bluuebunny/crossref_metadata_2025_split huggingface dataset:
Discontinuation of the liposomal delivery of bupivacaine has no effect on pain management after primary total knee arthroplasty
Authors: Feng James E. , Ikwuazom Chibuokem P. , Mahure Siddharth A. , Waren Daniel P. , Slover James D. , Schwarzkopf Ran S. , Long William J. , Macaulay William B. 
Published: May 2021

Aims Liposomal bupivacaine (LB) as part of a periarticular injection protocol continues to be a highly debated topic in total knee arthroplasty (TKA). We evaluated the effect of discontinuing the use of LB in a periarticular protocol on immediate postoperative pain scores, opioid consumption, and objective functional outcomes. Methods On 1 July 2019, we discontinued the use of intraoperative LB as part of a periarticular injection protocol. A consecutive group of patients who received LB as part of the protocol (Protocol 1) and a subsequent group who did not (Protocol 2) were compared. All patients received the same opioid-sparing protocol. Verbal rating scale (VRS) pain scores were collected from our electronic data warehouse and averaged per patient per 12-hour interval. Events relating to the opiate administration were derived as morphine milligram equivalences (MMEs) per patient per 24-hour interval. The Activity Measure for Post-Acute Care (AM-PAC) tool was used to assess the immediate postoperative function. Results A total of 888 patients received Protocol 1 and while 789 received Protocol 2. The mean age of the patients was significantly higher in those who did not receive LB (66.80 vs 65.57 years, p = 0.006). The sex, BMI, American Society of Anesthesiologists physical status score, race, smoking status, marital status, operating time, length of stay, and discharge disposition were similar in the two groups. Compared with the LB group, discontinuing LB showed no significant difference in postoperative VRS pain scores up to 72 hours (p > 0.05), opioid administration up to 96 hours (p > 0.05), or AM-PAC scores within the first 24 hours (p > 0.05). Conclusion The control of pain after TKA with a multimodal management protocol is not improved by the addition of LB compared with traditional bupivacaine. Cite this article: Bone Joint J 2021;103-B(6 Supple A):102–107.
Costs of unicompartmental compared with total knee arthroplasty
Authors: Burnett III Robert A. , Yang JaeWon , Courtney P. Maxwell , Terhune E. Bailey , Hannon Charles P. , Della Valle Craig J. 
Published: May 2021

Aims The aim of this study was to compare ten-year longitudinal healthcare costs and revision rates for patients undergoing unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA). Methods The Humana database was used to compare 2,383 patients undergoing UKA between 2007 and 2009, who were matched 1:1 from a cohort of 63,036 patients undergoing primary TKA based on age, sex, and Elixhauser Comorbidity Index. Medical and surgical complications were tracked longitudinally for one year following surgery. Rates of revision surgery and cumulative mean healthcare costs were recorded for this period of time and compared between the cohorts. Results Patients undergoing TKA had significantly higher rates of manipulation under anaesthesia (3.9% vs 0.9%; p < 0.001), deep vein thrombosis (5.0% vs 3.1%; p < 0.001), pulmonary embolism (1.5% vs 0.8%; p = 0.001), and renal failure (4.2% vs 2.2%; p < 0.001). Revision rates, however, were significantly higher for UKA at five years (6.0% vs 4.2%; p = 0.007) and ten years postoperatively (6.5% vs 4.4%; p = 0.002). Longitudinal-related healthcare costs for patients undergoing TKA were greater than for those undergoing UKA at one year ($24,771 vs $22,071; p < 0.001) and five years following surgery ($26,549 vs $25,730; p < 0.001); however, the mean costs of TKA were comparable to UKA at ten years ($26,877 vs $26,891; p = 0.425). Conclusion Despite higher revision rates, patients undergoing UKA had lower mean healthcare costs than those undergoing TKA up to ten years following the procedure, at which time costs were comparable. In the era of value-based care, surgeons and policymakers should be aware of the costs involved with these procedures. UKA was associated with fewer complications at one year postoperatively but higher revision rates at five and ten years. While UKA was significantly less costly than TKA at one and five years, costs at ten years were comparable with a mean difference of only $14. Lowering the risk of revision surgery should be targeted as a source of cost savings for both UKA and TKA as the mean related healthcare costs were 2.5-fold higher in patients requiring revision surgery. Cite this article: Bone Joint J 2021;103-B(6 Supple A):23–31.
Can a robot help a surgeon to predict a good total knee arthroplasty?
Authors: Lee Gwo-Chin , Wakelin Edgar , Randall Amber , Plaskos Christopher 
Published: May 2021

AimsNeither a surgeon’s intraoperative impression nor the parameters of computer navigation have been shown to be predictive of the outcomes following total knee arthroplasty (TKA). The aim of this study was to determine whether a surgeon, with robotic assistance, can predict the outcome as assessed using the Knee Injury and Osteoarthritis Outcome Score (KOOS) for pain (KPS), one year postoperatively, and establish what factors correlate with poor KOOS scores in a well-aligned and balanced TKA.MethodsA total of 134 consecutive patients who underwent TKA using a dynamic ligament tensioning robotic system with a tibia first resection technique and a cruciate sacrificing ultracongruent TKA system were enrolled into a prospective study. Each TKA was graded based on the final mediolateral ligament balance at 10° and 90° of flexion: 1) < 1 mm difference in the thickness of the tibial insert and that which was planned (n = 75); 2) < 1 mm difference (n = 26); 3) between 1 mm to 2 mm difference (n = 26); and 4) > 2 mm difference (n = 7). The mean one-year KPS score for each grade of TKA was compared and the likelihood of achieving an KPS score of > 90 was calculated. Finally, the factors associated with lower KPS despite achieving a high-grade TKA (grade A and B) were analyzed.ResultsPatients with a grade of A or B TKA had significantly higher mean one-year KPS scores compared with those with C or D grades (p = 0.031). There was no difference in KPS scores in grade A or B TKAs, but 33% of these patients did not have a KPS score of > 90. While there was no correlation with age, sex, preoperative deformity, and preoperative KOOS and Patient-Reported Outcomes Measurement Information System (PROMIS) physical scores, patients with a KPS score of < 90, despite a grade A or B TKA, had lower PROMIS mental health scores compared with those with KPS scores of > 90 (54.1 vs 50.8; p = 0.043). Patients with grade A and B TKAs with KPS > 90 were significantly more likely to respond with “my expectations were too low”, and with “the knee is performing better than expected” compared with patients with these grades of TKA who had a KPS score of < 90 (40% vs 22%; p = 0.004).ConclusionA TKA balanced with robotic assistance to within 1 mm of difference between the medial and lateral sides in both flexion and extension had a higher KPS score one year postoperatively. Despite accurate ligament balance information, a robotic system could not guarantee excellent pain relief. Patient expectations and mental status also significantly affected the perceived success of TKA. Cite this article: Bone Joint J 2021;103-B(6 Supple A):67–73.
Hazards of fatigue: learning from aviation
Authors: Irfan A , Ahmed I , Malik M 
Published: May 2021

Fatigue can lead to a degradation in mental and physical performance. This increases the risk for error, which can be disastrous in healthcare or aviation. Professionals in these fields are at a greater risk for fatigue as they often work long hours at unnatural times. While the aviation industry has taken active measures to investigate and reduce fatigue through regulations imposed by its governing bodies, recognition of these effects has been slower in the medical field. Doctors are frequently reporting burnout and feel as though they are unable to perform effectively at work. As a consequence, physician retention is at an all-time low. The aviation industry provides a model for changes that need to be made to the healthcare schedules. If these are not implemented, the situation may continue to deteriorate and it is the patients who will ultimately suffer.
Teams, performance and trust: a perspective from the vanguard
Authors: James OP , Bowman CR , Parker J , Luton O , Robinson DBT , Hopkins L , Powell AGMT , Egan RJ , Lewis WG ,   * On behalf of the Welsh Surgical Research Initiative T Abdelrahman, E Barlow, C Brown, T Combellack, C Eley, J Hilton, H John, HG Jones, T Key, M Larsen, D Magowan, K Mellor, R Slade, J Wheat, L Wilks
Published: May 2021

Introduction The aim of this study was to determine surgical trainees’ perspectives on team environment, function, performance and trust. Methods A 44-point anonymous survey was distributed to all doctors working in surgery in a single UK statutory education body. Responses were received from 116 doctors (17 foundation year 1 [F1] doctors, 50 senior house officers [SHOs], 49 specialist registrars [SpRs]). Results Psychological safety was associated with trainee grade, with SHOs showing the lowest results relating to perception of support (F1 88%, SHO 60%, SpR 82%, p=0.016) and ability to ask for help (F1 100%, SHO 71%, SpR 92%, p=0.043). Dependability among colleagues was perceived to be poorer by women than by men (70% vs 88%, p=0.009). Clarity of team structure was associated with grade and perceived to be poor by SHOs (F1 94%, SHO 60%, SpR 78%, p=0.014). Meaningfulness and impact of team achievement was also associated with grade (F1 77%, SHO 69%, SpR 94%, p=0.005). Inverse correlations were observed between the prevalence of harassment/bullying and markers of psychological safety (rs=-0.382, p<0.001), dependability (rs=-0.270, p=0.003) and clarity of team structure (rs=0.355, p<0.001). Conclusions Important deficiencies in psychological safety had an adverse effect on two in five SHOs. Countermeasures (enhanced stress resilience training) are needed to protect morale, patient safety and clinical out
Multisource feedback for the physician associate role
Authors: Theodoraki M , Hany TS , Singh H , Khatri M 
Published: May 2021

Introduction Physician associates (PAs) are dependent medical practitioners who work alongside doctors and other healthcare professionals. There are approximately 350 PAs working throughout the UK, with another 550 in training. Methods An online questionnaire was sent to healthcare professionals throughout the North West region with a total of 119 responding. Participants were asked nine questions on clinical skills and three on communication skills. These were to be rated as ‘excellent’, ‘good’, ‘satisfactory’, ‘needs to improve’ or ‘unacceptable’. In addition, respondents were asked to indicate their agreement with 14 statements about the role of PAs. There was also a field for free text comments. Results Of the 1,071 individual responses to the survey questions on clinical skills, 859 (80%) were ‘excellent’ or ‘good’. Similarly, among the 357 answers to the questions on communication skills, 317 (89%) were ‘excellent’ or ‘good’. Comments in the free text field included both positive and negative observations, with all negative comments coming from junior doctors. Conclusions Overall feedback for the PA role was overwhelmingly positive. However, the most commonly mentioned problem was that they are not being utilised effectively and in turn, that they are taking learning opportunities from junior doctors. This is an important concern to note and warrants further investigation. PAs are clearly useful assets and are set to increase in number in the NHS over the coming years. It is therefore imperative that this new role works well with the existing roles and training structure of junior doctors.
40Ar/39Ar geochronology of Burdigalian paleobotanical localities in the central Paratethys (south Slovakia)
Authors: Šarinová Katarína , Rybár Samuel , Jourdan Fred , Mayers Celia , Frew Adam , Kováčová Marianna , Nováková Petronela , Lichtman Barbara , Kováč Michal 
Published: May 2021

The Lipovany and Mučín paleobotanical localities contain important floral associations within the tuff horizons, which were used for determination of subtropical to tropical climatic conditions during the Early Miocene. Based on the combination of results from plagioclase and biotite 40Ar/39Ar dating, the age of the tuff deposition is around 17.3Ma. For the Lipovany locality, single-grain 40Ar/39Ar convergent ages of 17.49±0.54Ma and 17.28±0.06Ma, for plagioclase and biotite were obtained, respectively. The Mučín locality only provide an imprecise convergent age of 16.5±1.4Ma due to the small size of the analyzed plagioclase crystals. The results thus allowed to include the fossil subtropical flora of the studied localities in the late Ottnangian regional stage (upper part of the Burdigalian). Additionally, these age data indicate that deposition of the overlaying Salgótarján Formation starts much later than originally thought (during Ottnangian-Karpatian boundary).
Essência versus Aparência? Perspectivas Teóricas sobre os Transtornos Psicológicos numa “Sociedade do Espetáculo” / Essence versus Appearance? Theoretical Perspectives about Psychological Disorders in a “Spectacle Society”
Authors: Gomes Lidiane Bernardo , Leite Junior Francisco Francinete 
Published: May 2021

O presente artigo tem por objetivo elaborar uma análise sobre a relação entre os transtornos psicológicos e o uso das redes sociais (WhatsApp, Facebook, Instagram, Twitter e Tinder) a partir de uma leitura da sociedade apresentada nas ideias de Guy Debord (1967), traçando um paralelo com a sociedade contemporânea, e obras da atualidade sobre o tema considerando os últimos 12 anos. Para tanto objetivamos investigar como a espetacularização da sociedade apresentada por Debord interfere na compreensão dos transtornos psicológicos na atualidade. Nesse sentido, metodologicamente seguimos o seguinte percurso: 1- da delimitação do tema inserindo à temática transtornos psicológicos: 2 - levantamento das publicações em artigo de bases de dados da internet e livros; 3 – análises e classificações das informações encontradas. Nessa fase foram considerados livros e artigos que apresentavam uma correlação entre sociedade atual e sua relação com as mídias e transtornos psicológicos; 4 – organização e escrita das ideias pré-estabelecidas. Diante deste estudo concluímos que, de acordo com o levantamento bibliográfico, existem pesquisas que mostram a relação entre selfies, em grande quantidade, com o transtorno de personalidade narcísico. Além disso, alguns estudos pesquisados sugerem o lado perigoso das selfies, quando a pessoa ultrapassa todos os limites para conseguir a selfie perfeita.
Logística Interna no Varejo de Eletrodomésticos: Um Estudo Bibliométrico dos últimos 10 anos (2011-2020) / Internal Logistics in the Retail of Home Appliances: A Bibliometric Study of the last 10 years (2011-2020)
Authors: Silva Mauricio Alexandre da 
Published: May 2021

Resumo: Atualmente o mercado de trabalho não tem exigido das empresas apenas investimento, mas o desenvolvimento de estratégias que conduza o negócio à sua sustentabilidade. A logística interna por sua vez, tem sido uma grande investida para fortalecer o processo de gerenciamento, as empresas em buscado a cada dia estruturar seus espaços físicos e sempre se colocarem a disposição para acréscimos futuros, tendo como foco principal estarem preparadas para a competitividade global.O presente estudo tem como objetivo identificar e descrever as publicações no Brasil sobre o tema: a importância da logística interna no varejo de eletrodomésticos. Este trabalho constitui-se emum estudo bibliométrico sobre varejo e gestão de estoque de eletrodomésticos no Brasil nos últimos dez anos (2011-2020) com base em artigos e periódicos encontrados nas bases de artigos da SciELO e do Google Acadêmico.
A Importância da Formação Continuada nos Processos de Ensino e Aprendizagem / The Importance of Continuing Education in the Teaching and Learning Processes
Authors: Alves Alzenir Teixeira , Miguel Joelson Rodrigues 
Published: May 2021

Resumo: O ato de educar, assim como o processo de alfabetização como um todo engloba inúmeros fatores políticos, constitucionais e educacionais, onde esses aspectos incluem em especial a perspectiva pedagógicas nos processos de ensino-aprendizagem. O estudo em tela discute a importância da formação continuada nos processos de ensino e aprendizagem que, diga-se de passagem, quando levados em consideração tem grande impacto na evolução da formação do educando. A metodologia utilizada é de natureza bibliográfica básica, baseada nos pressupostos teóricos de: Libâneo (2015); Freire, (1996); Castro, (2014); Tardiff (2002) e demais pesquisadores da área de educação. Concluiu-se que ainda há lacunas que precisam ser repensadas e melhoradas, como a realização de formações que permitam aos docentes estratégias mais adaptadas e contextualizadas com a realidade dos discentes, bem como ações que aproximem mais a escola da família. Políticas públicas mais efetivas que garantam atualização constante dos educadores é importantes estratégia para que se garanta uma educação de qualidade mais atualizada, em sintonia com as novas tecnologias educacionais.
Deficiência e Inclusão: Novos Desafios na Contemporaneidade / Disability and Inclusion: New Challenges in Contemporaneity
Authors: Sousa Francisco Gilberto Braga de , Miguel Joelson Rodrigues 
Published: May 2021

Resumo: A inserção do aluno com deficiência no ensino regular pode ser um caminho para a construção e reconstrução de conhecimento e, para o desenvolvimento cognitivo. Desta forma contribui para a formação de sua identidade e promovendo uma maior integração social. Este trabalho discute a deficiência e a inclusão como novos desafios na contemporaneidade, á luz da literatura, mais especificamente dos autores: Mantoan e Prieto (2003); Effgen (2017); Freire e Bianchetti (2017); Marcotti e Marques (2017); Coutinho (2018) e, Sousa (2020). Concluiu-se que a inclusão da pessoa com deficiência precisa ser compreendida através da valorização do outro e do respeito às diferenças e a diversidade. Para isso, é preciso implantar políticas educacionais de capacitação continuada de educadores, com base na inclusão, de forma a que o poder público possa prover os meios necessários para efetivação da garantia à uma educação inclusiva e de qualidade.
Considerações Terapêuticas no Transtorno Afetivo Bipolar na Terceira Idade: Uma Revisão da Literatura / Therapeutic Considerations in Bipolar Affective Disorder in the Third Age: A Literature Review
Authors: Queiroz Neto Hipólito Pessoa de , Marinho Ana Olívia De Oliveira , Barroso Marianna Leite , Quaresma Francisco Edvanilson De Lima , Cabral Symara Abrantes Albuquerque de Oliveira 
Published: May 2021

Resumo: o transtorno afetivo bipolar constitui-se de uma doença que tem por característica a alternância entre períodos de mania e depressão, podendo evoluir para sintomas psicóticos. É um transtorno que afeta um número considerável de indivíduos, sobretudo mulheres e pessoas de mais idade, provocando incapacidades civis e laborais. Sua complexidade desafia profissionais a buscarem, cada vez mais, melhores opções terapêuticas na busca pela melhoria da qualidade de vida dos indivíduos. Objetivo: consolidar informações capazes de fundamentar as melhores práticas terapêuticas, com respostas diretas na melhoria da qualidade de saúde e vida dos idosos acometidos por TAB. Metodologia: trata-se de uma revisão da literatura. Resultados e discussão: diversas são as drogas que prometem melhoria dos quadros que, por sua alternância de sintomatologias, requerem terapêuticas adjuvantes além das opções que incluem os processos terapêuticos. A polifarmácia, a falta de conhecimento e a incapacidade dos idosos constituem fatores que dificultam a terapêutica, existindo programas e estratégias capazes de transpor tais dificuldades. Conclusão: diante das mais diversas opções terapêuticas e abordagem de estratégias capazes de reduzir as barreiras para o tratamento, cabe aos profissionais atuarem no contexto da subjetividade, buscando as melhores estratégias terapêuticas para alcançar uma melhor qualidade de vida para os pacientes idosos acometidos por TAB.
Liderança e Motivação nas Empresas: Resultados Satisfatórios / Leadership and Motivation in Companies: Satisfactory Results
Authors: Bem Filho Odilon , Macêdo Maria Erilúcia Cruz 
Published: May 2021

Resumo: O estudo objetiva refletir sobre a evolução da liderança e sua atuação nos contextos motivacional e organizacional, observando as atividades do líder e sua importância na motivação da equipe. Desse modo, busca-se verificar o aumento da produtividade dos liderados. Para tanto, a pesquisa foi conduzida por meio de um estudo bibliográfico, tendo como fontes artigos, livros e sites. Por meio dos resultados foi identificado que todos os colaboradores afirmam que o líder deve usar mais de um estilo de liderança, visto que de acordo com a personalidade do colaborador, cada pessoa se comporta de maneira diferente, mas completam a afirmação informando que o estilo de liderança predominante na empresa é o democrático. Assumir um cargo de liderança não é tarefa fácil; exige muita competência e dedicação, pois as pressões por resultados são grandes e para atingi-los depende-se das pessoas que compõem a equipe.
Atendimento Humanizado nas Unidades de Urgência e Emergência / Humanized Care in Urgent and Emergency Units
Authors: Gregório Samuel De Sousa , Barbosa Francisca Luziene Fernandes , Bezerra Martha Maria Macedo 
Published: May 2021

Resumo: O presente estudo tem por objetivo geral refletir sobre o Atendimento humanizado nas unidades de urgência e emergência para melhor subsidiar a prática dos profissionais de saúde em relação aos indivíduos que estão presentes nesse contexto. Esta pesquisa caracteriza-se como sendo um estudo de revisão bibliográfica, desenvolvidono período de outubro a dezembro. A humanização busca satisfação dos pacientes e cidadãos que estão envolvidos no processo, seja interno ou externo, como o conceito de tornar mais humano as ações e atitudes voltadas a área da saúde, o que qualifica o ambiente hospitalar, e consequentemente garantir melhor bem-estar e recuperação dos enfermos. As principais referências do trabalho são a Política Nacional de Humanização (2004), Política Nacional de Atenção Básica (2004) e Pires (1999). Percebemos que as situações sociais, como infraestrura, altas demandas influenciam no desempenho dos profissionais de saúde, que muitas vezes ocasionam momentos hostis dentro das unidades hospitalares, porém humanizar é respeitar a vida humana, sua dignidade, considerando suas circunstâncias e procurando efetivar um bom relacionamento entre profissionais, pacientes e familiares.