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Orthopedic Surgery (orthopedic + surgery)
Selected AbstractsA Novel Interdisciplinary Analgesic Program Reduces Pain and Improves Function in Older Adults After Orthopedic SurgeryJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 1 2009R. Sean Morrison MD OBJECTIVES: To examine the effect of a multicomponent intervention on pain and function after orthopedic surgery. DESIGN: Controlled prospective propensity score,matched clinical trial. SETTING: New York City acute rehabilitation hospital. PARTICIPANTS: Two hundred forty-nine patients admitted to rehabilitation after hip fracture repair (n=51) or hip (n=64) or knee (n=134) arthroplasty. INTERVENTION: Pain assessment at rest and with physical therapy (PT) by staff using numeric rating scales (1 to 5). Physician protocols for standing analgesia and preemptive analgesia before PT were implemented on the intervention unit. Control unit patients received usual care. MEASUREMENTS: Pain, analgesic prescribing, gait speed, transfer time, and percentage of PT sessions completed during admission. Pain and difficulty walking at 6, 12, 18, and 24 weeks after discharge. RESULTS: In multivariable analyses intervention patients were significantly more likely than controls to report no or mild pain at rest (66% vs 49%, P=.004) and with PT (52% vs 38%, P=.02) on average for the first 7 days of rehabilitation, had faster 8-foot-walk times on Days 4 (9.3 seconds vs 13.2 seconds, P=.02) and 7 (6.9 vs 9.2 seconds, P=.02), received more analgesia (23.6 vs 15.6 mg of morphine sulfate equivalents per day, P<.001), were more likely to receive standing orders for analgesia (98% vs 48%, P<.001), and had significantly shorter lengths of stay (10.1 vs 11.3 days, P=.005). At 6 months, intervention patients were less likely than controls to report moderate to severe pain with walking (4% vs 15%, P=.02) and that pain did not interfere with walking (7% vs 18%, P=.004) and were less likely to be taking analgesics (35% vs 51%, P=.03). CONCLUSION: The intervention improved postoperative pain, reduced chronic pain, and improved function. [source] In vivo muscle architecture and size of the rectus femoris and vastus lateralis in children and adolescents with cerebral palsyDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 10 2009NOELLE G MOREAU PHD PT Aim, Our aim was to investigate muscle architecture and size of the rectus femoris (RF) and vastus lateralis (VL) in children and adolescents with cerebral palsy (CP) compared with age-matched typically developing participants. Method, Muscle architecture and size were measured with ultrasound imaging in 18 participants with spastic CP (9 females, 9 males; age range 7.5,19y; mean age 12y [SD 3y 2mo]) within Gross Motor Function Classification System levels I (n=4), II (n=2), III (n=9), and IV (n=3) and 12 typically developing participants (10 females, 2 males; age range 7,20y; mean age 12y 4mo [SD 3y 11mo]). Exclusion criteria were orthopedic surgery or neurosurgery within 6 months before testing or botulinum toxin injections to the quadriceps within 3 months before testing. Results, RF cross-sectional area was significantly lower (48%), RF and VL muscle thickness 30% lower, RF fascicle length 27% lower, and VL fascicle angle 3° less in participants with CP compared to the typically developing participants (p<0.05). Intraclass correlation coefficients were ,0.93 (CP) and , 0.88 (typical development), indicating excellent reliability. Interpretation, These results provide the first evidence of altered muscle architecture and size of the RF and VL in CP, similar to patterns observed with disuse and aging. These alterations may play a significant role in the decreased capacity for force generation as well as decreased shortening velocity and range of motion over which the quadriceps can act. [source] Surface Structures and Osteoblast Activity on Biomedical Polytetrafluoroethylene Treated by Long-Pulse, High-Frequency Oxygen Plasma Immersion Ion ImplantationADVANCED ENGINEERING MATERIALS, Issue 5 2010Liping Tong Abstract Polytetrafluoroethylene (PTFE) is a biologically safe polymer used widely in clinical medicine including oral and orthopedic surgery. However, the high bio-inertness of PTFE has hampered wider applications in the biomedical fields. In this work, we extend the treatment time in long-pulse, high-frequency oxygen plasma immersion ion implantation of PTFE and a more superhydrophobic surface with a water contact angle of 160° is created. X-ray photoelectron spectroscopy (XPS) and atomic force microscopy (AFM) reveal that the optimized long-pulse, high-frequency oxygen plasma immersion ion implantation process induces a rougher surface and to a lesser extent alters the surface oxygen concentration on the PTFE. Our data, especially long-term contact angles, suggest that the superhydrophobility stems from surface roughness alteration. Furthermore, the activity of MC3T3-E1 osteoblasts cultured on the treated surfaces is promoted in terms of quantities and morphology. [source] A Short-Term Bioresorbable Bone Filling Material Based on Hydroxyapatite, Chitosan, and Oxidized Starch Tested in a Novel Orthotopic Metaphyseal Mouse Model,ADVANCED ENGINEERING MATERIALS, Issue 8 2009Elias Volkmer Despite significant advances in orthopedic surgery, no perfect bioresorbable bone-filling material has yet been clinically established. A new candidate material based on hydroxyapatite, chitosan and oxidised starch, which has the potential to covalently bind to bone in a watery milieu was tested in a new murine model. A special focus lies on the in vivo biocompatibility and bioresorbability of the new material. [source] Subtle deficits of attention after surgery: quantifying indicators of sub syndrome deliriumINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 10 2010David Peter Lowery Abstract Objective To determine whether attentional impairments are reliable neuropsychological markers of sub syndrome delirium. Method A prospective cohort study with repeated assessment beginning pre-operatively and continuing through the first post-operative week. Computerized assessments of attention and the Mini-Mental State Examination were administered with one hundred patients admitted for elective orthopedic surgery, 70 years and over and free of dementia. Acute change of cognitive status was used to identify cases of sub syndrome delirium. Results There were significant differences of post-surgical performance between the ,no delirium' and ,sub-syndrome delirium' groups of reaction time, global cognition, accuracy and greater variability of reaction time (p,<,0.041). There were significant within subject main effects on reaction time (p,=,0.001), variability of reaction time (p,=,0.022) and MMSE (p,=,0.000) across the cohort; but no significant interaction effect of ,diagnosis' * ,time' on the computerized measures of attention (p,>,0.195). Conclusion The distinction between people with sub syndrome delirium and no delirium is difficult to quantify but computerized measures of attention might provide a sensitive indicator. Sub syndrome delirium is an observable marker of a clinical abnormality that should be exploited to improve care management for vulnerable patients. Copyright © 2010 John Wiley & Sons, Ltd. [source] Postoperative delirium after elective orthopedic surgeryINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 6 2005A. M. Contín No abstract is available for this article. [source] A Novel Interdisciplinary Analgesic Program Reduces Pain and Improves Function in Older Adults After Orthopedic SurgeryJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 1 2009R. Sean Morrison MD OBJECTIVES: To examine the effect of a multicomponent intervention on pain and function after orthopedic surgery. DESIGN: Controlled prospective propensity score,matched clinical trial. SETTING: New York City acute rehabilitation hospital. PARTICIPANTS: Two hundred forty-nine patients admitted to rehabilitation after hip fracture repair (n=51) or hip (n=64) or knee (n=134) arthroplasty. INTERVENTION: Pain assessment at rest and with physical therapy (PT) by staff using numeric rating scales (1 to 5). Physician protocols for standing analgesia and preemptive analgesia before PT were implemented on the intervention unit. Control unit patients received usual care. MEASUREMENTS: Pain, analgesic prescribing, gait speed, transfer time, and percentage of PT sessions completed during admission. Pain and difficulty walking at 6, 12, 18, and 24 weeks after discharge. RESULTS: In multivariable analyses intervention patients were significantly more likely than controls to report no or mild pain at rest (66% vs 49%, P=.004) and with PT (52% vs 38%, P=.02) on average for the first 7 days of rehabilitation, had faster 8-foot-walk times on Days 4 (9.3 seconds vs 13.2 seconds, P=.02) and 7 (6.9 vs 9.2 seconds, P=.02), received more analgesia (23.6 vs 15.6 mg of morphine sulfate equivalents per day, P<.001), were more likely to receive standing orders for analgesia (98% vs 48%, P<.001), and had significantly shorter lengths of stay (10.1 vs 11.3 days, P=.005). At 6 months, intervention patients were less likely than controls to report moderate to severe pain with walking (4% vs 15%, P=.02) and that pain did not interfere with walking (7% vs 18%, P=.004) and were less likely to be taking analgesics (35% vs 51%, P=.03). CONCLUSION: The intervention improved postoperative pain, reduced chronic pain, and improved function. [source] Comparison of cobalt chromium, ceramic and pyrocarbon hemiprostheses in a rabbit model: Ceramic leads to more cartilage damage than cobalt chromiumJOURNAL OF BIOMEDICAL MATERIALS RESEARCH, Issue 2 2008Martin Jung Abstract Cartilage wear after hemiarthroplasty remains a problem in orthopedic surgery. The main cause of cartilage wear, apart from incongruency of the joint partners, is generally considered to be the tribology of the material surfaces. This study evaluates in 27 rabbits the degree of cartilage wear of the tibia plateau after hemiarthroplasty with proximal interphalangeal prostheses made of three different materials [cobalt chromium (CoCr), pyrocarbon (PyCa), and ceramic (Cer)]. Three months after hemiarthroplasty, the articulating tibial cartilage was histomorphologically examined and degenerative damage was graded using the modified Mankin score. The mechanical capacity of the cartilage was assessed by stress relaxation testing. The biomechanical properties of the cartilage were significantly superior in the CoCr group as compared with the Cer group (p < 0.03), indicating less damage to the articulating cartilage surface. The Mankin score showed significantly lower values in the CoCr compared with Cer group (p = 0.011), whereas no differences were found between PyCa and CoCr or PyCa and Cer. In contrast to earlier reports, in this hemiarthroplasty model, the CoCr alloy showed less cartilage damage than a ceramic surface. Further, in vivo experiments are necessary to elucidate the controversial issue of the most suitable material for hemiarthroplasty. © 2007 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 2008 [source] Intravenous magnesium sulfate for post-operative pain in patients undergoing lower limb orthopedic surgeryACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 8 2009A. DABBAGH Introduction: This study looks at the effect of supplementary intravenous magnesium sulfate on acute pain when administered in patients undergoing lower limb orthopedic surgery using spinal anesthesia with bupivacaine. Method and materials: In this double-blind, randomized, placebo-controlled clinical trial, 60 patients were selected and randomly divided into two groups. Efforts were made to place both groups under the same method of anesthesia. One group received 8 mg/kg intravenous magnesium sulfate, started before the incision and continued up to the end of the surgical procedure, using a 50 ml syringe, via a peripheral large bore catheter; the second group received the same volume of placebos using the same method. To present the results, mean (± SD) was used; a P value of <0.05 was considered significant. Results: There was no difference between the two groups in terms of the basic variables. Pain reported by the first group that received magnesium sulfate was significantly less at the first, third, sixth and 12th hours after the operation in comparison with the group that received placebo. Also, the intravenous morphine requirements in the first 24 h after the surgery were less in the magnesium group (4.2 ± 1.6 mg) than in the control group (9.8 ± 2.1 mg). Conclusion: Intravenous magnesium sulfate can serve as a supplementary analgesic therapy to suppress the acute post-operative pain, leading to less morphine requirements in the first 24 h. [source] Cefazolin embedded biodegradable polypeptide nanofilms promising for infection prevention: A preliminary study on cell responsesJOURNAL OF ORTHOPAEDIC RESEARCH, Issue 8 2010Hongshuai Li Abstract Implant-associated infection is a serious complication in orthopedic surgery, and endowing implant surfaces with antibacterial properties could be one of the most promising approaches for preventing such infection. In this study, we developed cefazolin loaded biodegradable polypeptide multilayer nanofilms on orthopedic implants. We found that the amount of cefazolin released could be tuned. A high local concentration of cefazolin was achieved within the first a few hours and therefore may inhibit bacterial colonization in the critical postimplantation period. The developed cefazolin loaded nanofilms showed their in vitro efficacy against Staphylococcus aureus; the more antibiotics loaded, the longer the nanocoated implant had antibacterial properties. More interestingly, antibiotic-loaded polypeptide multilayer nanofilms also improved osteoblast bioactivity including cell viability and proliferation. These findings suggested that biodegradable polypeptide multilayer nanofilms as antibiotic carriers at the implant/tissue interface are compatible with human cells such as osteoblasts and bactericidal to bacteria such as S. aureus. These characteristics could be promising for preventing implant-associated infection and potentially improving bone healing. © 2010 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 28:992,999, 2010 [source] Osteogenesis induced by extracorporeal shockwave in treatment of delayed osteotendinous junction healingJOURNAL OF ORTHOPAEDIC RESEARCH, Issue 1 2010Ling Qin Abstract Healing at the osteotendinous junction (OTJ) is challenging in orthopedic surgery. The present study aimed to test extracorporeal shockwave (ESW) in treatment of a delayed OTJ healing. Twenty-eight rabbits were used for establishing a delayed healing (DH) model at patella-patellar-tendon (PPT) complex after partial patellectomy for 4 weeks and then were divided into DH and ESW groups. In the ESW group, a single ESW treatment was given at postoperative week 6 to the PPT healing complex. The samples were harvested at week 8 and 12 for radiographic and histological evaluations with seven samples for each group at each time point. Micro-CT results showed that new bone volume was 1.18 ± 0.61,mm3 in the ESW group with no measurable new bone in the DH group at postoperative week 8. Scar tissue formed at the OTJ healing interface of the DH group, whereas ESW triggered high expression of VEGF in hypertrophic chondrocytes at week 8 and regeneration of the fibrocartilage zone at week 12 postoperatively. The accelerated osteogenesis could be explained by acceleration of endochondral ossification. In conclusion, ESW was able to induce osteogenesis at OTJ with delayed healing with enhanced endochondral ossification process and regeneration of fibrocartilage zone. These findings formed a scientific basis to potential clinical application of ESW for treatment of delayed OTJ healing. © 2009 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 28:70,76, 2010 [source] Control of Crystallinity of Hydrated Products in a Calcium Phosphate CementJOURNAL OF THE AMERICAN CERAMIC SOCIETY, Issue 4 2009Tao Yu A novel calcium phosphate cement (CPC) was prepared by dry-mechanochemical rout in this work. With the different crystallinity, the CPC showed the different degradation ratio after setting. The degradation ratio of CPC was characterized by the calcium ion-dissolving ratio in deionized water after different soaking time. With the increment of crystallinity, the setting times of CPC were prolonged, and the different mechanical property of CPC were obtained. This novel CPC was supposed to match the new bone ingrowth in vivo and have the potential application in orthopedic surgery for filling non-load-bearing bone defects. [source] How can we reduce disagreement among guidelines for venous thromboembolism prevention?JOURNAL OF THROMBOSIS AND HAEMOSTASIS, Issue 4 2010M. SOBIERAJ-TEAGUE See also Struijk-Mulder MC, Ettema HB, Verheyen CC, Büller HR. Comparing consensus guidelines on thromboprophylaxis in orthopedic surgery. This issue, pp 678,83. [source] Laboratory and clinical outcomes of pharmacogenetic vs. clinical protocols for warfarin initiation in orthopedic patientsJOURNAL OF THROMBOSIS AND HAEMOSTASIS, Issue 10 2008P. A. LENZINI Summary.,Background:,Warfarin is commonly prescribed for prophylaxis and treatment of thromboembolism after orthopedic surgery. During warfarin initiation, out-of-range International Normalized Ratio (INR) values and adverse events are common. Methods:,In orthopedic patients beginning warfarin therapy, we developed and prospectively validated pharmacogenetic and clinical dose refinement algorithms to revise the estimated therapeutic dose after 4 days of therapy. Results:,The pharmacogenetic algorithm used the cytochrome P450 (CYP) 2C9 genotype, smoking status, peri-operative blood loss, liver disease, INR values and dose history to predict the therapeutic dose. The R2 was 82% in a derivation cohort (n = 86) and 70% when used prospectively (n = 146). The R2 of the clinical algorithm that used INR values and dose history to predict the therapeutic dose was 57% in a derivation cohort (n = 178) and 48% in a prospective validation cohort (n = 146). In 1 month of prospective follow-up, the percent time spent in the therapeutic range was 7% higher (95% CI: 2.7,11.7) in the pharmacogenetic cohort. The risk of a laboratory or clinical adverse event was also significantly reduced in the pharmacogenetic cohort (Hazard Ratio 0.54; 95% CI: 0.30,0.97). Conclusions:,Warfarin dose adjustments that incorporate genotype and clinical variables available after four warfarin doses are accurate. In this non-randomized, prospective study, pharmacogenetic dose refinements were associated with more time spent in the therapeutic range and fewer laboratory or clinical adverse events. To facilitate gene-guided warfarin dosing we created a non-profit website, http://www.WarfarinDosing.org. [source] Prevention of venous thromboembolism after major orthopedic surgery: ,new' clinical trials for new antithrombotic agentsJOURNAL OF THROMBOSIS AND HAEMOSTASIS, Issue 12 2003P. Mismetti No abstract is available for this article. [source] Biostimulation; Cardiovascular, general surgery, thoracic, orthopedic surgeryLASERS IN SURGERY AND MEDICINE, Issue S13 2001Article first published online: 29 MAR 200 No abstract is available for this article. [source] Cardiovascular, general surgery, thoracic, orthopedic surgery; Dentistry/O & MLASERS IN SURGERY AND MEDICINE, Issue S13 2001Article first published online: 29 MAR 200 First page of article [source] Preparation of Clay/PMMA Nanocomposites with Intercalated or Exfoliated Structure for Bone Cement SynthesisMACROMOLECULAR MATERIALS & ENGINEERING, Issue 6 2006Jyh-Horng Wang Abstract Summary: Clay/PMMA nanocomposites were prepared by melt blending of an organically modified MMT with PMMA under various process conditions. The MMT clay was initially cation exchanged with octadecylammonium to enhance its hydrophobicity and to expand the interlamellar space of the silicate plates. PMMA was then inserted into the inter-lamellar space of the modified clay by melt blending at an elevated temperature. The effects of blending temperature, blending time, and clay/PMMA compositions on the level of expansion and homogenization were investigated. Composites with intercalated and/or exfoliated clay structure were obtained depending upon the process conditions, as confirmed by XRD diffractometry. The thermal decomposition temperature (Td) and glass transition temperature (Tg) of the composites were determined, respectively, by TGA and DSC analyses. Marked improvements, up to 35,°C, of the thermal stability (Td) with respect to pure PMMA were achieved for many of the composite samples. The Tg of the composites, however, does not increase accordingly. Furthermore, a novel type of bone cement was synthesized by applying the clay/PMMA nanocomposites as a substitute for PMMA in a typical formulation. These bone cements demonstrated much higher impact strength and better cell compatibility than the surgical Simplex P cement. Therefore, the bone cements with clay/PMMA nanocomposites meet the requirement for the architectural design of orthopedic surgery. TEM images of an OA-clay/PMMA composite. [source] Deep venous thrombosis: Diagnostic value of non-contrast-enhanced MR venography using electrocardiography-triggered three-dimensional half-fourier FSEMAGNETIC RESONANCE IN MEDICINE, Issue 1 2010Atsushi Ono Abstract We prospectively assessed the diagnostic accuracy of non-contrast-enhanced MR venography using both the flow-refocused fresh-blood imaging (FR-FBI) and the swap phase-encode arterial double-subtraction elimination (SPADE) techniques for detecting deep vein thrombosis (DVT), as compared using conventional X-ray venography as the reference standard. Forty-one legs of 32 consecutive patients (eight men, 24 women; mean age ± standard deviation, 69.4 ± 15.3 years) suspected of having deep vein thrombosis and thus examined using conventional X-ray venography underwent MR FR-FBI and SPADE. Twenty-five of the 32 patients had nonmagnetizing, metal implants they had received during hip or leg surgery. Two radiologists independently assessed the MR venograms as either diagnostic or nondiagnostic and with either the presence or absence of thrombi. The sensitivities of FR-FBI and SPADE for diagnosing thrombus were 100% (53 of 53) for both reviewers. Nondiagnostic segments were excluded from this analysis. The corresponding specificities were 100% (238 of 238 for reviewer A) and 99.6% (237 of 238 for reviewer B). The interobserver agreement regarding the MR images for the assessment of thrombosis was high (, = 0.92). Non-contrast-enhanced MR venography using SPADE and FR-FBI is highly accurate and reproducible for diagnosing DVT. This is especially advantageous for patients who have received nonmagnetizing, metal implants during orthopedic surgery. Magn Reson Med, 2010. © 2010 Wiley-Liss, Inc. [source] Capsaicin delays regeneration of the neuromuscular junction of rat extensor digitorum longus muscle after ischemiaMUSCLE AND NERVE, Issue 4 2006Béla Turchányi MD Abstract Trauma or the tourniquet used in orthopedic surgery is often associated with ischemia,reperfusion (I/R) injury with a consequent decrease of muscle power. To explore whether components of the neuromuscular junction (NMJ) are involved in this muscle dysfunction, NMJs were ultrastructurally characterized in the extensor digitorum longus muscle of rats at reperfusion times of 1, 24, 72, and 168 h after a 120-min arterial occlusion. Disorganization of the presynaptic membrane and mitochondrial injury was noted at 1 h, followed by fragmentation and partial engulfment of nerve terminals by Schwann cells at 24 and 72 h. The magnitude of degenerative changes declined at 168 h, suggesting the commencement of regeneration. The postsynaptic membrane remained intact throughout the whole period. In our previous study, deafferentation with pretreatment of the sciatic nerve with capsaicin, which reduces neurogenic inflammation and has a selective effect on nociceptive fibers, improved functional recovery of the muscle after I/R. The present results document a significantly delayed structural regeneration of the motor nerve terminals after combined capsaicin and I/R treatment. Since capsaicin treatment alone had no discernible effect on the structure of NMJs, the findings point to a possibly indirect effect of capsaicin on the motor nerves, which may predispose them to increased susceptibility unmasked only by a subsequent injury. The mismatch between the enhanced functional improvement of the muscle and delayed regeneration of the nerve after capsaicin pretreatment questions the efficient use of such deafferentation to protect the integrity of neuromuscular junctions in I/R injury. Muscle Nerve, 2006 [source] The Use of Cerebral Oximetry as a Monitor of the Adequacy of Cerebral Perfusion in a Patient Undergoing Shoulder Surgery in the Beach Chair PositionPAIN PRACTICE, Issue 4 2009Gregory W. Fischer MD Abstract Four cases of ischemic injury have been reported in patients undergoing orthopedic surgery in the upright position. We describe the use of cerebral oximetry as a monitor of the adequacy of cerebral perfusion in a 63-year-old woman who underwent arthroscopic rotator cuff surgery in a beach chair under general anesthesia. During positioning, a decrease in blood pressure was accompanied by a decrease in cerebral oxygen saturation (SctO2) and was treated with phenylephrine. When spontaneous ventilation resumed, an increase in end-tidal carbon dioxide was accompanied by an increase in SctO2. Cerebral oximetry may prove useful as a guide monitor and manage nonsupine patients. [source] Anesthesia for sickle cell disease and congenital myopathy in combinationPEDIATRIC ANESTHESIA, Issue 8 2006REBECCA FANNING FCARCSI Summary We report on the perioperative management of anesthesia and analgesia in a child with sickle cell disease and a congenital myopathy, presenting for corrective orthopedic surgery. The case illustrates two valuable points of interest: the many benefits of regional anesthesia in complex medical cases and the successful use of tourniquets in children with sickle cell disease. [source] Neuropathic pain following multilevel surgery in children with cerebral palsy: a case series and reviewPEDIATRIC ANESTHESIA, Issue 5 2005G.R. LAUDER MBBCh FRCA Summary Six children with cerebral palsy are presented who developed neuropathic pain following multilevel orthopedic surgery. This significant complication is previously unreported. The diagnosis and treatment options are reviewed. Treatment should be kept as simple and noninvasive as possible, and aim to enable physiotherapy to continue. Early recognition and interdisciplinary treatment is important to prevent a downward spiral of increasing pain and decreased function. A good outcome in respect of improved pain and functioning was achieved in five of these six children. It is our opinion that this complication should form part of informed consent for multilevel surgery and that anesthetists should be aware of this complication when managing postoperative pain control. [source] Rural Illinois Hospital Chief Executive Officers' Perceptions of Provider Shortages and Issues in Rural Recruitment and RetentionTHE JOURNAL OF RURAL HEALTH, Issue 1 2006Michael Glasser PhD ABSTRACT:,Background: It is important to assess rural health professions workforce needs and identify variables in recruitment and retention of rural health professionals. Purpose: This study examined the perspectives of rural hospital chief executive officers (CEOs) regarding workforce needs and their views of factors in the recruitment and retention process. Methods: A survey was mailed to CEOs of 28 Illinois rural hospitals, in towns ranging from 3,396 to 33,530 in population size. The survey addressed CEO perceptions of number of physicians needed by specialty, need for other health professionals, and variables important to recruitment and retention. Findings: Twenty-two CEOs (79%) responded to the survey. Eighty-six percent indicated a physician shortage in the community, with 64% reporting the need for family physicians. CEOs also indicated the need for physicians in obstetrics-gynecology, general and orthopedic surgery, general internal medicine, cardiology, and psychiatry. In terms of needs for other health professionals, most often mentioned were registered nurses (91%), pharmacists (64%), and nurses' aides (46%). Related to recruitment and retention, most often mentioned by the CEOs was community attractiveness in general, followed by practice and physician career opportunities. Conclusions: CEOs offer 1 important perspective on health professions needs, recruitment, and retention in rural communities. While expressing a range of opinions, rural hospital CEOs clearly indicate the need for more primary care physicians, call for an increased capacity in nursing, and point to community development as a key factor in recruitment and retention. [source] Multifactorial dysphagia: Diffuse idiopathic skeletal hyperostosis and eosinophilic esophagitis,THE LARYNGOSCOPE, Issue 1 2010Grace Nimmons MD Abstract Swallowing is a complex, multistage event with oral, pharyngeal, and esophageal phases. A thorough clinical examination for swallowing complaints begins to differentiate whether the problem is due to anatomic, mechanical, or neurologic etiologies. Based on the clinical suspicion, additional tests may be beneficial, including fluoroscopic and direct imaging methods, and electrophysiologic measurements. A multidisciplinary approach may also be advantageous, as in this case of dysphagia from diffuse idiopathic skeletal hyperostosis and eosinophilic esophagitis, which incorporated care from otolaryngology, speech pathology, orthopedic surgery, and gastroenterology. Laryngoscope, 2010 [source] Role of interleukin-1, in postoperative cognitive dysfunctionANNALS OF NEUROLOGY, Issue 3 2010Mario Cibelli MD Objective: Although postoperative cognitive dysfunction (POCD) often complicates recovery from major surgery, the pathogenic mechanisms remain unknown. We explored whether systemic inflammation, in response to surgical trauma, triggers hippocampal inflammation and subsequent memory impairment, in a mouse model of orthopedic surgery. Methods: C57BL/6J, knock out (lacking interleukin [IL]-1 receptor, IL-1R,/,) and wild type mice underwent surgery of the tibia under general anesthesia. Separate cohorts of animals were tested for memory function with fear conditioning tests, or euthanized at different times to assess levels of systemic and hippocampal cytokines and microglial activation; the effects of interventions, designed to interrupt inflammation (specifically and nonspecifically), were also assessed. Results: Surgery caused hippocampal-dependent memory impairment that was associated with increased plasma cytokines, as well as reactive microgliosis and IL-1, transcription and expression in the hippocampus. Nonspecific attenuation of innate immunity with minocycline prevented surgery-induced changes. Functional inhibition of IL-1,, both in mice pretreated with IL-1 receptor antagonist and in IL-1R,/, mice, mitigated the neuroinflammatory effects of surgery and memory dysfunction. Interpretation: A peripheral surgery-induced innate immune response triggers an IL-1,-mediated inflammatory process in the hippocampus that underlies memory impairment. This may represent a viable target to interrupt the pathogenesis of postoperative cognitive dysfunction. ANN NEUROL 2010;68:360,368 [source] Hemospan: Design Principles for a New Class of Oxygen TherapeuticARTIFICIAL ORGANS, Issue 2 2009Kim D. Vandegriff Abstract Hemoglobin-based oxygen carriers have been under development for decades, but safety concerns have prevented commercial approval. Early designs for modified hemoglobins by polymerization or intramolecular cross-linking reactions increased molecular size and decreased oxygen affinity, but all exhibited side effects of vasoconstriction and reduced blood flow. A new strategy has been established by applying principles of oxygen transport to cell-free hemoglobin. Sangart has developed a new oxygen therapeutic, Hemospan, using site-specific, poly(ethylene) glycol conjugation chemistry designed on two principles: (i) increased macromolecular size to prolong intravascular retention time, and (ii) increased oxygen affinity to prevent premature oxygen offloading in arterioles. In contrast to early-generation products, Hemospan infusion maintains normal arteriolar vascular tone and capillary flow. Phase I and Phase II clinical trials have been completed, showing that Hemospan is well-tolerated in humans, with evidence of efficacy to impart hemodynamic stability in surgical patients under anesthesia. Phase III trials in orthopedic surgery have recently completed enrollment in Europe. [source] | ||||||||||||||||||||||||||||