bluuebunny/crossref_metadata_2025 huggingface dataset:
L’effet performatif de l’ambition RSE des experts-comptables : identification des cercles de normes explicatifs
Authors: Chapellier Philippe , Gillet-Monjarret Claire , Rivière-Giordano Géraldine
Published: April 2021

Cet article propose d’étudier dans quelle mesure l’ambition RSE, nouvellement affirmée par des cabinets d’expertise comptable, pourrait avoir un effet performatif, c’est-à-dire s’imposer en tant que nouveau levier de création de valeur interne et externe. Notre objectif est d’adapter la conception réaliste critique de la performativité de Baker & Modell (2019) au domaine de l’expertise comptable, en identifiant les cercles de normes, caractéristiques de l’activité des cabinets, qui favorisent l’effet performatif de l’ambition RSE. Une étude qualitative nous a ainsi permis d’identifier trois cercles de normes censés conditionner l’effet performatif de l’ambition RSE des experts-comptables : la gouvernance partenariale, les attentes sociales et l’ambition environnementale, ainsi que les attentes des PME clientes.
La structure syntactico-sémantique de jouer dans la construction [ Jouer + du + Nom d’instrument de musique ] : une affaire de zone active massive
Authors: Lemghari El Mustapha
Published: April 2021

Cet article a pour objet d’étude la construction [ Jouer + du + Nom d’instrument de musique ]. Il prend comme point de départ la thèse généralement admise que le verbe jouer est transitif indirect et, partant, que la forme du est l’article contracté. Nous argumenterons contre cette thèse en réexaminant la structure syntactico-sémantique du verbe jouer à l’aune du sémantisme des noms des instruments de musique. Sur la base de l’hypothèse de la polysémie de ce paradigme de noms, nous montrerons que jouer change de sens et de structure verbale selon qu’il est employé avec un SN au sens de ‘objet physique’ ou au sens de ‘activité de musique’. Il sera transitif indirect au sens [+comptable] de ‘manier un instrument’ et transitif direct au sens [+massif] de ‘savoir interpréter des airs, des morceaux en se servant d’un instrument de musique’.
Entre objectivité et subjectivité : il est évident que (P)
Authors: Lenepveu Véronique
Published: April 2021

En français contemporain, il est évident que p fait partie des formes impersonnelles qui, en prenant la proposition pour argument, expriment une modalité à statut de métaprédicat (Gosselin, 2010). Nous montrons, dans le cadre d’une sémantique instructionnelle, que cette forme impersonnelle, qui possède la propriété d’être implicative ( il est évident que p implique p), ne marque ni l’objectivité ( ce qui est vrai indépendamment de tout sujet ) ni la subjectivité collective ( ce qui est vrai pour la plupart ), mais une intersubjectivité ( ce qui est vrai pour n’importe quel sujet ). Du fait de cette valeur intersubjective, il est évident que vient non seulement renforcer l’engagement du locuteur relativement à la vérité de la proposition (la prise en charge), mais signaler systématiquement la stabilisation du jugement, que celui-ci soit a priori ou fondé sur le résultat d’un examen approfondi de la situation ( a priori, il est évident que p / à y regarder de plus près, il est évident que p).
Substitution of non-forage fibre sources for cereal grains and molasses in calf starter on performance and development of ruminal function
Authors: Vagnoni D.B. , Sousa C. , Messman M.A.
Published: April 2021

One hundred and thirty-six, new-born female Holstein calves (body weight (BW) = 37.6±0.79 kg) were allocated to one of four starter feeds to evaluate the effects of replacing cereal grains and (or) molasses with non-forage fibre sources on intake, weight gain, and indicators of ruminal development. Diets consisted of a typical, low (16%) neutral detergent fibre (NDF) texturised calf starter, texturised calf starter with moderately higher (20%) NDF, texturised calf starter with moderately higher (21%) NDF and no molasses, and a complete pelleted high (25%) NDF calf starter. Average daily gains and starter intakes were unaffected by moderate levels of NDF. Average daily gain and feed intakes were increased in the preweaning phase but decreased in the postweaning phase by the high NDF complete pelleted diet. Total tract apparent NDF digestibility increased linearly with age but did not differ among diets. Blood concentrations of glucose and β-hydroxybutyrate (BHB) decreased and increased, respectively, with age. Further, blood BHB concentrations were largely unaffected by diet and did not change with increasing dry matter (DM) intake until a threshold was reached, and then increased linearly. Calf-side blood BHB testing resulted in an appreciable number of measurements below the limit of detection of the meter, resulting in censored data. Application of appropriate statistical methodology, required for proper parameter estimation from censored data, suggest the potential for successful field application of calf-side BHB measurements for monitoring starter intake and readiness for weaning in commercial settings. Feeding solely a complete pelleted calf starter throughout the starter phase may provide insufficient levels of effective fibre. Integration of the results of this study with previously published literature via a quantitative analysis suggests that maintaining intake may be the key to successful inclusion of non-forage fibre sources in calf starters.
Cardiac Preceptor Model: Access to Learning by Nurses in Rural Communities
Authors: Ferris Laurice
Published: April 2021

This article describes how faculty at the University of North Carolina along with extensive statewide nursing input by a Cardiovascular Curriculum Task Force dealt with the issues of access to Cardiac Care Educational Courses and availability of qualified cardiac instructor-preceptors in rural communities of North Carolina. The Cardiac Preceptor Model expanded resource in education and practice by the creation of a cardiac preceptor network in the rural areas of the stale. During one-year follow-up of the first class of cardiac preceptors, approximately 276 nurses were educated by 10 nurse preceptors. As more cardiac preceptors were educated, the number of nurses prepared in cardiac care continued to increase. Mobility of cardiac preceptors was enhanced because they received similar educational background based on standardized content in curriculum prepared by the Cardiovascular Curriculum Task Force.
Oncology Nurse Education: The First Step
Authors: Hennessey Sylvia A , Wright Charlotte C
Published: April 2021

An extensive cancer knowledge base, group consolidation, and program planning were three major priorities for seven nurses whose goal was to become cancer nurse educators and implement a three-year cancer nursing education project. Extensive reading, conferences with experts, and onsite visits to cancer care facilities were used to achieve the first priority. Group process began at this initial stage, was fostered throughout the project, and resulted in personal growth and group stability and efficiency. These characteristics were essential in the planning, implementing, and evaluating a multi-leveled nurse education program when at any given moment a member of this group could be teaching a class, coordinating a core course, working with participants in the clinical area, or supervising a community-based teaching experience.
Impact of a Continuing Education Program in Cancer Nursing Part II: Results Affecting the Learner
Authors: Valencius Jeanne C
Published: April 2021

Data collected from 250 registered nurses who completed a variety of cancer nursing educational programs over a three-year period are presented. Postprogram activities such as role changes, memberships in oncology related professional organizations and preparation of educational materials are presented. Perceived organizational barriers ana supports for application of cancer concepts ana skills learned are also delineated.
Methods of Teaching-Revisited Self-Learning Packages
Authors: Gentine Michele
Published: April 2021

Self-learning packages can provide nursing educators with an easy-to-use method to meet individual learning needs. This article explores the purposes and possibilities of self-learning packages in the hospital setting. General directions for developing such packages are explained, using tracheostomy care as an example. The author believes that self-learning packages encourage personal growth and interest in further learning, making them a worthwhile addition to hospital education programs.
Teaching Mental Health Principles Through Continuing Education
Authors: Browne Susan E , Jacobson Mary Gail Nagai
Published: April 2021

This article describes an innovative continuing education model implemented in Appalachia to help nurses better meet the mental health needs of their patients, Faculty serve as role models for positive mental health as they build trust and encourage risk-taking behavior in a safe interpersonal environment. Participants, who have a wide variety of backgrounds and experiences, come together in small groups with outside mental health consultants. They explore attitudes toward mental health and mental illness, share experiences and ideas, learn and practice new behaviors, and work on problems related to menial health in their daily work. Ongoing year-round workshops and discussions reinforce learning that occurs during an intensive summer session. Specific teaching methods are discussed. Results of this project are seen in individuals, as well as throughout the larger health care system.
Methods of Teaching - Revisited The Interview
Authors: Cooper Signe S
Published: April 2021

The eighteenth in a series of articles on methods of teaching, this is the first of five describing various ways of initiating group discussion. Readers are encouraged to share their experiences with successful teaching strategies.
Needs Assessment as a Marketing Strategy
Authors: Wise Pat S Yoder
Published: April 2021

The First National Conference on Marketing for Continuing Health Educators, sponsored by the University of Texas Health Science Center at San Antonio, was held in November 1979. As an interdisciplinary conference, three nurses made presentations during the poster sessions. This article and the following two articles are based on those presentations and focus on one aspect of marketing. They do not reflect the great diversity of content in the conference.
Developing Clinical Decision-Making Skills in Staff Nurses: An Educational Program
Authors: Harman Linda , Wabin Doris , MacInnis Lois , Baird Deborah , Mattiuzzi Daniela , Savage Pamela
Published: April 2021

ABSTRACT

Clinical decision-making (CDM) is central to professional nursing practice. Use of this process enhances the nurses ability to assess patients, to identify problems, and to plan individualized care. The Nursing Department at the Toronto General Hospital recognized that in order for nurses to effectively plan individualized care for their patients, they first needed help to develop their CDM skills. In response, a hospital-wide educational program was designed and implemented. This article describes the program and highlights the factors found to be crucial to its success. General recommendations are outlined for those who wish to design similar CDM skill-developing programs.
Solving the Orem Mystery: An Educational Strategy
Authors: Reid Barbara , Allen Ann Frances , Gauthier Teresa , Campbell Heather
Published: April 2021

ABSTRACT

Three years ago Orem's Self-Care Deficit Theory was introduced in five pilot units at the Toronto General Hospital. To augment the existing implementation program and to introduce the basic concepts of the theory to staff from nonproject units, the clinical nurse specialist group developed a multimedia exhibit showing the theory in action. The theory was interpreted within the framework of the nursing process. A case study approach was developed so that a global perspective of the actual application of the model could be readily visualized. This article describes the activities involved in producing a self-learning educational presentation that can be put to a variety of uses, such as orientation of new staff and a review for current project unit staff, and that can also be revised and augmented as use of the theory becomes more sophisticated.
Computer Literacy: A Mission for Continuing Education for Professional Nurses
Authors: Reynolds Audree , Ferrell Mary Jane
Published: April 2021

ABSTRACT

Because of the necessity for nurses to become computer literate, the continuing education program at the University of Texas at El Paso, College of Nursing and Allied Health offers basic computer workshops. This article describes the workshops, the participants, the approach to minimizing computer anxiety, and the response to the workshops.
Consulting for Quality Continuing Education
Authors: Koppe Judith A
Published: April 2021

ABSTRACT

The consultant's role in continuing education (CE) is presented and discussed from a variety of perspectives. This article proposes that using a consultant will enhance the quality of continuing education and be cost effective at the same time.

The steps to be taken to select a consultant include: determining the consultant's role, acquiring a content or process expert, and finalizing the contractual agreement. The American Nurses' Association (ANA) criteria for continuing education offerings are provided as a reference table. Emphasis throughout the article is on how to obtain quality service at a minimal cost.
Programmed Instruction Revisited: A Solution to Infection Control Inservice Education
Authors: Goldrick Barbara A
Published: April 2021

ABSTRACT

Recent standards established by the Occupational Safety and Health Administration (OSHA) regarding protection against occupational exposure to hepatitis B virus (HBV) and human immunodeficiency virus (HIV) presents a challenge to staff development and inservice educators to provide the necessary education and training in light of the 24-hour operation of a hospital, the nursing shortage, and the use of part-time personnel.

In order to provide initial and periodic infection control programs for nursing personnel, a self-managed module in the form of a programmed unit of instruction (PUI) was developed and tested to determine its effectiveness and efficiency for teaching the basic principles of infection control to inservice nurses. Results of the study indicated that nurses who took a PUI in the basic principles of infection control scored higher on posttests than those who attended a lecture, regardless of their pretest scores, educational level, and experience (p<.0001).
Nursing Model Encourages Care Planning
Authors: Smith Marcella B , Dugan Janet S
Published: April 2021

ABSTRACT

After examining the pitfalls of nursing care plans done in a medicai model format, a system based entirely on the nursing model was developed in a 500-bed acute care hospital. By centering the format, the structure, and the education around the patient problems treated by nurses, the nurses in this hospital began to do care plans for the purpose of improving patient care rather than for compliance with the Joint Commission on Accreditation of Healthcare Organizations' regulations. The system has led to more knowledgeable nurses and a more autonomous and rewarding practice setting.
Evaluation of an Inservice Education Program Regarding Aggressive Behavior on a Psychiatric Unit
Authors: Goodykoontz Lynne , Herrick Charlotte A
Published: April 2021

ABSTRACT

A four-part inservice program on dealing with aggressive behavior on a psychiatric unit was developed, presented, and evaluated. The program was aimed at meeting staff members' cognitive, emotional, and psychomotor needs. Twenty-seven staff members participated. The program was successful in reducing extreme levels of burnout among staff members, and occurrences of patient aggressive behavior resulting in incidents declined after the program. Staff members reported that they felt more confident in dealing with aggression. Protocols and nursing care plans were developed, and ongoing support groups to examine staff members' feelings were established.
Evaluation of a Training Program in Breast Cancer Nursing
Authors: Alexander Mary A
Published: April 2021

ABSTRACT

A training program in breast cancer nursing was evaluated in terms of its effects on 55 nurse participants and 18 breast cancer patients who were assigned to a control or to a program group. The quasi-experimental evaluation design employed both standard and investigator-developed instruments. Pre- and posttests were used to measure nurse participants' knowledge and attitudes and appraisal of usefulness and satisfaction with the program. Effect on patient outcomes was measured by means of a Perception of Care Questionnaire, a Breast Cancer Knowledge Quiz, and the Multiple Affect Adjective Checklist. In the cognitive and attitude domains, nurse participants improved significantly and appraised the program as highly useful and satisfactory. Program group patients scored significantly higher scores on the Perception of Care and Breast Cancer Knowledge Questionnaires and exhibited significantly less anxiety than control group patients. Results support the use of evaluation as a part of systematic program development. The evaluation of patient outcomes is a challenging but essential component of program evaluation.
Adapting to Change: Reconsidering Staff Development Organization, Design, and Purpose
Authors: Gundlach Ann-Michele
Published: April 2021

ABSTRACT

Staff development educators must perform a balancing act between maintaining the routine learning services and responding to and facilitating the emergent learning needs that shape success. This article proposes a dual-track structuring to address both needs and to create a cutting-edge approach to organizational learning needs.
Continuing Professional Education and Interacting Variables Affecting Behavioral Change in Practice: Instrument Development and Administration
Authors: Ryan Marilyn , Campbell Nancy , Brigham Carole
Published: April 2021

ABSTRACT

Background: Instruments were developed to measure variables identified by Cervero that evaluate the complex processes and effectiveness of continuing professional education.

Method: Content validity was established with a panel of experts. Four studies were conducted to determine reliability. Data were merged to conduct factor analysis.

Results: Reliability was confirmed across studies using Cronbach's alpha. Stability was confirmed in a test-retest study. Factor analysis confirmed instrument items measure the concepts of Cervero's Model.

Conclusion: The reliable and valid instruments may be useful for continuing education and staff development nurses to measure the effectiveness of education on behavioral change in practice.
Continuing Education Needs of Nurses Employed in Nursing Facilities
Authors: Glass J Conrad , Todd-Atkinson Sandra
Published: April 2021

ABSTRACT

The purpose of this investigation was to determine the self-perceived learning needs of nurses, both RNs and licensed practical nurses (LPNs), employed in nursing facilities. Questionnaires were used to gather data from 319 nurses employed in 14 nursing facilities, representing 10% of all nursing facilities in North Carolina. A total of 164 nurses returned usable questionnaires. The nurses indicated a large number of continuing education needs, with Management Skills, Drug Therapy/Interactions, and Behavioral Problems being particularly important Night shift nurses and nurse educators had different leaning needs when compared to other subsets of nurses.
INFECTION AFTER KNEE REPLACEMENT SURGERY
Authors: Cozen Lewis
Published: April 2021

ABSTRACT: Vigorous treatment is not always necessary to eradicate late postoperative infection after total knee implantation. Aspiration of the pus and intravenous antibiotic administration was enough to eradicate the infection in the case reported.
SLIPPED CAPITAL FEMORAL EPIPHYSIS IN A PATIENT WITH INFANTILE TIBIA VARA
Authors: Schmidt Thomas L , Mallo George J
Published: April 2021

ABSTRACT: This paper is a case report of an obese black female with infantile tibia vara and slipped capital femoral epiphysis. Two cases of tibia vara and slipped capital femoral epiphysis in obese black male patients have previously been reported. The infrequent occurrence of this association of abnormalities precludes defining a common etiology of their pathogenesis. Abnormal pressures are implicated in the pathogenesis of both diseases.
PSEUDOSARCOMATOUS PROLIFERATION OF SOFT TISSUE SECONDARY TO BACTERIAL INFECTION
Authors: Pu Freddie H , Scranton Pierce E
Published: April 2021

ABSTRACT: An unusual case of an inflammatory lesion simulating a sarcoma is presented. The topic of pseudosarcomatous proliferation of soft tissue is reviewed, and the difficulties in diagnosis and management of such soft tissue lesions are discussed.
MENINGOCOCCAL ARTHRITIS IN CHILDREN
Authors: Congeni Blaise , Weiner Dennis S
Published: April 2021

ABSTRACT: Three recent cases of arthritis associated with meningococcal infection will hopefully draw attention to this not uncommon relationship. The historical evolution of the recognition of this association, treatment and sequelae are reviewed up to the present time. Although surgical evacuation of the affected purulent joint fluid was effective in rapidly resolving the joint findings, its role remains unclear in light of recent evidence suggesting "immune complex" arthropathy.
IMMOBILIZATION HYPERCALCEMIA ASSOCIATED WITH MULTIPLE TRAUMA
Authors: Scheller Arnold , Crothers Omar
Published: April 2021

ABSTRACT: This entity is an infrequently reported phenomena, because its manifestations are nonspecific and protean. Three young patients are described who developed hypercalcemia during immobilization following multiple injuries including femoral fractures. This syndrome presented itself with symptoms of continuous anorexia and nausea. Gastrointestinal symptoms occurred within two weeks of immobilization, but the diagnosis was not made for a month. They were treated for hypercalcemia by a decrease in calcium intake, saline infusion, phosphates and mobilization when possible. As the serum calcium levels reached normal limits, the symptoms of anorexia and nausea were alleviated. Mobilization was the definitive treatment for their immobilization hypercalcemia. The protean manifestations of hypercalcemia must be emphasized. When they occur in patients with multiple trauma, hypercalcemia must be evaluated and treated.
ANSWER PLEASE
Authors: Grana William
Published: April 2021

Acute Injury of the Knee in a 15-Year-Old
A UNIQUE FRAME FOR BACK SURGERY
Authors: Andrews E Trent
Published: April 2021

ABSTRACT: A new frame has been designed to maintain patients in what the author chooses to call the prone sitting position during back surgery. Studies have shown such a position to be far superior to other positions in minimizing blood loss during surgical procedures on the back. The new frame has the advantages of accommodating all body habitus types, including the markedly obese, with a minimum of effort in putting the patient on the frame, thus overcoming the limitations of the frames currently available for the prone sitting position.
A QUANTITATIVE APPROACH TO TOTAL WRIST ARTHROPLASTY: DEVELOPMENT OF A "PRECENTERED" TOTAL WRIST PROSTHESIS
Authors: Hamas Robert S
Published: April 2021

ABSTRACT: The major problem with total wrist arthroplasty has been "imbalance" resulting from a lack of information on where to position the axes of motion of the prosthesis. This paper presents a precise method for determining the optimal location for the axes of motion of the prosthesis in any patient's wrist. It is based on a study of the normal biomechanics and was tested clinically in ten patients. The resultant "balance" and range of motion were excellent. A new prosthesis design evolved from this work which should simplify the operative procedure and make the results more reliable.
HYPERCALCEMIA OF IMMOBILIZATION IN NEUROLOGICALLY INJURED CHILDREN: A PROSPECTIVE STUDY
Authors: Cristofaro Robert L , Brink Joyce D
Published: April 2021

ABSTRACT: Seven of 20 consecutive admissions to the Children's Head Injury and Spinal Injury Services of the Rancho Los Amigos Hospital demonstrated hypercalcemia ranging from 10.7 mg % to 13.2 mg %, with an average of 11.4 mg % (normal range 8.5 mg-10.5 mg %). Return to normocalcemia coincided with mobilization in five of the seven patients. Four patients in the series developed heterotopic ossification; two of these demonstrated concurrent hypercalcemia. This association has not been previously reported. This study has helped to clarify the clinical suspicion that hypercalcemia of immobilization occurs more frequently than is suggested in the literature. Elevated alkaline phosphatase levels are associated with heterotopic ossification. The role of hypercalcemia in the development of heterotopic ossification remains speculative.
COMPUTED TOMOGRAPHY FOR INTRA-ARTICULAR KNEE MASSES: A CASE REPORT
Authors: Linson Marc A
Published: April 2021

ABSTRACT: The use of computed tomographic scanning is presented in aiding in the diagnosis of synovial hemangioma of the knee, and demonstrates the value of this technique in evaluating intraarticular masses.
PES ANSERINUS TRANSPLANTATION WITHOUT A ROUTINE MEDIAL MENISCECTOMY: A REVIEW OF TWENTY-TWO CASES
Authors: Taylor Michael M , Shields Clarence L , Kerlan Robert K , Jobe Frank W , Carter Vincent S , Lombardo Stephen J
Published: April 2021

ABSTRACT: Of 549 pes anserinus transplantations performed at the National Athletic Health Institute, Inglewood, California from 1971 through 1977, only 27 involved the transfer for anteromedial rotational instability in the presence of an intact medial meniscus. The 22 patients reviewed were evaluated with a questionnaire, physical and roentgenogram examinations, and hamstring and quadriceps muscle testing with Cybex II isokinetic dynamometer. Average length of follow-up was one year, four months. Acute anteromedial rotational instability was seen in 16 patients while six had chronic instability. All had an injury to the anterior cruciate ligament, and 12 had associated medial collateral ligament tears. One year postoperatively, 93% of the patients were participating in athletics and 70% rated their knee as above 90% of normal. The Cybex evaluation, however, revealed only 50% of the patients had 90% of normal strength in hamstrings and quadriceps. One patient developed anteromedial rotational instability, and one a torn medial meniscus, two years postsurgery. It was concluded that: I) Routine medial meniscectomy is not necessary with pes anserinus transplantation; 2) Anterolateral rotary instability does not routinely develop after pes anserinus transplantation done without medial meniscectomy; and 3) Hamstring and quadricep muscle strength below 90% of the normal extremity is not indicative of a subjective unsatisfactory functional result.

Indexing terms: pes anserinus transplant; medial meniscectomy; anteromedial rotational instability; anterior cruciate ligament; and medial collateral ligament.
OSTEOMYELITIS OF THE SACRUM AND SEPSIS OF THE HIP COMPLICATING PELVIC ACTINOMYCOSIS
Authors: Marcus Norman A , Grace Thomas G , Hodgin U G
Published: April 2021

ABSTRACT: A twenty-six year old female using an intrauterine contraceptive device developed a severe intrapelvic infection which spread to the sacrum and the soft tissue of the buttocks. Several organisms were cultured as part of a mixed infection. In spite of aggressive surgical debridement and antibiotic therapy, the infection spread to the left hip. Cultures of the excised sacrum revealed Actinomyces israelii.
HINGED TOTAL ELBOW REPLACEMENT
Authors: Dryer Randall F , Buckwalter Joseph A , Sprague Bruce L
Published: April 2021

ABSTRACT: Total elbow arthroplasty using a hinged prosthesis was performed on 17 elbows in 12 patients. Clinical follow up ranged from 18 to 85 months, and averaged 56 months. Indications for surgery included disabling pain, restricted motion of the elbow, and roentgenographic evidence of joint destruction. We did not use this prosthesis in patients with restricted shoulder motion or in those with demanding occupational or recreational activities. Fifteen elbows showed good results; one elbow was complicated by ectopic ossification, and one prosthesis was removed for a deep wound infection. No other instances of symptomatic loosening were found, although radiographs demonstrated a lucent line around the cement in four elbows and a cement fracture in one elbow. All patients were relieved of their pain. The low incidence of loosening may be explained by the selective use of the hinged prosthesis. Index Terms: elbow, arthroplasty, hinged prosthesis.
Advanced Prosthetic Techniques for Below Knee Amputations
Authors: Staats Timothy B
Published: April 2021

ABSTRACT: Recent advances in the evaluation of the amputation stump, the materials that are available for prosthetic application, techniques of improving socket fit, and prosthetic finishings promise to dramatically improve amputee function. Precision casting techniques for providing optimal fit of the amputation stump using materials such as alginate are described. The advantages of transparent check sockets for fitting the complicated amputation stump are described. Advances in research that promise to provide more functional prosthetic feet and faster and more reliable socket molding are the use of CAD-CAM (computer aided design-computer aided manufacturing) and the use of gait analysis techniques to aid in the alignment of the prosthesis after socket fitting. Finishing techniques to provide a more natural appearing prosthesis are described. These advances will gradually spread to the entire prosthetic profession.
Functional Demands on the Stance Limb in Walking
Authors: Skinner Stephen R , Antonelli Daniel , Perry Jacquelin , Lester D Kevin
Published: April 2021

ABSTRACT: In normal human locomotion, the lower extremities must maintain the erect posture while at the same time permitting forward progression of the body. Walking involves a complex interplay of gravity, momentum changes, and muscle action. A quantitative analysis of the effects of gravity and momentum changes on the stance limb in normal gait has been performed. These effects, represented by the ground reaction force, impose challenges to the muscles of the lower extremity. The nature of the torques about the hip, knee, and ankle joints has been investigated and correlated with the timing of muscle action throughout the gait cycle. Mechanical events in the earliest part of stance phase have been more clearly described than in previous work. Analysis of the effects of gravity and momentum changes improves our understanding of the mechanics of normal walking, and can aid in the diagnosis and treatment of disabled patients.
Limb Salvage in Primary Malignant Bone Tumors
Authors: Sim Franklin H , Bowman William E , Wilkins Ross M , Chao Edmund Y S
Published: April 2021

ABSTRACT: Advances in adjuvant chemotherapy and improvements in techniques ot oncologic reconstruction have stimulated renewed interest in limb saving operation for malignant bone tumors. Between 1970 and 1981, 160 patients underwent local resection for malignant osseous lesions at the Mayo Clinic. This included 102 patients with chondrosarcoma, 44 with osteosarcoma, and 14 with fibrosarcoma. Ninety-three of the lesions were stage I and 67 were stage II. The overall local recurrence rate was 11.8%. The reconstructive procedures were effective in providing adequate functional restoration. Limb sparing operation is a valid viable option in carefully selected patients with malignant bone tumors. A continued search for effective adjuvant treatment programs is necessary.
Pulsatile Irrigation in Orthopedics
Authors: Sobel Jonathan W , Goldberg Victor M
Published: April 2021

ABSTRACT: A brief history of the use of irrigation fluids in the management of traumatic and surgical wounds is presented. The development of irrigation fluid as a debridement technique and some of the problems in controlling the fluid dynamic parameters are described. Orthopedics requires varied applications of irrigation devices, and a machine has been developed which combines irrigation lavage or pulsatile debridement technique with the rapid suction removal of effluent. The applications, technique, and precautions in using a Rapid Suction Removal System are described.
Reconstruction of Soft Tissue Injuries of the Foot and Ankle with Microsurgical Techniques
Authors: Gould John S
Published: April 2021

ABSTRACT: Microsurgical reconstruction for injuries of the foot and ankle includes, in addition to repair of small nerves, vessels, and tendons, coverage of soft tissue defects. Local transpositional and island pedicle flaps are ideal when available and adequate. The choice of free vascularized flaps is based on its potential durability, contour, bulk, and appearance. Thin cutaneous flaps, fascial flaps, and muscle flaps covered with split thickness skin grafts are appropriate in specific areas. Neurosensory flaps and methods of reinnervation may have a place in extensively denervated feet. Good postoperative pedorthic care aids in the final outcome.
SOMETHING NEW
Authors: Anonymous
Published: April 2021

Appearance of a product in this section in no way implies endorsement by Orthopedics, including Us publisher and editorial board. This section is presented solely as a service to our readers.
Fracture of Polyethylene Tibial Component in a Total Knee Replacement: A Case Report
Authors: Mowery Carol , Botte Michael , Bradley Gary
Published: April 2021

ABSTRACT: Aseptic loosening is the most common mode of failure for total knee replacements. Component breakage is rare, usually attributable to errors of design or manufacture. A case is presented in which rotational malplacement of the femoral component resulted in accelerated wear and eventual fracture of the polyethylene tibial component.
Subclavian Vein Thrombosis Following Fracture of the Clavicle: A Case Report
Authors: Lim Edward V A , Day Lorraine J
Published: April 2021

ABSTRACT: Clavicular fractures are common injuries, usually with uneventful sequela. A case of subclavian vein thrombosis following a clavicular shaft fracture is reported emphasizing the awareness and treatment of this uncommon complication.
RADIOLOGIC CASE STUDY
Authors: Silberstein Michael J , Luisiri Atchawee , Sotelo Cirilo , Graviss E Richard , Sundaram Murali
Published: April 2021

Cranial Fasciitis and Its Resemblance to Histiocytosis
Tenography in Unresolved Ankle Tenosynovitis
Authors: Reinus William R , Gilula Louis A , Lesiak L Frank , Blair Vilary A , Winer Michael
Published: April 2021

ABSTRACT: Tenosynovitis can be a source of prolonged ankle pain and disability. Based on a review of the literature and past clinical experience at our institution, early establishment of the correct diagnosis enabling definitive treatment may be difficult. We describe six patients with tenosynovitis of tendons about the ankle, the value of tenography in staging the severity of their disease, and its value in choosing appropriate definitive therapy.
Luque Segmental Spinal Instrumentation: The Use of the Hartshill Rectangle
Authors: Dove John
Published: April 2021

ABSTRACT: This article describes the use of the Hartshill rectangle for the correction of spinal deformity. The Hartshill system is a modification of the Luque method of segmental spinal instrumentation whereby rather than two separate "L" rods a welded rectangle is formed from a single stainless steel rod. A "roof is bent into each end of the rectangle so that it conforms with the lamina. The Hartshill rectangle avoids the problems of overlapping L rods and gives increased stability and correction of rotation.
A Double Blind Trial of NSAID Versus Placebo During Rehabilitation
Authors: Arvidsson Inga , Eriksson Enjar
Published: April 2021

ABSTRACT: Forty patients participated in a randomized, parallel, double blind study of Piroxicam, 20 mg daily, versus placebo, given orally for 10 days following open partial meniscectomy. On day 1, 3, 7, 11, and 21 after surgery the following parameters were studied: quadriceps torque measured isokinetically; patients' assessment of pain; active and passive range of motion measured with goniometer; degree of swelling and irritation of the operated knee; and efficacy of the medication.

The mean values for all parameters, except for pain assessment, were in favor of the piroxicam group. This difference was most marked on day 7 and 11 and on these days highly significant. Our findings indicate that piroxicam may be able to improve early postoperative rehabilitation.
Liposarcoma of the Soft Tissues
Authors: Schwartz Herbert S , Weiss Sharon W , Sim Franklin H , Beabout John W
Published: April 2021

ABSTRACT: A case report presents a liposarcoma of the extremities and an overall review of this disease entity. Past and present histologic classifications of liposarcoma are discussed, as are the clinical behavior and treatment options in relation to the surgical stage of the tumor. The importance of a well-planned biopsy site is stressed.
Acetabular Development in Legg-Calvé-Perthes Disease
Authors: Bellyei Árpád , Mike Georg
Published: April 2021

ABSTRACT: The normal development of the proximal femur epiphysis and the acetabulum of 50 children with unilateral Perthes disease were analyzed on the unaffected side with serial xrays using the epiphysis and the acetabular index. The same factors were studied on the affected side. A pathological process has been established in the affected hip. However, while these pathological processes run parallel up to 9 to 10 years of age on the femur epiphysis and in the acetabulum, the elastic ability of the acetabulum ceases over 9 years ot age. This smaller plastic ability is the probable cause of unfavorable results in older children.
Review of the Brachial Plexus Part II: Reconstruction After Chronic Upper Plexus Injuries
Authors: Ferenz Clint C
Published: April 2021

ABSTRACT: Chronic and complete, brachial plexus injuries are a burden for society and the patient. A literature review reveals the different options in treating upper plexus deficits. Analysis of early, and more recent, results is provided with an emphasis placed on the more reliable procedures to date.
Decompression Laminectomy and Lateral Spinal Fusion in Patients With Previously Failed Lumbar Spine Surgery
Authors: Quimjian John D , Matrka Paul J
Published: April 2021

ABSTRACT: Sixty-two patients who had had previous failed lumbar disk surgery (average 1.4 surgeries) were treated with a decompression laminectomy and lateral spinal fusion. Follow up averaged 4.2 years and results were based on pain relief, improved function, and return to work as recorded on a patient questionnaire. Using a scoring system to quantify the change from the patients felt the surgery was very worthwhile, 32% had a good result, 29% had a fair result, and 38% had a poor result. However, 53% of the patients felt the surgery was very worhtwhile, 37% rated it somewhat worthwhile, and 10% responded that the surgery was not worthwhile. Factors which statistically correlated with a higher improvement score were the presence of a unilateral radicular pain pattern, a year pain free interval since the previous surgery, and a myelogram which was more indicative of a disk herniation rather than cicatrix formation. Similarly, those patients who were found to have a recurrent or new disk at the time of surgery did better than those whose major finding was scar formation. The quality of the fusion mass was positively correlated with a better final result with questionable statistical significance (P = .06). Finally, those patients who were industrial improved much less and only 14% returned to work as compared to 61% of the non-industrial patients.
Septic Arthritis: Process, Etiology, Treatment Outcome: A Literature Review
Authors: O'Meara Patrick M , Bartal Ely
Published: April 2021

ABSTRACT: Septic arthritis is a serious infection that can lead to truly devastating complications. The key to minimizing irreversible damage is rapid initiation of treatment. The best results are obtained when treatment is instituted within 1 week of the onset of symptoms. Effective treatment involves antibiotics, joint drainage and decompression, and immobilization followed by rehabilitation of the affected joint. The best choice of empiric antibiotics can be made by considering the patient's age, the synovial fluid gram stain results, and any preexisting conditions (eg, alcoholism, hypogammaglobulinemia). An episode of septic arthritis requires long-term follow up to check for relapses and to assess the outcome of any residual joint damage.
Esophageal Obstruction Secondary to Diffuse Idiopathic Skeletal Hyperostosis
Authors: Burkus J Kenneth
Published: April 2021

ABSTRACT: Diffuse idiopathic skeletal hyperostosis is a disorder of skeletal tissues which most commonly effects elderly white males. Characteristic radiographic findings involve the production of large juxtacortical osteophytes in the absence of degenerative joint changes. The thoracic spine is the most frequently involved portion of the body, followed by the lumbar and cervical spine. Anterior osteophyte formation in the cervical spine may cause symptoms of dysphagia secondary to esophageal obstruction. These symptoms can be successfully treated by anterior osteophyte resection.
The Effect of Anaerobiosis on Antistaphylococcal Antibiotics
Authors: Tsukayama Dean T , Guay David R P , Gustilo Ramon B , Wicklund Barbara , Gruninger Robert , Peterson Phillip K
Published: April 2021

ABSTRACT: The activity of eight antimicrobial agents which might be used in the treatment of staphylococcal osteomyelitis was tested under anaerobic conditions similar to those found in chronically infected bone. An agar-dilution method was employed to determine the minimum inhibitory concentrations of tobramycin, vancomycin, teicoplanin, ciprofloxacin, clindamycin, ceftriaxone, ticarcillinclavulanic acid, and amoxicillin-clavulanic acid against 25 coagulase-positive and 25 coagulase-negative staphylococcal strains. The activity of tobramycin against coagulasepositive staphylococci, and of amoxicillinclavulanic acid and ticarcillin-clavulanic acid against coagulase-negative staphylococci was markedly decreased with anaerobiosis. Vancomycin, teicoplanin, and ciprofloxacin were active against coagulase-positive and coagulase-negative staphylococci under both aerobic and anaerobic conditions. It was also found that antibiotic concentrations comparable to the high levels which might be achieved with local antibiotic therapy of osteomyelitis were not sufficient to overcome the level of resistance (10µg/ml) of staphylococci which were not susceptible to tobramycin, clindamycin, ceftriaxone, and ticarcillin-clavulanic acid.
Intraarticular Trochanteric Wire Migration Following Bilateral Total Hip Arthroplasty: A Case Report
Authors: Ritter Merrill A , Meding John B
Published: April 2021

ABSTRACT: A 64-year-old man underwent bilateral simultaneous total hip replacement and experienced articular interposition of a wire fragment in the right hip joint 3 years postoperatively. Because of destructive wear of the acetabulum, this eventually required revision total hip arthroplasty 12 years after the original surgery.
MRI of Peripheral Neurofibromas in Children
Authors: Glasier Charles M , Williamson Michael R , Lange Thomas A
Published: April 2021

ABSTRACT: Magnetic resonance imaging was performed as a preoperative examination in three children with neurofibromatosis and soft-tissue plexiform neurofibromas. In all three patients, MRI showed more widespread soft tissue involvement than was suspected clinically including extension towards the spine in each case. Patient management was changed in each case after MRI was performed.
Intracapsular Hip Fractures: Case Reports and Discussion
Authors: Dabezies E Jean , D'Ambrosia Robert
Published: April 2021

ABSTRACT: Two cases of intracapsular hip fracture illustrate some of the treatment options available for Garden Stage IV fractures. In Case 1, a prosthesis was chosen because of the patient's physiologic age and poor general health. In Case 2, a compression screw augmented with a single-pin fixation to prevent rotation was used. This patient, although only 3 years younger than the first patient, was in good health. Although there was some posterior comminution, an attempt at fixation, allowing time for bone healing, was appropriate. Arthroplasty may be needed in several years if bone healing fails.
Computed Tomographic Evaluation of Fatty Neoplasms of the Extremities: A Clinical, Radiographic, and Histologic Review of Cases
Authors: Wolfe Scott W , Bansal Manjula , Healey John H , Ghelman Bernard
Published: April 2021

ABSTRACT: Eleven lipomatous tumors of the extremities (7 liposarcomas, 4 lipomas) were evaluated radiographically by several modalities, including computed tomography (CT) in all lesions. Lipomas were seen on CT scan as well delineated, homogeneous masses with negative attenuation coefficients ranging from -95 to -160. Liposarcomas were inhomogeneous, multilobulated, poorly delineated lesions located exclusively in the subfascial or intramuscular planes, with an intermediate range of attenuation coefficients between those of fat and those of muscle. In six of seven liposarcomas, definite low density areas were identified by attenuation coefficient as fatty tissue. Magnetic resonance imaging (MRI) was obtained in two patients and was helpful in defining the extent of the tumors and their relationship to vital structures, but MRI could not differentiate benign from malignant tissue. Computed tomography is recommended as the cornerstone in the initial radiographic evaluation of growing or painful lipomatous soft tissue masses of the extremities.
The Bipolar Endoprosthesis and Bone Graft in the Management of Aseptic Acetabular Component Loosening
Authors: Ochsner J Lockwood , Penenberg Brad L , Dor Lawrence D , Conaty J Pierce
Published: April 2021

ABSTRACT:Ten patients with large acetabular defects underwent hip arthroplasty revision with the use of allografts in conjunction with a bipolar prosthesis. Six patients had solid femoral head allografts and the others, morselized allografts. Radiographs at 2-year follow up showed an average of 8 mm of superior migration and 4 mm of medial migration. Our experience has shown that bipolar revision arthroplasties tend to migrate against the allograft. We recommend that bipolar revisions be limited to small acetabular defects that give the bipolar prosthesis full rim contact.
Roentgenographic Evaluation of Suspected Shoulder Dislocation: A Prospective Study Comparing the Axillary View and the Scapular 'Y' View
Authors: Silfverskiold Jan P , Straehley Douglas J , Jones Wallace W
Published: April 2021

ABSTRACT: This study compares the axillary and the scapular "Y" view in 75 consecutive patients with suspected shoulder dislocation who were evaluated according to a prospective protocol. In each patient, an AP, axillary, and scapular "Y" view was obtained. Evaluation was by the following criteria: accuracy of diagnosis; patient preference; ease of technique; and diagnosis of associated pathology. In 69 cases (92%), the scapular "Y" view and axillary view resulted in the same diagnosis. However, in six cases (8%), the axillary view failed to give the correct diagnosis when compared to the scapular "Y" view. Sixty-one patients (81%) preferred the scapular "Y" view to the axillary view because of less pain. Once the technician was adept with the scapular "Y" view, it was preferred and was considered easier to obtain than the axillary view. With the exception of the Hill-Sachs lesion, the axillary view and scapular "Y" view visualized associated pathology equally well. A new method to obtain the scapular "Y" view is described. The technique is easy to use, and routinely results in an accurate diagnosis with minimal patient discomfort.