bluuebunny/crossref_metadata_2025 huggingface dataset:
How Effectively Do You Function in a Cardiac Arrest? A Creative Program Approach to Code Skills
Authors: Rivera Tiziana M , Gabriel Sharon
Published: April 2021

ABSTRACT

Novice and experienced nurses are consistently concerned about their knowledge, skills and abilities to function appropriately in arrest situations. The clinical teachers at Mount Sinai Hospital in Toronto have established an innovative, creative, practical and cost-effective workshop that addresses nurses' code skills. The 500 evaluations received from nurses who have attended the workshops show the program is a resounding success. The 4-hour workshop concentrates on the nurses' role during cardiac arrests in four key areas: leadership, drug administration, suctioning, and airway management. The program is complete with goals and objectives, props, specific evaluation forms, and a take-home examination. The hands-on component of the workshop allows the application of new information under close observation and supervision of knowledgeable and skilled clinical teachers.
Competence: An Evolving Concept
Authors: Nagelsmith Laurie
Published: April 2021

ABSTRACT

Formal and informal definitions of competence are the basis for building a useful understanding of the concept However, further dissection and analysis are necessary before the concept of competence can be rebuilt into a new and more meaningful whole useful in theory development and hypothesis generation around staff development and continuing education in nursing. Reflection, analysis, thought, perception, visualization, and contextualization of the concept of competence are the foci of this article.
Development of a Nursing Care Manual to Improve the Knowledge of Nurses Caring for Hospitalized Patients with Diabetes
Authors: Dunning Trisha
Published: April 2021

ABSTRACT

Nurses have a responsibility to ensure that they have adequate knowledge in order to provide competent care. A wide literature search failed to identify adequate documentation of the specific nursing care of people with diabetes, although the medical aspects are covered in detail. In addition, several papers document a deficiency of knowledge among nurses about diabetes and the appropriate care of patients with diabetes.

This project sought to address the apparent lack of documentation. The aim was to formulate a Manual of Nursing Care of People with Diabetes Mellitus (the manual), to be used as a self-directed learning resource in the clinical setting. This article reports the development and evaluation of the manual.
Nursing Informatics: The Trend of the Future
Authors: Nagelkerk Jean , Ritola Patricia M , Vandort Patti J
Published: April 2021

ABSTRACT

Nursing informatics is a combination of computer, information, and nursing sciences. This new and expanding field addresses the efficient and effective use of information for nurses. Preparing nurses for computerization is essential to confront an explosion of sophisticated computerized technology in the workplace. It is critical in a competitive health care market for preparing nurses to use the most cost-effective methods. A model is presented that identifies six essential factors for preparing nurses for computerization. Strong leadership, effective communication, organized training sessions, established time frames, planned change, and tailored software are the essential factors to consider for development of a successful educational program.
A Gaming Strategy for Teaching the Use of Critical Cardiovascular Drugs
Authors: Saethang Tessie , Kee Carolyn C
Published: April 2021

ABSTRACT

This article reports the use of a successful strategy for teaching non-critical care nurses how to safely administer critical cardiovascular drugs. The use of a gaming technique to accomplish this, accompanied by a caricature case study, is described in detail. Participants' evaluations evidenced a high degree of satisfaction and enjoyment in learning the pharmacological content. Readers can adapt this game to other learning topics for rapid and effective learning of material specific to their institutions.
National Training for a New Nurse Staffing Resource Management Methodology
Authors: Blazey Mary E , Williams Margaret M
Published: April 2021

ABSTRACT

The Veterans Affairs (VA) nursing services has implemented a new resource management methodology for determining nurse staffing based on the expert judgment of panels of nurses. This article describes how two educators worked with a development task force to design and implement a national education program to prepare 172 individual health care facility coordinators to implement the methodology. The education program was based on a systems approach emphasizing data collection and analysis, consensus building, and expert decision-making. Two pilot programs were conducted and recommendations resulted in a series of 1 ½-day training sessions conducted across the United States.
UNUSUAL LESIONS OF THE PATELLA
Authors: Weinert Carl R , Wiss Donald A
Published: April 2021

ABSTRACT: Degenerative or traumatic disorders of the patellofemoral articular cartilage are the usual cause of patellar pain. However, a wide variety of diseases may occasionally affect the bony center of the patella and closely mimic articular disease. Three cases, one each of giant cell tumor, metastatic carcinoma and monostotic Paget's disease are presented, with a review of the pertinent literature to illustrate the diversity of nonarticular disorders which should be considered in the differential diagnosis of patellar pain.
EPIPHYSEAL GROWTH PLATE FRACTURE-SEPARATIONS: A PATHOPHYSIOLOGIC APPROACH
Authors: Shapiro Frederic
Published: April 2021

ABSTRACT: The physiologic events in epiphyseal growth plate fracture-separations that lead to growth disorders relate to 1) destruction of the epiphyseal circulation, and 2) communication between the epiphyseal circulation with its osteoprogenitor cells and the metaphyseal circulation with its osteoprogenitor cells, thus forming a bone bridge. A pathophysiologic classification of growth plate injuries based on these criteria is presented. Such injuries are classified currently on a pathoanatomic basis defined by the pathway of breakage as seen radiologically. A review of 1,300 cases from the literature outlines the pathoanatomic types at each epiphysis and their results. By superimposing the pathophysiologic classification on the pathoanatomic classification, such injuries can be considered on the basis of the cellular events that are the main determinants of the end results.
Arthroscopic Meniscal Repair
Authors: Clancy William G , Graf Ben K
Published: April 2021

ABSTRACT: Repairs of peripheral meniscus tears have been shown to be an effective and successful procedure. Arthroscopic instruments and techniques have been improved to allow for the repair of some of these tears. Two techniques have been utilized by the authors in a limited number of cases with excellent results to date.
Laser Energy in Arthroscopic Meniscectomy
Authors: Whipple Terry L , Caspari Richard B , Meyers John F
Published: April 2021

ABSTRACT: Rationale and technique are discussed for performing arthroscopic meniscectomy with a carbon dioxide laser, including presentation of findings in limited rabbit and human studies.
External Callus Formation of Closed Femoral Shaft Fractures Treated by Medullary Fixation
Authors: Kernek Clyde B , Robs John A
Published: April 2021

ABSTRACT: Various radiographic patterns were observed for external callus formation of closed femoral shaft fractures treated by dosed and open medullary Rush pin fixation. Closed pinning tends to form more adequate lateral callus, to have less looping of bridging callus over the cortex, and to form smooth, dense caiius. Open pinning tends to form less lateral callus, to have more looping (radiolucent space under callus) of the callus over the cortex and fracture site, and to have areas of exuberant callus with the appearance of myositis ossificans. The circulatory status of the cortex and soft tissues seem to be a factor in these callus patterns. Avascular cortex of shaft fractures is interred by the radiographic findings of bridging callus loops over the cortex, relative increased density of cortical bone, and resorption of cortical bone.
Diagnostic and Operative Arthroscopy of the Hip
Authors: Eriksson Ejnar , Arvidsson Inga , Arvidsson Hakan
Published: April 2021

ABSTRACT: Diagnostic and operative arthroscopies of the hip joint have been performed from an anterior approach after extension of the joint. The force needed to achieve a sufficient visualization of the hip joint was studied. In an anesthetized patient 300 Newtons (N) to 500 N was required, whereas up to 900 N was needed in an unanesthetized subject to achieve sufficient joint extension. Hip arthroscopy has been performed with a standard 5 mm SiOTZ arthroscope. Alternatively, fluid and gas was used. It was possible to achieve good visualization of the anterior parts ol the hip. Gas gave better information about the degree of degenerative arthritis while fluid was preferable for operative arthroscopy, eg, arthroscopic synovectomy. Synovial biopsies, removal of loose bodies, and partial arthroscopic synovectomy have been performed. The advantage was a very short time of rehabilitation. No serious complications occurred.
Reconstruction of the Posterior Cruciate Ligament
Authors: Eriksson Ejnar , Häggmark Tom , Johnson Robert J
Published: April 2021

ABSTRACT: Presented is a three to eight year follow up of reefing of the posterior cruciate in 20 cases, and reconstruction of the posterior cruciate with a patellar tendon, quadriceps tendon flap as a "reversed Jones' procedure" in 10 cases. Using the reefing procedure, there were six excellent results, ten acceptable, and four poor results. The reconstruction resulted in no excellent results, six acceptable, and four unchanged. Further improvements in present techniques are necessary before satisfactory results following reconstruction of lhe posterior cruciate ligament can be routinely expected.
New Techniques for Arthroscopic Surgery of the Ankle: Preliminary Report
Authors: Guhl James F
Published: April 2021

ABSTRACT: The history of the development of techniques for arthroscopy of the ankle up to the 1980s was reviewed. The author's early experience with ankle arthroscopy and surgery is analyzed and illustrated to show how the need for better access to this joint, particularly posteriorly, led to the development of these methods. Laboratory work was done to prove their safety. Materials and methods are shown. Steps for performing both techniques are described in detail. A protocol has been developed for study and analysis of a series of patients to be reported at a later date. This should further verify the safety of the above. The end results with the employment of these techniques and of the final operative long-term results will be submitted. Methods for the prevention of complications were developed. This study, therefore, should establish better indications, as well as safer and far better means of performing diagnostic and operative arthroscopy of the ankle joint.
Clinical Basis for a Mechanical Etiology in Adolescent Blount's Disease
Authors: Beskin James L , Burke Stephen W , Johnston Charles E , Roberts John M
Published: April 2021

ABSTRACT: The exact etiology and treatment of adolescent Blount's disease remains uncertain. In this study, the clinical and radiographic characteristics of eight consecutive patients (ten knees) with late onset tibia vara are reviewed to identify common features suggestive of aberrant mechanical forces causing their deformity. Consistent clinical features include progressive varus during the adolescent growth spurt and gross obesity. All patients were black, most were males with unilateral disease, and the only female patient had bilateral involvement. All were symptomatic cases, but in no case was trauma the cause of their disease. In addition, measurements of the physeal widths of the proximal tibia and distal femur on preoperative x-rays demonstrate consistent characteristics compatible with aberrant forces predicted by Heuter-Volkman and Delpech's laws. The clinical findings along with our surgical results confirm that these patients are best treated by corrective osteotomy to neutral mechanical axis and that overcorrection is unwarranted.
Case Report of a Rare Mallet Finger Injury
Authors: Cohn Bruce T , Froimson Avrum I
Published: April 2021

ABSTRACT: Mallet finger injuries are commonly seen in the emergency room and the treatment is usually simple, consisting of extension splinting of the DIP joint. The hyperextension mallet finger is a rare variant. The diagnosis can be made if the fracture fragment involves more than 50% of the joint surface. For this injury splinting is inadequate and open reduction is the treatment of choice.
Atraumatic Osteolysis of the Distal Clavicle: Histologic Evidence of Synovial Pathogenesis: A Case Report
Authors: Brunet Michael E , Reynolds Mary C , Cook Stephen D , Brown Thomas W
Published: April 2021

ABSTRACT: Osteolysis of the distal clavicle was diagnosed in a young male athlete following many years as a baseball pitcher with a supplementary weightliftlng program. There was no history of ligamentous injuries, contusions, fractures or separation of the acromioclavicular joint. As such, this case was categorized as "atraumatic" osteolysis. Non-decalcified histologic sections from the resected clavicle suggest that the pathogenesis of this atraumatic osteolysis arose from the synovium.
The Effect of the Radial Head and Prosthetic Radial Head Replacement on Resisting Valgus Stress at the Elbow
Authors: Pribyl Charles R , Kester Mark A , Cook Stephen D , Edmunds J Ollie , Brunet Michael E
Published: April 2021

ABSTRACT: Five fresh nonembalmed elbows were tested for resistance to valgus stress in their anatomic state, after radial head resection, and after insertion of Silastic® and polymethylmethacrylate (PMMA) radial head replacements. The resistance to valgus stress was found to be reduced an average of 28% after radial head resection. The PMMA and Silastic® implants restored valgus stiffness an average of 86% and 78% respectively, as compared to intact elbow values for corresponding flexion angles.

Testing in pronation, supination and neutral forearm rotation demonstrated no difference in valgus stiffness. For each elbow, resistance to valgus stress was greatest at full extension and dropped approximately 30% at all other flexion angles as compared to corresponding full extension value.

These data support the concept of the radial head as a stabilizer to valgus stress in the in vitro elbow. Further, this data demonstrated the ineffectiveness of current radial head replacement systems in restoring this biomechanical function and suggest that the use of a stiffer implant material may be beneficial in resisting valgus stress. Additional testing is indicated to determine the performance of a stiffer implant at the clinical and biological levels.
HETEROTOPIC BONE FORMATION AFTER TOTAL HIP ARTHROPLASTY IN PATIENTS WITH PRIMARY OR SECONDARY COXARTHROSIS
Authors: Kjærsgaard-Andersen Per , Hougaard Kjeld K , Linde Frank , Christiansen Svend Erik , Jensen Jørn
Published: April 2021

ABSTRACT

Heterotopic bone formation was investigated in 392 Charnley low-friction total hip arthroplasties. A multivariate linear regression analysis was used to account for the influence of co-variables: sex, age at surgery, postoperative treatment with antiinflammatory drugs during at least the first 2 weeks, and previous ipsilateral hip surgery. A total of 232 hips had been treated for primary coxarthrosis, and 114 and 46 hips for secondary coxarthrosis due to congenital dislocation and fracture-dislocation of the hip, respectively. None of the hips with primary coxarthrosis previously had ipsilateral hip surgery, whereas 41 hips (36%) in patients with congenital dislocation of the hip and 28 hips (61%) in patients with fracture-dislocation of the hip had one or more ipsilateral surgical procedures prior to the arthroplasty. The sex ratio varied between the groups, with a male:female hip ratio of 1:1, 1:10, and 3:1 for the three groups, respectively. The risk of developing grades 2 or 3 heterotopic ossification after total hip arthroplasty were significantly higher in men, patients without postoperative treatment with antiinflammatory drugs, and patients above age 60. In contrast, the analysis documented that previous ipsilateral hip surgery and type of coxarthrosis did not influence lesion development, supporting the theory that a systemic, rather than local factor, is responsible for the development of heterotopic bone formation after total hip arthroplasty.
CONGENITAL VERTICAL TALUS: SURGICAL CORRECTION BY A ONE-STAGE MEDIAL APPROACH
Authors: Schrader Lawrence F , Gilbert Robert J , Skinner Stephen R , Ashley R Kirklin
Published: April 2021

ABSTRACT

A single stage procedure for correction of congenital vertical talus using a medial approach is described. The operation was performed on 14 feet with good initial anatomical results in all cases. No wound healing complications were observed.
CLOSED TREATMENT OF CANINE NONUNIONS BY CONTROLLED COMPRESSION AND DISTRACTION USING AN ILIZAROV FIXATOR: A PRELIMINARY STUDY
Authors: Kummer Frederick J , Meislin R J , Pankovich A , Frankel V H
Published: April 2021

ABSTRACT

The Ilizarov fixator was used for closed treatment of canine nonunions by controlled compression and distraction. The fibrous matrix and cartilage formed within the nonunion site transformed to osteoid and bone with increased vascularity. Healing was demonstrated by substantia] bone bridging the nonunion at 6 weeks. The Ilizarov method appears to be a viable treatment for nonunions.
Isolated Closed Diaphyseal Fractures of the Femur in Children: Comparison of Effectiveness and Cost of Several Treatment Methods
Authors: Clinkscales Carlton M , Peterson Hamlet A
Published: April 2021

ABSTRACT

The effectiveness of several treatment modalities for isolated closed femur fractures in children ages 4 through 16 years is compared based on outcome (clinical results, morbidity, and parents' satisfaction) and cost. Between 1986 and 1993, 30 patients were treated. Treatment methods included immediate hip spica cast application, distal femoral skeletal traction pin to align the fracture followed by early hip spica cast incorporating the pin (6th day), in-hospital traction, primary external fixation, and primary intramedullary nailing. Average follow up was 4.1 years.

Overall results were excellent with minimal morbidity for all treatment methods. Early application of hip spica cast with or without incorporation of the distal femoral traction pin required the fewest hospital days, the shortest time to union, and had the lowest overall cost. Complications, mainly malunion and femoral length discrepancy, however, were greater. Skeletal traction resulted in the longest hospital stay and was equal in cost to external fixation and intramedullary nailing. Primary external fixation appears most applicable in patients who are unlikely to tolerate early casting and who are at increased risk of avascular necrosis with femoral nailing. Patients treated with an intramedullary nail had the fewest complications. Age, size, and gender of patient, location and type of fracture, as well as social circumstances are all significant factors in choosing the optimal method of treatment.
The Theory of Early Loosening of Hip Prostheses
Authors: Mjöberg Bengt
Published: April 2021

ABSTRACT

The issue of prosthetic loosening is currently a matter of debate, particularly with regard to the timing and nature of the precipitating events. The theory presented here postulates that loosening begins at an early stage due to either insufficient initial fixation or early loss of fixation. The loosened prosthetic component is then affected by varying degrees of mechanical stress associated with normal daily activity, which differs according to patient characteristics (body weight and level of physical activity) and the components used (prosthetic design, positioning, friction, and wear). This theory of early loosening can explain without supplementary ad hoc assumptions the rapid early prosthetic migration detected by roentgen stereophotogrammetry, the development of focal osteolysis and wear granulomas, the phenomenon known as stress-shielding, and, to a great extent, the epidemiology of clinical failure.
The Proximal Porous Coating Alternative for Primary Total Hip Arthroplasty
Authors: Head William C , Mallory Thomas H , Emerson Roger H
Published: April 2021

Primary Femoral Fixation Options
Femoral Neck Fractures: To Pin or Not
Authors: Cabanela Miguel E
Published: April 2021

Primary Hip Arthroplasty: Operative Management Problems
Total Hip Arthroplasty Following Acetabular Fracture
Authors: Berry Daniel J
Published: April 2021

Primary Hip Arthroplasty: Operative Management Problems
Structural Femoral Allografts: A Last Hope
Authors: Head William C
Published: April 2021

Revision Total Hip Arthroplasty: Fixation Options & Outcomes
Hip Challenges: What Would You Do?
Authors: Dorr Lawrence D
Published: April 2021

Case Challenges in Hip & Knee Surgery
Magnetic Resonance Imaging of Tuberculous Spondylitis
Authors: Akman Senol , Sirvanci Mustafa , Talu Ufuk , Gogus Abdullah , Hamzaoglu Azmi
Published: April 2021

Abstract

The clinical and imaging findings of patients with a confirmed diagnosis of tuberculous spondylitis were retrospectively analyzed to assess the diagnostic value of magnetic resonance imaging (MRI) and determine the different patterns of spine involvement. Fifty-three patients with plain radiographs and MRI of the entire spinal column were included in the study. Sagittal T1- and T2-weighted MRIs of the entire spine and axial T1- and T2weighted MRIs at the levels of interest were retrospectively evaluated. Plain radiographic correlation was obtained in all patients. The lower thoracic and thoracolumbar spine was the most commonly involved region.

Magnetic resonance imaging is effective in the early diagnosis of tuberculous spondylitis. It also detects lesions, which may not be apparent on plain radiographs.
Refracture Following Plate Removal in Supracondylar-Intercondylar Femur Fractures
Authors: Davison Brian L
Published: April 2021

Abstract

In a study of 41 supracondylar-intercondylar femur fractures treated with open reduction and plate fixation, 1 5 patients requested plate removal due to lateral knee pain over the hardware. A refracture of the distal femur occurred within 1 0 weeks of hardware removal in 4 (27%) of 15 patients. All refractures occurred during normal functional activities. Patients who request hardware removal following union of a distal femur fracture treated with open reduction and plating should be informed of the possibility of refracture.
Overdiagnosed Sciatica and Stenosis, Underdiagnosed Hip Arthritis
Authors: Swezey Robert L
Published: April 2021

Abstract

A retrospective analysis of 43 consecutive patients with hip osteoarthritis was performed. Twenty-four patients had previously been diagnosed with hip osteoarthritis, and 19 were treated solely for coexistent spine-related disorders without recognition of hip osteoarthritis. Four of 19 patients had previous spinal surgery for sciatica or spinal stenosis, 6 of 19 had epidural injections, 17 of 19 had magnetic resonance imaging or computed tomography, and 3 of 19 had electrodiagnostic studies.
Does Morbid Obesity Negatively Affect the Hospital Course of Patients Undergoing Treatment of Closed, Lower-Extremity Diaphyseal Long-Bone Fractures?
Authors: Baldwin Keith D. , Matuszewski Paul E. , Namdari Surena , Esterhai John L. , Mehta Samir
Published: April 2021

Obesity is prevalent in the developed world and is associated with significant costs to the health care system. The effect of morbid obesity in patients operatively treated for long-bone fractures of the lower extremity is largely unknown.

The National Trauma Data Bank was accessed to determine if morbidly obese patients (body mass index >40) with lower extremity fractures have longer length of hospital stay, higher cost, greater rehabilitation admission rates, and more complications than nonobese patients. We identified patients with operatively treated diaphyseal femur (6920) and tibia (5190) fractures. Polytrauma patients and patients younger than 16 years were excluded. Morbidly obese patients were identified by ICD-9 and database comorbidity designation (femur, 131 morbidly obese; tibia, 75 morbidly obese). Patients meeting these criteria who were not morbidly obese were used as controls. Sensitivity analyses were performed to analyze patients with isolated trauma to the tibia or femur. Morbidly obese patients were more likely to be admitted to a subacute facility. Length of stay trended higher in morbidly obese patients. There was no significant relationship between obesity and inpatient mortality or inpatient complications. These trends held true when considering patients with multiple injuries and patients who had isolated long-bone injuries.

Our study showed that morbidly obese patients may have greater rehabilitation needs following long-bone fractures in the lower extremity. Our study showed no difference in mortality or complications, although further studies are needed to confirm these findings.
Contact Pressure Comparison of Proud Osteochondral Autograft Plugs Versus Proud Synthetic Plugs
Authors: Harris Joshua D. , Solak Kraig K. , Siston Robert A. , Litsky Alan , Richards Jason , Flanigan David C.
Published: April 2021

Osteochondral autograft transfer is an accepted treatment for chondral and osteochondral defects of the knee. Synthetic plugs may eventually be used for primary treatment of defects. Currently they are largely used for osteochondral donor site backfill. Placement of osteochondral or synthetic plugs proud leads to articulating surface incongruity, increases in contact pressure, and potential for both plug and opposing surface degenerative change.

We conducted a biomechanical study of human cadaver knees to determine whether differences exist in the contact pressure of osteochondral autograft plugs placed proud versus synthetic plugs placed proud. Ten human cadaveric knees were used (20 condyles). Contact pressure was measured with Tekscan sensor technology (South Boston, Massachusetts) with both static and cyclical loads (of 250 and 500 cycles) created by an MTS Bionix system (Eden Prairie, Minnesota) under the following conditions: native articular cartilage, surgically created defect (7-mm diameter), 1-mm proud osteochondral autograft, and 1-mm proud synthetic graft. Proud osteochondral autograft plugs resulted in a 21.4% increase in peak contact pressure over surrounding native articular cartilage versus a 4.9% increase with proud synthetic plugs. Synthetic plugs compressed their structure and subsided versus subchondral bone collapse with compressive load in osteochondral autograft plugs. Proud osteochondral autograft plugs have significantly higher peak contact pressures than proud synthetic plugs when placed for treatment of chondral and osteochondral defects in the knee.
Long-Term Results of Bulk Femoral Head Autograft in Cementless THA for Developmental Hip Dysplasia
Authors: Saito Shu , Ishii Takao , Mori Sei , Hosaka Kunihiro , Nemoto Naho , Tokuhashi Yasuaki
Published: April 2021

We evaluated the fate of bulk femoral head autograft in cementless total hip arthroplasty (THA) for developmental hip dysplasia. Of 87 hips (80 patients) studied, 37 hips (32 patients) were available for follow-up at a mean of 18.5 years (range, 15–24 years) postoperatively. The mean age of these 32 patients at the index procedure was 53.8 years (range, 40–65 years). The initial diagnosis was osteoarthritis in all 32 patients. The degree of acetabular dysplasia according to Crowe classification was type I in 18 hips (48.6%), type II in 14 (37.8%), type III in 5 (13.5%).

The mean percentage of horizontal coverage of the acetabular components with graft bone was 34% (range, 25%–45%). Trabecular bridging across the graft–host interface was seen at a mean of 4 months (range, 2–6 months) postoperatively. Trabecular reorientation of the grafted bone was seen in all hips at a mean of 27 months (range, 12–36 months) postoperatively. There was no evidence of collapse and bony resorption of the grafted bone in the weight-bearing portion. Acetabular component fixation was stable in all hips at final follow-up. Of the 37 hips (32 patients), 2 acetabular components required revision: 1 for a late postoperative deep infection and 1 for dissociation of the polyethylene liner. The survival rate was 94.5% (95% confidence interval, 91.3–96.5) for the acetabular component at 18.5 years of follow-up.

This study found that bulk femoral head autograft in cementless THA for developmental hip dysplasia produces excellent long-term results.
A Synovial Osteochondroma Replacing the Anterior Cruciate Ligament at the Intercondylar Notch
Authors: Chung Jong-Won , Lee Soon-Hyuck , Han Seung-Beom , Hwang Hyun-Jung , Lee Dae-Hee
Published: April 2021

A woman presented with knee pain and locking. Pain was exacerbated at the end of the range of motion, especially during extension, with locking symptoms similar to those associated with a meniscus bucket handle tear. Ligamentous laxity was not definite. Plain radiographs showed multiple calcified loose bodies. Magnetic resonance imaging (MRI) showed a lobulated mass that was hypointense to muscle on T1-weighted sequences and hyperintense to muscle on T2-weighted sequences in the anterior cruciate ligament (ACL). Arthroscopically, multiple loose bodies were observed in the intercondylar notch and posterolateral compartment. A huge mass replaced the normal ACL and was caught in the intercondylar notch. The mass in the intercondylar notch caused loss of extension range of motion (ROM) because the piece caused a mechanical blockage. However, the loss of flexion ROM was likely caused by a loss of elasticity of the ligament rather than mechanical blockage. We resected the ACL mass, and removed the free bodies from the posterolateral corner. It was not possible to preserve the ACL fibers. Histological examination confirmed a diagnosis of osteochondromatosis. All symptoms resolved postoperatively. At 20 months postoperatively, the patient was pain free and had regained full knee motion without recurrence evidenced by follow-up MRI. However, ACL removal caused the knee instability. To date the patient has not undergone ACL reconstruction because she prefers conservative treatment and has experienced little discomfort in activities of daily living. To our knowledge, this is the first report to describe synovial osteochondromatosis wholly replacing the ACL fibers and causing mechanical blocking of both extension and flexion.
Hoffa Fracture in a 14-Year-Old
Authors: Flanagin Brody A. , Cruz Aristides I. , Medvecky Michael J.
Published: April 2021

Coronal shear fractures of the femoral condyle (ie, Hoffa fracture) are an uncommon clinical entity typically seen in adults after higher-energy trauma. Historically poor outcomes have been reported in the literature with nonoperative treatment of these fractures. Conversely, open reduction and internal fixation of these fractures has been shown to produce good long-term clinical results in adults. These fractures appear to be even more uncommon in skeletally immature patients, with only 3 case reports documented in the literature to date. Two of the 3 cases presented as a symptomatic nonunion after initial nonoperative treatment. Herein we present a case report of a Hoffa fracture of the lateral femoral condyle in a 14-year-old boy after a wrestling injury. The fracture was treated with diagnostic arthroscopy followed by conversion to an arthrotomy for open reduction and internal fixation. Rigid fixation of the fracture was obtained with 4 headless compression screws. Twelve months postoperatively, the fracture was radiographically healed and the patient was pain free with restoration of full knee motion and return to sporting activity. The Hoffa fracture is a unique and relatively uncommon clinical entity that has a different personality than other intra-articular fractures of the knee in both adults and children. Instability of the fracture fragment can lead to a higher likelihood of nonunion with persistent pain and disability. These fractures should be treated with open reduction and internal fixation to achieve anatomic reduction with stable fixation and preservation of the blood supply to achieve early, active mobilization. We believe this optimizes the chance for good long-term functional results.
Total Hip Arthroplasty with Ceramic-on-Ceramic Bearing Failure from Third-Body Wear
Authors: Bonnaig Nicolas S. , Freiberg Richard A. , Freiberg Andrew A.
Published: April 2021

This article describes a new mechanism of failure of a ceramic-on-ceramic total hip arthroplasty (THA) due to fretting corrosion and failure of the Morse taper. A 46-year-old man with hip osteonecrosis underwent THA in 2006. A ceramic-on-ceramic, un-cemented THA with a titanium femoral component and metal-on-ceramic Morse taper was implanted.

Two years postoperatively, he presented with swelling in his groin and a painless medial thigh mass. The thigh mass was diagnosed as an abscess. Incision and drainage was performed and resulted in a sinus tract that continuously drained copious amounts of seropurulent fluid. Two months later, the patient underwent irrigation, debridement, and explantation of his hip. Frozen sections showed no signs of infection. There was dramatic visible wear of the Morse taper and pieces of metal embedded in the ceramic. Permanent sections showed chronic inflammation and foreign body reaction. He subsequently underwent an uneventful re-implantation with a metal-on-highly-cross-linked-polyethylene THA.

In this case, failure of the morse taper led to metal debris, which reacted with the ceramic and caused dramatic third-body wear. The thigh mass, which appeared to be an infection, proved to be a massive foreign body granuloma. Malfunction of the morse taper as reported in this case represents a possible failure mechanism of a ceramic-on-ceramic THA.
Educating the Nursing Profession for Role Transformation
Authors: Weiss Sandra
Published: April 2021

ABSTRACT

This article proposes the use of a role transformation model to facilitate the assumption of more progressive attitudes and more autonomous, responsible behavior by nurses. Five major areas of content which need to be addressed in the role transformation process are detailed: 1) Defining and Articulating the Nursing Domain, 2) Legitimizing the Nursing Profession, 3) Communicating in Professional rather than Non-professional Modes, 4) Negotiating Collaborative Roles, and 5) Cultivating the Organizational Network. Emphasis is placed on the responsibility of nursing educators to model and facilitate role transformation for students and nursing colleagues.
Learning Style Preferences and Selection of Learning Strategies: Consideration and Implications for Nurse Educators
Authors: Ostmoe Patricia M , Van Hoozer Helen L , Scheffel Annette L , Crowell Carolyn M
Published: April 2021

BEIEFS
Role-Orientation Change Among RNs in an Upper-Division Level Baccalaureate Program
Authors: Whelan Elaine Gilligan
Published: April 2021

ABSTRACT

Using the Corwin Role-Orientation Instrument as modified by Dr. M.E. Bevis, the author conducted a study within an upper division level Baccalaureate Nursing Program to determine the extent to which students were "professionalized" in the process of attaining a BS in Nursing. The study design involved a cross-sectional sample of entering and exiting students within the same university program. In addition to assessing the students for their role-orientations, personal and demographic data were collected in order to compare the respective student groups for profile similarities and differences. Analysis of the data collected suggested some similarities between the student groups in terms of such variables as age dispersion, sex, and basic nursing preparation. Differences detected between the groups included marital status, amount of clinical experience, educational goals, and career goals. Statistical analysis is presented to describe the distribution of scores attained by the two groups on the Corwin Role-Orientation Instrument. Responses to the 22-item questionnaire determine the extent to which the subject has a "bureaucraticorientation," a "service-orientation," and a "professional orientation." In this study, students who were about to graduate from the upper division level Baccalaureate Nursing Program hold a role-orientation which is less bureaucratic, more professional and more service oriented than their entering counterparts.
Problems in the Development, Use and Testing of Nursing Theory
Authors: Engstrom Janet L
Published: April 2021

ABSTRACT

This paper identifies and describes seven areas of difficulty in the development, use, and testing of nursing theory. These problems are as follows: (1) the belief that there are absolute truths about nursing and that these truths can be found; (2) a lack of understanding of the definition and functions of theory; (3) the notion that there is only one theory of nursing and that this theory can account for all nursing activities; (4) the belief that members of the profession must all agree on the theory or theories that should be used; (5) the failure to empirically validate the theories that have been developed; (6) the failure to allow for modification of existing theories; and, (7) the failure to develop theory from and relate theory to clinical practice.
Professionalism Among Nurse Educators
Authors: Schriner Janet G , Harris Isabel
Published: April 2021

ABSTRACT

Three hundred seventy nurse educators who teach in a midwestern state in nursing education programs participated in a mailed survey to investigate the relationship of educational preparation of faculty to their attitude on professionalism. Hall's 25-item Professional Scale was used to measure the dependent variables of autonomy, use of the professional organization as a major referrant, belief in the public service nature of nursing, belief in self-regulation and sense of calling to the field, and the independent variable educational preparation of the nursing faculty member. There were very few significant differences among nurse educators when grouped according to highest level of education. Mean scores on the attitudinal components of professionalism, however, illustrated a consistent pattern of the higher the educational preparation, the higher the attitudes on professionalism. Implications for further study are discussed.
Value Analysis: A Method for Teaching Nursing Ethics and Promoting the Moral Development of Students
Authors: Frisch Noreen Cavan
Published: April 2021

ABSTRACT

In an investigation of junior-level baccalaureate nursing students, the value analysis teaching strategy was used to teach content related to nursing ethics. It was hypothesized that such a strategy, which emphasized the need for careful evaluation and weighing of facts preparatory to drawing conclusions, would impact on the student's level of cognitive moral development. Cognitive moral development was defined in accord with Kohlberg's theory of moral development. Control and experimental populations were derived from two groups of students sequentially enrolled in the same course. Pre- and post-testing using scores on Rest's Defining Issues Test (DIT) showed significant differences in gain between control and experimental subjects. There was a strong association between DIT score gains and selfreport of peer discussion of ethical issues. The major implication of this study is that instructional intervention produces measurable change in some students' level of moral judgment.
Health Promotion Behaviors in Nursing Students
Authors: Richter Judith M , Malkiewicz Judy A , Shaw Dale
Published: April 2021

ABSTRACT

The purpose of the study was to determine if there were significant differences in wellness behaviors in three groups of nursing students. One group of students had completed a course entitled Health Promotion Behaviors, one group had participated in a personalized health assessment program in an interdisciplinary health clinic, and one group that served as the control had no unusual treatment. The intent was to determine if either teaching strategy was more effective in promoting health behaviors.

The Lifestyle Assessment Questionnaire as well as physiological parameters, such as apical pulse and systolic and diastolic blood pressure, and a height/weight ratio were used to measure wellness behaviors.

While the findings revealed significant differences in the treatment groups with regard to exercise and pulse rate, the overall trend was for wellness behaviors to actually decrease in all groups over the course of six months. The results are discussed with their implications for nursing education.
Student Reaction to the 12-Hour Shift in an Undergraduate Baccalaureate Nursing Program
Authors: Heaslip Jane
Published: April 2021

ABSTRACT

Over the past two years, students in their final year of nursing studies at our university have rotated through a combined medical- surgical Intensive Care and Coronary Care Unit where they have been required to work 12-hour shifts. This article presents the reactions of those students to this scheduling pattern and describes faculty concerns regarding the experience.
A Feminist Framework for Graduate Education in Women's Health
Authors: Andrist Linda C
Published: April 2021

ABSTRACT

Graduate programs in the area of women's health have focused primarily on childbearing issues. Titles of programs such as Parent-Child Nursing, Maternal -Newborn Nursing, and Maternal-Child Nursing suggest a focus on reproduction and reproductive organs. It cannot be assumed that programs presume a feminist framework or produce graduates who are women-centered and look beyond reproductive issues. It is essential that graduate education in women's health encompasses the values of feminism and women-centered philosophy. Feminist theory, as a world view of women, brings to nursing the underpinnings for a conceptual framework in women's health. Women's health is committed to health promotion, maintenance, and restoration of the whole person through women-centered practice. The graduate curriculum provides students with the philosophy and tools for advanced nursing practice; therefore graduate curricula in women's health must include two important purposes. The first purpose is refocusing the curriculum on the whole personwoman, not solely on obstetrics and gynecology. The second purpose is socialization of students towards feminist practice, in the profession, in clinical practice, and in research.
Nursing Students' Perspectives of Unethical Teaching Behaviors
Authors: Theis E Charlotte
Published: April 2021

ABSTRACT

This preliminary study set out to collect free response data from nursing students about the nature of unethical teaching behaviors they had encountered in the classroom or clinical setting. Senior nursing students enrolled in three baccalaureate nursing programs were used as subjects. Data were analyzed using content analysis. Unethical teaching behaviors, as described by the subjects, were classified according to three major ethical principles that had been violated: Respect for persons; Justice; and Beneficence. Results revealed that the largest number of unethical teaching behaviors involved violations of respect for students.

Findings from this initial investigation will serve as the basis for the development of a structured, scaled instrument that will identify not only the types of unethical teaching behaviors that nursing students encounter, but also their frequency and the degree to which students find these behaviors problematic.
Recruitment and Retention of Black Students in Baccalaureate Nursing Programs
Authors: Allen Mary E , Nunley Jess Celia , Scott-Warner Marcia
Published: April 2021

ABSTRACT

The purposes of this study were to 1) identify the major factors that influence the retention of Black undergraduate nursing students in baccalaureate nursing programs; 2) compare and contrast the major retention problems of Black baccalaureate nursing students in predominantly white universities with those of all Black students in similar institutions; and 3) generate questions for further study in the area of student retention.

The study used a convenience sample which included one private university and one public state university with baccalaureate nursing programs from the Eastern, Southern, Midwest, and Western regions in the country. Contact persons at each institution were asked to administer questionnaires to Black nursing students enrolled in the professional sequence of the curriculum, Black nursing faculty and administrators, and White nursing faculty and administrators. Data analysis consisted of a comparison between the responses of students, faculty, and administrators in 1980 and those of nursing students, faculty and administrators in 1984 to identified admission-retention barriers and possible remedies.
Confirming Communication of Nurses in Interaction With Physicians
Authors: Garvin Bonnie J , Kennedy Carol W
Published: April 2021

ABSTRACT

Communication is an essential component of the theory and practice of nursing. This study used a confirmation/ disconfirmation framework to describe the communication characteristics of 40 registered staff nurses videotaped in a decision-making task with a resident physician. Nurses were found to be confirming in 87% of their discourse. Differences in confirmation proportions were not found when educational preparation and sex were examined. Older nurses and nurses with more years of professional experience were more confirming in their communication than younger and less experienced nurses. Implications of the study are discussed.
The Leadership/Management Role: A Differentiating Factor for ADN/BSN Programs?
Authors: Schank Mary Jane , Stollenwerk Ruth
Published: April 2021

ABSTRACT

The resurgence of the ADN/BSN issue relative to educational preparation and roles and the concomitant development of positions taken by the professional associations and National Commission on Nursing pointed to the need for study of current ADN/BSN curricula and utilization of graduates. Based upon a brief historical literature review and ADN/BSN competency statements, the leadership/ management role was selected for study as a possible differentiating factor between these programs. Findings from a statewide study of ADN and BSN programs and a representative sample of nurse executives indicated that an education and service dilemma exists relative to this role. The majority of ADN program directors noted that a leadership/management component should be part of ADN curricula, whereas BSN program directors did not concur. Nurse executives utilized ADN graduates in leadership/ management positions and stated that length of experience was an influencing factor in selection. Numerous other findings showed a discrepancy in beliefs and practices among educators and nurse executives. This survey demonstrates the need for curriculum changes and role clarification. The leadership/management role may be a viable area for consideration.