salary system, the program has been a retention bonus for registered nurses at Santa Rosa Children's Hospital. In addition, the career ladder program has been very successful in promoting professional nursing practice within the hospital.
Marketing University-Based Continuing Education Programs
Authors: Kuramoto Alice M
Published: April 2021

ABSTRACT

It is important for nursing educators engaged in the highly competitive business of continuing education (CE) to understand marketing educational programs. There has been hesitancy in using the word "marketing" in the educational setting; and it has only been recently that marketing directors have been hired at some universities to promote their educational programs. The author describes how marketing techniques and business strategies are used in educational settings, especially for marketing CE programs.
An Orientation Plan for Hospital-Based Case Managers
Authors: Kortbawi Patricia A
Published: April 2021

ABSTRACT

The key to a successful case management program is the case manager. This article is a description of a six-week orientation program provided for new case managers at St. Peter's Medical Center in New Jersey. The principal components of the program are basic content modules, addressing individual learning needs, specific teaching strategies, and a self-paced approach.
Hospitals and the Educational Institution: An Innovative Partnership for Nursing Specialty Education
Authors: Varcoe Colleen , Cresswell Seonag
Published: April 2021

ABSTRACT

Rapid technological and economic change require that educational institutions respond efficiently and effectively to the needs of the health care industry. Nurses demand education that is accessible, affordable, and relevant, and demand recognition for educational achievement in terms of credentials and financial rewards.

This article describes a partnership between British Columbia Institute of Technology (which is driven by and responds to industry) and The School of Health Science (which prepares nurses for speciality practice). The partnership permits a proactive relationship that utilizes the best qualities of both the health care and educational institutions. Although this alliance has been used extensively to prepare nurses for specialty areas, this partnership model could be implemented by a variety of institutions to meet educational needs in many health care professions.
Collaborative Preceptor Training: A Creative Approach in Tough Times
Authors: Williams Jane , Baker Grace , Clark Betty , Ehnis-Roebuck Carol , Gupta Lisa , Johnson Jackie , Nix M Louise , Petrillo Sherry Spear
Published: April 2021

ABSTRACT

Rapid changes in the health care environment have challenged educators to find more efficient methods of developing nurses. These demands are leading to the use of collaborative approaches to education. Nurse educators have also found that they have to rely on preceptors for orientation of new employees. The Texas Medical Center Collaborative Preceptor Program was developed in 1989 to prepare nursing preceptors for all nine participating institutions. The goals of the program were to increase efficient use of instructor time, standardize preceptor preparation in the Texas Medical Center, and offer more programs and prepare more nurses per year than each individual institution could do alone. There were many unexpected benefits as well, and future plans for collaboration are already being formulated.
Learning Environment: The Catalyst for Work Excitement
Authors: Lickman Patricia , Simms Lillian , Greene Connie
Published: April 2021

ABSTRACT

A recent study investigated the relationship between learning environment and work excitement among a group of nurses. In a secondary analysis of the original survey of 268 nurses, approximately 20% were very excited about their work. The learning environment variables (availability of learning opportunities; stimulating, motivating, challenging environment; and opportunity to work with other professionals) were found to be related to the level of work excitement among nurses. Results of this study suggest that enhancement of the learning environment can lead to higher levels of work excitement. Nurses in staff development can use the knowledge obtained in this study to assist nurses to find excitement in their work through new learning and work behaviors. The results suggest the importance of unitbased learning opportunities and flexible work groups that include other health professionals.
CE News
Authors: Anonymous
Published: April 2021

American Nurses Credentialing Center to Offer Informatics Certification
Acknowledging Preceptors: Not an Easy Task
Authors: Yonge Olive , Krahn Harvey , Trojan Lorraine , Wilson Sharon
Published: April 2021

ABSTRACT

Educators commonly discuss the need to reward nurse preceptors. A survey of 295 preceptors teaching nursing students found 118 nurses (36.6%) did not feel a reward was appropriate, while the remainder felt it was. When asked if they had enough support, 68 (22.9%) reported "no" and 213 (73%) reported "yes." Recommendations stemming from this research include: the need to redefine "reward" to be more congruent with the preceptor's perceptions; to provide acknowledgment to preceptors reflective of their educational and professional role; and to recognize that the ongoing communication and feedback with nursing faculty is a crucial factor in preceptors' perceptions of support.
Self-Efficacy Measurements: An Approach for Predicting Practice Outcomes in Continuing Education?
Authors: Murdock Jane E , Neafsey Patricia J
Published: April 2021

ABSTRACT

This study assessed the usefulness of measurements of self-efficacy in evaluating practice outcomes following a continuing education course in advanced practice pharmacology. Self-efficacy, a central construct in social-cognitive theory, refers to an individual's confidence in being able to perform a specific task to successful completion. The study demonstrated that a valid and reliable measure of self-efficacy could be developed from program objectives and used in conjunction with pre- and post-knowledge measures to gain a broader perspective of learning outcomes. Measurement of self-efficacy was a useful adjunct in postinstruction evaluation and may be a cost-effective alternative to longitudinal impact evaluation.
Networking for Educational Resources in a Rural Community
Authors: Hemman Eileen A , McClendon Beverly J , Lightfoot Shiloh F
Published: April 2021

ABSTRACT

Four community organizations in a geographically isolated area shared resources and collaborated in providing a continuing education program on trauma care to meet the needs of the healthcare community. The process, from initial needs assessment and educational design through the steps involved in program planning and implementation among coproviders, is outlined. Response was overwhelmingly positive from the participants.
COMMUNITY PSYCHIATRY AND SOCIETY
Authors: Rome Howard P
Published: April 2021

The professional identity of community psychiatry is a blend of the medical specialty and the secular morality. Up to now, this identity has been a mixture of the ambiguities inherent in these entirely dissimilar disciplines.
PSYCHIATRY IN INDUSTRY
Authors: Levinson Harry
Published: April 2021

There is a psychological contract paralleling any business contract. The interweaving of these, and a clear understanding of the complexities of the employee/management relationship is fundamental.
COMMON SEXUAL DYSFUNCTIONS
Authors: Hastings Donald W
Published: April 2021

Impotence for the man is like of female response for the woman.

His biggest problem: premature ejaculation.

Hers: coitus without orgasm.

He won't have conditions like vaginismus or dyspareunia.

But she, after all, may have the higher sexual potential.
TRANSSEXUALISM AND TRANSVESTISM
Authors: Stoller Robert J
Published: April 2021

They both cross-dress but for different reasons. The transsexual, disliking his male body, expresses his real feminine nature. The transvestite, accepting his malesness, enjoys the feel of his body under women's clothes.
mental factors and cardiovascular disease
Authors: Henry James P , Ely Daniel L , Stephens Patricia M
Published: April 2021

Psychosocial Factors Facilitating and Inhibiting the Influence of the Neuroendocrine Alarm Responses Upon the Course of Cardiovascular Disease
Self-Maintenance Skills
Authors: Zerbe Melissa , Hickey Tom
Published: April 2021

A Continuing Education Program for Geriatric Nursing*
MEET YOUR LEADERS
Authors: Anonymous
Published: April 2021

Meet the New Officers of the ANA Division on Gerontological Nursing
EQUINUS CONTRACTURE FOLLOWING BRYANT'S TRACTION
Authors: Clark Mary Williams , D'Ambrosia Robert D , Roberts John M
Published: April 2021

ABSTRACT: A case of a 14-year-old girl with both foot and hip sequelae secondary to the use of Bryant's traction at the age of 2 years, 8 months, is presented. It serves as a reminder of the dangers of Bryant's traction, which should be used with discretion, if at all.
SUPRACONDYLAR FRACTURE OF THE FEMUR AS A COMPLICATION OF THE PATELLAR TENDON BEARING CAST: A CASE REPORT
Authors: Kleinman Richard , Oda Marjorie , Horowitz Bruce
Published: April 2021

ABSTRACT: This article presents the history of a 19year-old man who underwent treatment for a compound fracture of the left tibia and fibula. While weight bearing in a patellar tendon bearing cast, the patient sustained a supracondylar fracture of the left femur. This particular complication was unreported previously and perhaps could be avoided in similar cases by stricter adherence to the principles of early weight bearing as outlined by Sarmiento and others.
HOSPITAL-ACQUIRED ASPERGILLUS FLAVUS INFECTION IN A SURGICAL WOUND: A CASE REPORT
Authors: Brook Itzhak , Aaron Roy K
Published: April 2021

ABSTRACT: This report describes a case of hospitalacquired Aspergillus flavus subcutaneous inflammation. The infection developed in a surgical wound and was cured by repeated debridement and amphotericin B therapy.

The rare occurrence of this inflammation is noted. Pressure and necrosis caused by casts may provide a favorable environment for the growth of Aspergillus organisms.
HIP FRACTURE: A REVIEW OF 1,166 CASES IN A COMMUNITY HOSPITAL SETTING
Authors: Russin Lester A , Russin Michael A
Published: April 2021

ABSTRACT: A consecutive series of 1,166 patients 50 years of age and older with acute hip fracture, treated at a community hospital over a 20-year period, is analyzed as to age, sex, type of fracture, associated diseases, and treatment in relation to mortality and morbidity. Mortality was 8.66% overall (6.58% for patients treated surgically, 30.39% for nonoperative patients). The postoperative complication rate for surgical patients was 21%. Associated diseases, type of treatment and delay prior to surgery were major factors contributing to mortality. It was found that a patient's survival chances are enhanced by adequate control of associated diseases prior to and following injury, early surgery, and competent treatment of the fractured hip. Also, the mortality rate for patients with fractured hips was found to be lower for patients treated in community hospitals than for patients treated in municipal or county hospitals.
MALIGNANT HEMANGIOENDOTHELIOMA OF BONE: A CLINICAL ANALYSIS OF 11 CASES TREATED AT HENRY FORD HOSPITAL
Authors: Wu Kent K , Guise Edwin R
Published: April 2021

ABSTRACT: This article describes the clinical manifestations, roentgenographic appearance, gross and microscopic pathologic features, treatments, and long-term results of 11 cases of malignant hemangioendothelioma of bone. The authors recommend that surgery, radiotherapy, and chemotherapy be integrated carefully and tailored to meet the needs of each individual patient.
THE DEVELOPMENT, TECHNIQUE, AND EARLY CLINICAL RESULTS OF TOTAL JOINT REPLACEMENT FOR THE METACARPOPHALANGEAL JOINT OF THE FINGERS
Authors: Steffee Arthur D , Beckenbaugh Robert D , Linscheid Ronald L , Dobyns James H
Published: April 2021

ABSTRACT: A metal-on-plastic semi-joined snaplock prosthesis has been developed for the metacarpophalangeal joint of the fingers. The components are cemented in place. Results were satisfactory in 55% of 160 joints replaced with the first design and in 86% of 272 joints replaced with an improved model that had a lower center of rotation. Pain was relieved in 94% of the patients and ulnar deviation was corrected in 87%. The current model is associated with motion that averaged -17° extensions to 63° flexion. Complications included infection in two patients, dislocation in two, and fracture of the component in two. Roentgenographic evidence of loosening of the distal components was seen in 18% of joints that had follow-up of more than one year, but such loosening has not as yet been symptomatic. Factors in cementing technique and prosthesis positioning have been identified which may decrease the rate of roentgenographic loosening.

Key Words: Total joint replacement; metacarpophalangeal joints; finger joints; metacarpophalangeal prosthesis; prosthesis for rheumatic diseases; finger prosthesis
TENDON REPAIRS WITH DACRON VASCULAR GRAFT SUTURE: A FOLLOW UP REPORT
Authors: Frazier Calvin H
Published: April 2021

ABSTRACT: This paper is a follow-up report on the subject of the use of dacron vascular graft material to repair major tendons. This paper examines the long term fate of one of these grafts, based on an examination at autopsy of an Achilles tendon repaired with this type of graft.
AN EVALUATION OF THREE CURRENT TECHNIQUES OF INTERNAL FIXATION FOR INTERTROCHANTERIC AND SUBTROCHANTERIC FRACTURES OF THE HIP
Authors: Richmond John C , Kazes John A , MacAuslane William R
Published: April 2021

ABSTRACT: The image intensifier has permitted the development of the technique of condylocephalic nailing for intertrochanteric and subtrochanteric fractures of the femur. This comparison between the sliding compression screw and Ender nails confirms the advantage of decreased operative time and blood loss with Ender nails. Our results show a high incidence of union in external rotation with shortening in those patients treated with Ender nails as compared with the other techniques. Adherence to the principles of reduction in valgus and internal rotation while filling the femoral shaft with Ender nails with prebent anteversion should decrease this problem. Three weeks of postoperative skeletal traction is recommended for subtrochanteric fractures treated with Ender nails.
THE PATELLAR SYNDROME-A COMPLICATION SECONDARY TO ENDOPROSTHETIC REPLACEMENT OF THE KNEE JOINT: A RETROSPECTIVE STUDY OF 102 KNEE JOINTS OVER A PERIOD OF SEVEN YEARS
Authors: Kohler Gerd , Richter Robert , Coldewey Johann F
Published: April 2021

ABSTRACT: Until recently, loosening, infection and fractures of the prosthesis have been considered the only major complications of otherwise good initial results with total endoprosthetic replacement of the knee joint; however, another serious long term complication has become apparent. Severe degenerative changes of the retropatellar cartilage are being observed, which seem to be caused by a possible axial malalignment of the knee, progression of a preexisting retropatellar arthrosis, and additional metallosis induced by the prosthesis. The resulting symptoms and complaints, in accordance with Debeyre, are summarized by the term Patellar Syndrome. Our studies indicate that these symptoms develop in 50% of all patients with a total knee endoprosthesis within three years after surgery. In 10% of the cases these symptoms are severe enough to require additional surgical intervention.
Application of Segmental Spinal Instrumentation
Authors: Flatley Thomas J
Published: April 2021

ABSTRACT: Segmental spinal instrumentation has been applied to three groups other than scoliosis. It has been used: 1) to treat fractures of the thoracic and lumbar spine; 2) to control instability secondary to malignant destruction; 3) as a closed loop to help stabilize lumbar instability secondary to degenerative disease. A case history ot each was presented. Complications in this series of 63 patients Included three Instances of broken wires, one broken rod, one partial loss of reduction due to wire migration and one deep infection two years postoperative. There was no absolute need for postsurgical immobilization.
High-Performance Activity With Below-Knee Cast Treatment, Part I: Mechanics and Demonstration
Authors: Nuzzo Roy M
Published: April 2021

ABSTRACT: Much of the disability associated with wearing a below-knee cast is a result of the treatment rather than the disease. A simple practice of placing thecasted limb in a shoe with a cushioned heel to tilt the cast so that the knee is ahead of the ankle at mid-stance reduces this disability. High-performance activity, including participation in sports, is possible in most (including bilateral) cases. Despite increased activity, this method reduces the incidence of cast failure. Healing does not appear to suffer and in some instances may be superior. Mechanics are discussed in Part I, including illustrative cases and comparative evaluation. Part Il will deal with methods of cast application as well as treatment groups that include fracture, Achilles rupture, idiopathic and spastic equinus (not excluding th ose with rocker deformity of the foot) , muscular dystrophy, and a newly proposed disease category made up of ailments that the author suspects share a common cause or aggravating aspect. This latter group includes Sever's disease, adolescent (and occasionally adult) Achilles tendinitis, shin splints, painful kneecaps, and flat feet. Methods of cast application differ for each group. Gait mechanics is reviewed to illustrate similarities when comparing function levels achieved by cast treatment with those achieved by orthotic or prosthetic management.
Infection Rate Following First-Time Joint Implants in 1978 at The New England Baptist Hospital: A Preliminary Report
Authors: Miley Gerald , Gagnon Richard N , Scheller Arnold , English Ellen , Potter Theodore
Published: April 2021

ABSTRACT: Followup of 390 first-time joint implants performed at the New England Baptist Hospital in 1978 was undertaken by means of chart review and postoperative letters to the patients and operating surgeons. There were three superficial and one deep infection. An overall infection rate of 1.03% was determined.
Hematogenous Proteus Mirabilis Osteomyelitis
Authors: Thorpe Michael A , Buckwalter Joseph A
Published: April 2021

ABSTRACT: Hematogenous gram negative infection of the long bones can present a confusing clinical picture that may delay treatment or lead to an inappropriate choice of initial treatment, and thereby compromise the resuit. This report emphasizes the common clinical features of this condition: previous urinary or gastrointestinal tract instrumentation, a long history of diffuse pain, swelling, and tenderness of the affected limb, weight loss and anorexia, and a potentially nondiagnostic radiographic appearance.
An Intrahepatic Abscess as a Rare Complication of a Pelvic Fracture from Blunt Trauma to the Abdomen
Authors: Fadel Jeffrey N , Ambach John W , Fitzpatrick James F , Liebert Carl W
Published: April 2021

ABSTRACT: An otherwise healthy young male sustained a non-displaced fracture of the pelvis in a blunt trauma from a motor vehicle accident. A fever developed on his second post injury day which led to discovery of an intrahepatic abscess by CAT scan. After blunt trauma to the abdomen, one must consider not only a retroperitoneal hematoma but also, subphrenic, subdiaphragmatic and intrahepatic abscess as its complication.
Three Dimensional Imaging of Bone From Analysis of Computed Tomography Data
Authors: Woolson Steven T , Fellingham Linda L , Dev Parvati , Vassiliadis Arthur
Published: April 2021

ABSTRACT: A computer system was developed to reconstruct three dimensional images of bone from analysis of computed tomography data. Images of bone can be made within minutes and rotated for viewing from any direction. An editing process allows visualization of the articular surfaces of any joint. Solid models of the bone images can be produced with an accuracy of 1 mm to 3 mm by interfacing the image data with a computer numerically controlled milling machine. This technology will provide better information to the surgeon for preoperative diagnosis and planning and for the design of customized implants.
Spongious and Cortical Osteoblastoma of the Axial Skeleton
Authors: Floman Yizhar , Milgrom Charles , Kenan Shmuel , Sabato Shabtai , Robin Gordon C
Published: April 2021

ABSTRACT: Eleven cases of osteoblastoma (spongious osteoblastoma) and four cases of osteoid osteoma (cortical osteoblastoma) involving the spine, diagnosed at Hadassah Hospital between 1970 and 1983 were analyzed. The age range was 7 to 34 years and the average clinical follow up was 63 months. The cervical spine was involved in four patients, thoracic in tour, lumbar in six and the sacrum in one patient. Back or neck pain associated with stiffness was present in all cases and was often accompanied by scoliosis or torticollis. All the patients with osteoid osteoma were symptom relieved by surgery without recurrence. Seven of the patients with benign osteoblastoma presented with neurological signs or symptoms and three of these had recurrence following primary surgery. Although cortical and spongious osteoblastoma are considered as members of the same family of benign tumors of osteoblastic derivation, spongious osteoblastoma does not seem to be limited in growth potential as is cortical osteoblastoma.
Epidemiology, Mortality and Morbidity in Multiple Trauma Patients
Authors: Gustilo Ramon B , Corpuz Vicente , Sherman Robert K
Published: April 2021

ABSTRACT: Three hundred, twenty-nine multiple trauma patients with skeletal injuries admitted to Hennepin County Medical Center, Minneapolis were analyzed for mortality and morbidity based on injury severity score (ISS) and timing of fracture stabilization. Fifty-three deaths (16%) occurred with 38% dying during the first six hours. Survival prospects with injury severity score over 40 were bleak. Agei sex, mechanism of injury, and time of occurrence of injury was also tabulated.

Two hundred, twenty-nine patients with 474 long bone fractures were analyzed based on timing of fracture stabilization: a) immediate stabilization within 24 hours; b) delayed primary stabilization over 24 hours to one week; c) secondary osteosynthesis more than one week; d) nonoperative treatment.

Respiratory distress syndromes occurred in 6%, 2.4%, 9%, and 12%; mortality rate of 3%, 0%, 6.4%, and 26% for treatment groups A, B1 C, and D respectively. However, it must be noted that treatment group B with lower ARDS and mortality rate had no type III open fractures and lower injury severity score.
RADIOLOGIC CASE STUDY
Authors: Luisiri Atchawee , Silberstein Michael J , Sundaram Murali , Graviss E Richard , Brodeur Armand E
Published: April 2021

Platyspondyly in Cushing's Syndrome
Free Vascularized Bone and Muscle Flaps for Osteomyelitis
Authors: Moore J Russell , Weiland Andrew J
Published: April 2021

ABSTRACT: Chronic, post-traumatic osteomyelitis remains an unsolved problem for orthopedists. With improved knowledge of skin and muscle flap circulation, surgeons are now capable of covering wide defects left by debridement. Early clinical experience with muscle and skin flaps to improve vascularity and achieve a stable, closed wound have been encouraging. Management of wounds with infected bone is primarily aimed at resection of infected or nonviable tissue. Antibiotics are of value, however are of secondary importance to a thorough debridement. It is uncertain as to whether osteomyelitis is a curable entity. However, free tissue transfer affords the surgeon the opportunity to perform a thorough debridement and achieve a stable closed wound.
Experimental Free Vascularized Epiphyseal Transplants
Authors: Bowen Vaughan
Published: April 2021

ABSTRACT: Growth plates have been transferred both clinically and in experimental models since the end of the 19th century. Results have been unpredictable and frequently unsatisfactory due to postoperative ischemia. Modern microvascular techniques have minimized this problem and preservation of growth plate structure and function has been reported after replantation and free tissue transfers in children and immature animals.

Experimental revascularized growth plate transplants were first reported in 1979. Viable orthotopic transfers are associated with rapid bony union, maintenance of radiological structure, and continued growth in length at near normal rates. Detailed studies have demonstrated a continuation of cell division, metabolic activities, and normal histology. Technetium bone scans have been a useful postoperative indicator of viability, and ischemic times of more than three hours can be tolerated.

The behavior of heterotopic transplants has not yet been fully studied. Early attempts suggest that biomechanical problems may be troublesome.
Head and Neck Carcinoma Metastases to the Hand and Foot: A Case Report of Simultaneous Involvement
Authors: Mess Dennis , Songer Matthew
Published: April 2021

ABSTRACT: Metastatic tumors to the foot are a rare phenomenon which are often initially misdiagnosed. This article reports two cases of head and neck carcinoma metastases to the foot which were initially diagnosed as infection. These tumors have not been reported previously as metastasizing to the feet. In addition, one of the cases had metastasis to the hand and foot. Only five previously reported cases of such a combination could be found in the literature.
Solitary Eosinophilic Granuloma of Bone Presenting With Only Referred Signs and Symptoms: A Case Report
Authors: Linson Marc A
Published: April 2021

ABSTRACT: An unusual case of solitary eosinophilic granuloma of rib in a young adult man is reported. He presented only with referred signs and symptoms distant from the lesion. This is a unique presentation and demonstrates the ubiquitousness of this disease when localizing signs and symptoms are absent.
SPORTS MEDICINE: The Use of Computerized Thermography in the Evaluation of Non-Traumatic Anterior Knee Pain
Authors: Siegel Mark G , Siqueland Karen A , Noyes Frank R
Published: April 2021

ABSTRACT: Computerized thermography was used to evaluate eight patients with the complaint of non-traumatic anterior knee pain. Computerized thermograms were recorded before and after subjects performed a specific rehabilitation program. Thermographic imaging was then repeated 4 weeks to 8 weeks after the initial thermogram. Among the subject group, thermal asymmetries were noted in the involved knees, but a specific abnormal thermal pattern could not be recognized. Changes in temperature and thermal patterns after exercise and over time were consistent within each subject, but were not consistent between subjects. Thermal asymmetries did not appear to resolve over time. It is felt that the pathology investigated by this study may involve many etiologies, therefore making it difficult to establish a single abnormal thermal pattern with regard to non-traumatic anterior knee pain.
Automatic Wire Twister
Authors: Smith Joseph F , Rodeheaver George T , Thacker John G , Morgan Raymond F , Chang Dillon E , Fariss Bruce L , Edlich Richard F
Published: April 2021

ABSTRACT: This automatic wire twister used in surgery consists of a 6-inch needle holder attached to a twisting mechanism. The major advantage of this device is that it twists wires significantly more rapidly than the conventional manual techniques. Testing has found that the ultimate force required to disrupt the wires twisted by either the automatic wire twister or manual techniques did not differ significantly and was directly related to the number of twists. The automatic wire twister reduces the time needed for wire twisting without altering the security of the twisted wire.
The Treatment of Intercostal-Brachial Neuromas by Posterior Intercostal Neurectomies: A Case Report
Authors: Hankin Fred M , Jaeger Scott H , Whiteneck Steven
Published: April 2021

ABSTRACT: The development of sensory neuromas in a postoperative field is a recognized and undesirable complication. Neuroma formation can impair patient cooperation and postoperative function. Treatment efforts are frequently unrewarding and may contribute to the patient's frustration. Intercostal-brachial neuromas which develop following first rib resections are representative of this problem. Posterior intercostal neurectomy may provide an alternative treatment modality.
Three Dimensional Imaging Techniques for the Reconstruction of a Complex Hip Problem: A Case Report
Authors: Kilgus Douglas J , Finerman Gerald A M , Kabo Michael
Published: April 2021

ABSTRACT: This report illustrates the use of three-dimensional imaging techniques to solve a difficult reconstruction problem of the hip. Custom prosthetic components manufactured by a computer-assisted design process are used in this procedure.
Double Contrast Arthrography of the Knee: A Comparison to Clinical Diagnosis and Arthroscopic Findings
Authors: Bonamo John J , Shulman Glenn
Published: April 2021

ABSTRACT: The accuracy of pre-arthroscopic double contrast arthrography was evaluated in 100 consecutive patients. Meniscal tears were correctly diagnosed arthrographically in 76% of cases, and clinically in 85% of cases. Although reasonably accurate in determining the location of the meniscal tear, arthrography was significantly inaccurate in the evaluation of the type of tear. The status of the anterior cruciate ligament was correctly interpreted by arthrogram in 76% of cases; the integrity of the ligament was correctly assessed in 94% of cases by clinical examination without anesthesia. It appears, therefore, when compared to initial clinical examination, double contrast arthrography is of limited usefulness as a pre-surgical aid to the diagnosis of intra-articular knee pathology.
Early Post-Surgical Prosthetic Limb Fitting in Dysvascular Below-Knee Amputees with a Pre-Fabricated Temporary Limb
Authors: Pinzur Michael S , Littooy Fred , Osterman Helen , Wafer David
Published: April 2021

ABSTRACT: Two consecutive series of patients undergoing below-knee amputation for peripheral vascular insufficiency were compared relative to the length of acute-care hospitalization and rehabilitation. The residual limb control group was treated with soft-surgical dressings and non-weight bearing ambulation with referral to the amputee clinic when the residual limb wound was "ready." The residual limb experimental group was treated with rigid plaster (cast) dressings with early post-surgical prosthetic limb fitting and progressive weight bearing ambulation.

Acute-care hospitalization following amputation surgery averaged 27.7 days in the control group, and 23.7 days in the treated group. Patients were either re-admitted or transferred to a rehabilitation unit where hospitalization averaged 42.9 days in the control group and 14.1 days in the treated group. This resulted in a cost savings of almost $15,000 per patient based on present hospital fees. The results of this study suggest that early post-surgical prosthetic limb fitting not only hastens recovery amputation, but can be safe and cost effective.
Skeletal Fluorosis: A Report of Two Cases
Authors: Bruns Brad R , Tytle Timothy
Published: April 2021

ABSTRACT: Two Illustrative cases of patients with skeletal fluorosis and classic radiographic changes are presented. One patient demonstrated a progressive paraparesis, while the other was diagnosed incidentally on routine radiographs. A review of the literature, treatment, and histologic findings are presented.
Cotrel-Dubousset Instrumentation
Authors: Shufflebarger Harry L , Clark Cynthia E
Published: April 2021

ABSTRACT: Cotrel-Dubousset Instrumentation (CDI) presents a diversified posterior implant system applicable in any situation requiring posterior spinal instrumentation. It acts in the three dimensions of the spine, frontalsagittal-axial. Correct hook site selection and direction provide spinal balance in three dimensions. The double major idiopathic scoliosis is an appropriate model on which to learn the principles of usage of CDI Results of CDI in a wide variety of spinal pathology have been excellent. There is a learning curve for CDI, hook placement being the most significant. Pitfalls and complications can be avoided.
The Wiltse Pedicle Screw Fixation System
Authors: Guyer David W , Wiltse Leon L , Peek Richard D
Published: April 2021

ABSTRACT: This article illustrates the application of the Wiltse pedicle screw fixation system and the general principles of pedicle screw insertion. The system is designed for stabilization of the lumbosacral spine. Indications, complications, and personal results are reviewed.
Wiring Techniques of the Posterior Cervical Spine for the Treatment of Trauma
Authors: Stauffer E Shannon
Published: April 2021

ABSTRACT: Surgical stabilization of the cervical spine for maintaining reduction and facilitating fusion following trauma may be accomplished by wiring the dorsal elements together. Twenty gauge (0.8 mm) 316L stainless steel surgical wire is the most convenient size to use. Meticulous atraumatic technique is necessary to reduce and fix the unstable spine in order to prevent damage to the spinal cord. Multiple wiring techniques of the upper and lower cervical spine are described and demonstrated, noting the advantages and disadvantages of each.