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Sample records for orthopedic surgical team

  1. Sawbones laboratory in orthopedic surgical training

    PubMed Central

    Hetaimish, Bandar M.

    2016-01-01

    Sawbones are artificial bones designed to simulate the bone architecture, as well as the bone’s physical properties. The incorporation of sawbones simulation laboratories in many orthopedic training programs has provided the residents with flexibility in learning and scheduling that align with their working hour limitations. This review paper deliberates the organization of sawbones simulation in orthopedic surgical training to enhance trainee’s future learning. In addition, it explores the implications of sawbones simulation in orthopedic surgical teaching and evaluation. It scrutinizes the suitability of practicing on sawbones at the simulation laboratory to improve orthopedic trainee’s learning. This will be followed with recommendations for future enhancement of sawbones simulation-based learning in orthopedic surgical training. PMID:27052276

  2. Orthopedic surgical analyzer for percutaneous vertebroplasty

    NASA Astrophysics Data System (ADS)

    Tack, Gye Rae; Choi, Hyung Guen; Lim, Do H.; Lee, Sung J.

    2001-05-01

    Since the spine is one of the most complex joint structures in the human body, its surgical treatment requires careful planning and high degree of precision to avoid any unwanted neurological compromises. In addition, comprehensive biomechanical analysis can be very helpful because the spine is subject to a variety of load. In case for the osteoporotic spine in which the structural integrity has been compromised, it brings out the double challenges for a surgeon both clinically and biomechanically. Thus, we have been developing an integrated medical image system that is capable of doing the both. This system is called orthopedic surgical analyzer and it combines the clinical results from image-guided examination and the biomechanical data from finite element analysis. In order to demonstrate its feasibility, this system was applied to percutaneous vertebroplasty. Percutaneous vertebroplasty is a surgical procedure that has been recently introduced for the treatment of compression fracture of the osteoporotic vertebrae. It involves puncturing vertebrae and filling with polymethylmethacrylate (PMMA). Recent studies have shown that the procedure could provide structural reinforcement for the osteoporotic vertebrae while being minimally invasive and safe with immediate pain relief. However, treatment failures due to excessive PMMA volume injection have been reported as one of complications. It is believed that control of PMMA volume is one of the most critical factors that can reduce the incidence of complications. Since the degree of the osteoporosis can influence the porosity of the cancellous bone in the vertebral body, the injection volume can be different from patient to patient. In this study, the optimal volume of PMMA injection for vertebroplasty was predicted based on the image analysis of a given patient. In addition, biomechanical effects due to the changes in PMMA volume and bone mineral density (BMD) level were investigated by constructing clinically

  3. Academic characteristics of orthopedic team physicians affiliated with high school, collegiate, and professional teams.

    PubMed

    Makhni, Eric C; Buza, John A; Byram, Ian; Ahmad, Christopher S

    2015-11-01

    We conducted a study to determine the academic involvement and research productivity of orthopedic team physicians at high school, college, and professional levels of sport. Through Internet and telephone queries, we identified 1054 team physicians from 362 institutions, including 120 randomly selected high schools and colleges and 122 professional teams (baseball, basketball, football, hockey). For all physicians included in the study, we performed a comprehensive search of the Internet and of a citation database to determine academic affiliations, number of publications, and h-index values. Of the 1054 physicians, 678 (64%) were orthopedic surgeons. Percentage of orthopedic team physicians affiliated with an academic medical center was highest in professional sports (64%; 173/270) followed by collegiate sports (36%; 98/275) and high school sports (20%; 27/133). Median number of publications per orthopedic team physician was significantly higher in professional sports (30.6) than in collegiate sports (10.7) or high school sports (6). Median number of publications by orthopedic physicians also varied by sport, with the highest number in Major League Baseball (37.9; range, 0-225) followed by the National Basketball Association (32.0; range, 0-227) and the National Football League (30.4; range, 0-460), with the lowest number within the National Hockey League (20.7; range, 0-144). Academic affiliation and research productivity of orthopedic team physicians vary by competition level and professional sporting league.

  4. Radiation exposure from fluoroscopy during orthopedic surgical procedures

    SciTech Connect

    Riley, S.A. )

    1989-11-01

    The use of fluoroscopy has enabled orthopedic surgeons to become technically more proficient. In addition, these surgical procedures tend to have less associated patient morbidity by decreasing operative time and minimizing the area of the operative field. The trade-off, however, may be an increased risk of radiation exposure to the surgeon on an annual or lifetime basis. The current study was designed to determine the amount of radiation received by the primary surgeon and the first assistant during selected surgical procedures involving the use of fluoroscopy. Five body sites exposed to radiation were monitored for dosage. The results of this study indicate that with appropriate usage, (1) radiation exposure from fluoroscopy is relatively low; (2) the surgeon's dominant hand receives the most exposure per case; and (3) proper maintenance and calibration of fluoroscopic machines are important factors in reducing exposure risks. Therefore, with proper precautions, the use of fluoroscopy in orthopedic procedures can remain a safe practice.

  5. 78 FR 17940 - Certain Computerized Orthopedic Surgical Devices, Software, Implants, and Components Thereof...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-03-25

    ... COMMISSION Certain Computerized Orthopedic Surgical Devices, Software, Implants, and Components Thereof..., Software, Implants, and Components Thereof, DN 2945; the Commission is soliciting comments on any public... devices, software, implants, and components thereof. The complaint names as respondents Stanmore...

  6. The right team at the right time – Multidisciplinary approach to multi-trauma patient with orthopedic injuries

    PubMed Central

    Bach, John A.; Leskovan, John J.; Scharschmidt, Thomas; Boulger, Creagh; Papadimos, Thomas J.; Russell, Sarah; Bahner, David P.; Stawicki, Stanislaw P. A.

    2017-01-01

    Integrated, multidisciplinary team approach to the multiply injured patient can help optimize care, minimize morbidity, and reduce mortality. It also provides a framework for accelerated postinjury rehabilitation course. The characteristics and potential benefits of this approach, including team dynamics and interactions, are discussed in this brief review. Emphasis is placed on synergies provided by specialty teams working together in the framework of care coordination, timing of surgical and nonsurgical interventions, and injury/physiologic considerations. Republished with permission from: Bach JA, Leskovan JJ, Scharschmidt T, Boulger C, Papadimos TJ, Russell S, Bahner DP, Stawicki SPA. Multidisciplinary approach to multi-trauma patient with orthopedic injuries: the right team at the right time. OPUS 12 Scientist 2012;6(1):6-10. PMID:28382257

  7. Pre: Surgical orthopedic pre-maxillary alignment in bilateral cleft lip and palate patient

    PubMed Central

    Ellore, Vijaya Prasad Kamavaram; Ramagoni, Naveen Kumar; Taranatha, Mahantesha; Nara, Asha; Gunjalli, Gururaj; Bhat, Ashwin Devasya

    2012-01-01

    Pre-surgical orthopedic appliances are mainly used to retract and align the protruded and deviated pre-maxilla and to facilitate initial lip repair. This article presents a case report of a five year old male child patient with bilateral cleft lip and palate in whom a special custom made pre-surgical orthopedic appliance was delivered. Use of a special custom made presurgical orthopedic appliance for repositioning pre-maxilla in bilateral cleft lip and palate patient is discussed in this article. PMID:23293501

  8. Utilizing the physician assistant role: case study in an upper-extremity orthopedic surgical program

    PubMed Central

    Hepp, Shelanne L.; Suter, Esther; Nagy, Dwayne; Knorren, Tanya; Bergman, Joseph W.

    2017-01-01

    Background Shortages with resources and inefficiencies with orthopedic services in Canada create opportunities for alternative staffing models and ways to use existing resources. Physician assistants (PAs) are a common provider used in specialty orthopedic services in the United States; however, Canada has limited experience with PAs. As part of a larger demonstration project, Alberta Health Services (AHS) implemented 1 PA position in an upper-extremity surgical program in Alberta, Canada, to demonstrate the role in 4 areas: preoperative, operative, postoperative and follow-up care. Methods A mixed-methods evaluation was conducted using semi-structured interviews (n = 38), health care provider (n = 28) and patient surveys (n = 47), and 2 years of clinic data on new patients. Data from a double operating room experiment detailed expected versus actual times for 3 phases of surgery (pre, during, post). Results Preoperatively, the PA prioritizes patient referrals for surgery and redirects patients to alternative care. In the second year with the PA in place, there was an increase in total new patients seen (113%). Postoperatively, the PA attended rounds on 5 surgeons’ patients and handled follow-up care activities. Health care providers and patients reported that the PA provided excellent care. Findings from the operating room showed that the preparation time was greater than expected (38.6%), whereas the surgeon time (20.6%) and postsurgery time (37.2%) was less than expected. Conclusion After 24 months the PA has become a valuable member of the health care team and works across the continuum of orthopedic care. The PA delivers quality care and improves system efficiencies. PMID:28234216

  9. 21 CFR 888.4540 - Orthopedic manual surgical instrument.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ..., femoral neck punch, socket pusher, reamer, rongeur, scissors, screwdriver, bone skid, staple driver, bone screw starter, surgical stripper, tamp, bone tap, trephine, wire twister, and wrench. (b)...

  10. 21 CFR 888.4540 - Orthopedic manual surgical instrument.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ..., femoral neck punch, socket pusher, reamer, rongeur, scissors, screwdriver, bone skid, staple driver, bone screw starter, surgical stripper, tamp, bone tap, trephine, wire twister, and wrench. (b)...

  11. 21 CFR 888.4540 - Orthopedic manual surgical instrument.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ..., femoral neck punch, socket pusher, reamer, rongeur, scissors, screwdriver, bone skid, staple driver, bone screw starter, surgical stripper, tamp, bone tap, trephine, wire twister, and wrench. (b)...

  12. 21 CFR 888.4540 - Orthopedic manual surgical instrument.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ..., femoral neck punch, socket pusher, reamer, rongeur, scissors, screwdriver, bone skid, staple driver, bone screw starter, surgical stripper, tamp, bone tap, trephine, wire twister, and wrench. (b)...

  13. 21 CFR 888.4540 - Orthopedic manual surgical instrument.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ..., femoral neck punch, socket pusher, reamer, rongeur, scissors, screwdriver, bone skid, staple driver, bone screw starter, surgical stripper, tamp, bone tap, trephine, wire twister, and wrench. (b)...

  14. Intraoperative monitoring technician: a new member of the surgical team.

    PubMed

    Brown, Molly S; Brown, Debra S

    2011-02-01

    As surgery needs have increased, the traditional surgical team has expanded to include personnel from radiology and perfusion services. A new surgical team member, the intraoperative monitoring technician, is needed to perform intraoperative monitoring during procedures that carry a higher risk of central and peripheral nerve injury. Including the intraoperative monitoring technician on the surgical team can create challenges, including surgical delays and anesthesia care considerations. When the surgical team members, including the surgeon, anesthesia care provider, and circulating nurse, understand and facilitate this new staff member's responsibilities, the technician is able to perform monitoring functions that promote the smooth flow of the surgical procedure and positive patient outcomes.

  15. Surgical safety checklists briefings: Perceived efficacy and team member involvement.

    PubMed

    McDowell, D S; McComb, S

    2016-06-01

    Researchers have shown inconsistencies in compliance, outcomes and attitudes of surgical team members related to surgical safety checklist briefings. The purpose of this study was to examine surgical circulator and scrub practitioners' perceptions of safety checklist briefings and team member involvement, and to identify potential improvements in the process based on those perceptions. An anonymous survey was conducted with members of the Association of periOperative Registered Nurses (AORN) and the Association of Surgical Technologists (AST). Questions focused on perceptions of checklist briefing efficacy and team member involvement in safety practices. From the 346 usable responses, a third respondent group of self-identified perioperative leaders emerged. Significant results were obtained related to leaders' perceptions, post-procedure briefings and various perceptions of team member involvement. Study results indicate that variances in safety practices continue as perceived by surgical team members thus presenting opportunities for further examination and improvement of processes in reducing surgical errors.

  16. Surgical team mapping: implications for staff allocation and coordination.

    PubMed

    Sykes, Mark; Gillespie, Brigid M; Chaboyer, Wendy; Kang, Evelyn

    2015-02-01

    Perioperative team membership consistency is not well researched despite being essential in reducing patient harm. We describe perioperative team membership and staffing across four surgical specialties in an Australian hospital. We analyzed staffing and case data using social network analysis, descriptive statistics, and bivariate correlations and mapped 100 surgical procedures with 171 staff members who were shared across four surgical teams, including 103 (60.2%) nurses. Eighteen of 171 (10.5%) staff members were regularly shared across teams, including 12 nurses, five anesthetists, and one registrar. We found weak but significant correlations between the number of staff (P < .001), procedure start time (P < .001), length of procedure (P < .05), and patient acuity (P < .001). Using mapping, personnel can be identified who may informally influence multiple team cultures, and nurses (ie, the majority of team members in surgery) can lead the development of highly functioning surgical teams.

  17. The creation and evaluation of an ambulatory orthopedic surgical patient education web site to support empowerment.

    PubMed

    Heikkinen, Katja; Suomi, Reima; Jääskeläinen, Miika; Kaljonen, Anne; Leino-Kilpi, Helena; Salanterä, Sanna

    2010-01-01

    The use and evaluation of Web sites in ambulatory surgery patients' education are rare; hence, innovative approaches to educate these patients should be adopted and evaluated. The aim of this study was to describe the creation of and evaluate the utility and usability of an ambulatory orthopedic surgical patient education Web site. A descriptive study design was used. The evaluators were 72 ambulatory orthopedic surgery patients receiving education through a Web site. The data were collected after education preoperatively and 2 weeks postoperatively. Two instruments were used: "Patients' Evaluation of Education" and "Diary of the Use of the Website." Web site evaluators' scores for utility of the Web site ranged from 57.56 to 87.87 of 100. Utility of the Web site evaluations was significantly higher (P < .05) 2 weeks postoperatively than immediately after the operation. Web site evaluators' scores for usability of the Web site ranged from 85.69 to 88.32. The use of this program as educational material for orthopedic surgery patients was supported by the patients' opinions of the usability and utility of the Web site.

  18. An artificial system for selecting the optimal surgical team.

    PubMed

    Saberi, Nahid; Mahvash, Mohsen; Zenati, Marco

    2015-01-01

    We introduce an intelligent system to optimize a team composition based on the team's historical outcomes and apply this system to compose a surgical team. The system relies on a record of the procedures performed in the past. The optimal team composition is the one with the lowest probability of unfavorable outcome. We use the theory of probability and the inclusion exclusion principle to model the probability of team outcome for a given composition. A probability value is assigned to each person of database and the probability of a team composition is calculated from them. The model allows to determine the probability of all possible team compositions even if there is no recoded procedure for some team compositions. From an analytical perspective, assembling an optimal team is equivalent to minimizing the overlap of team members who have a recurring tendency to be involved with procedures of unfavorable results. A conceptual example shows the accuracy of the proposed system on obtaining the optimal team.

  19. Orthopedic surgical site infections: analysis of causative bacteria and implications for antibiotic stewardship.

    PubMed

    Norton, Thomas D; Skeete, Faith; Dubrovskaya, Yanina; Phillips, Michael S; Bosco, Joseph D; Mehta, Sapna A

    2014-05-01

    Data that can be used to guide perioperative antibiotic prophylaxis in our era of emerging antibiotic resistance are limited. We reviewed orthopedic surgeries complicated by surgical site infections (SSIs). Eighty percent of 69 arthroplasty and 80 spine fusion SSIs were infected with Gram-positive bacteria; most were staphylococcal species; and more than 25% of Staphylococcus aureus and more than 65% of coagulase-negative staphylococci were methicillin-resistant. Gram-negative bacteria were isolated from 30% of arthroplasty SSIs and 25% of spine fusion SSIs. Resistance to cefazolin was higher than 40%. A significant proportion of SSIs were caused by resistant organisms, and antibiotic guidelines were altered to provide more adequate surgical prophylaxis.

  20. Developing observational measures of performance in surgical teams

    PubMed Central

    Healey, A; Undre, S; Vincent, C

    2004-01-01

    Team performance is increasingly recognised as an essential foundation of good surgical care and a determinant of good surgical outcome. To understand team performance and to develop team training, reliable and valid measures of team performance are necessary. Currently there is no firm consensus on how to measure teamwork, partly because of a lack of empirical data to validate measures. The input–process–output model provides a framework for surgical team studies. Objective observational measures are needed in surgery as a basis for interdisciplinary team assessment and training. The "observational teamwork assessment for surgery" (OTAS) tool assesses two facets of the surgical process. Observer 1 monitors specific tasks carried out by team members, under the categories patient, environment, equipment, provisions, and communications. Observer 2 uses a behavioural observation scale to rate behaviour for the three surgical phases (pre-operative, operative, and post-operative) with components of teamwork: cooperation, leadership, coordination, awareness, and communication. Illustrative data from an initial series of 50 cases is presented here. The OTAS tool enables two independent observers, a surgeon and psychologist, to record detailed information both on what the theatre team does and how they do it, and has the potential to identify constraints on performance that might relate to surgical outcome. PMID:15465953

  1. Use of a Surgical Safety Checklist to Improve Team Communication.

    PubMed

    Cabral, Richard A; Eggenberger, Terry; Keller, Kathryn; Gallison, Barry S; Newman, David

    2016-09-01

    To improve surgical team communication, a team at Broward Health Imperial Point Hospital, Ft Lauderdale, Florida, implemented a program for process improvement using a locally adapted World Health Organization Surgical Safety Checklist. This program included a standardized, comprehensive time out and a briefing/debriefing process. Postimplementation responses to the Safety Attitudes Questionnaire revealed a significant increase in the surgical team's perception of communication compared with that reported on the pretest (6% improvement resulting in t79 = -1.72, P < .05, d = 0.39). Perceptions of communication increased significantly for nurses (12% increase, P = .002), although the increase for surgeons and surgical technologists was lower (4% for surgeons, P = .15 and 2.3% for surgical technologists, P = .06). As a result of this program, we have observed improved surgical teamwork behaviors and an enhanced culture of safety in the OR.

  2. Risk of Orthopedic Surgical Site Infections in Patients with Rheumatoid Arthritis Treated with Antitumor Necrosis Factor Alfa Therapy

    PubMed Central

    da Cunha, Bernardo Matos; Maria Henrique da Mota, Licia; dos Santos-Neto, Leopoldo Luiz

    2012-01-01

    Introduction. International guidelines recommend interruption of anti-TNF medications in the perioperative period, but there are no randomized trials to support such recommendation. Objectives. To study literature evidence assessing the risk of surgical site infections in orthopedic surgery patients with RA using anti-TNF drugs, compared to untreated patients or those using conventional DMARD. Methods. Systematic review of cohort studies is concerning surgical site infections in orthopedic procedures in patients with RA. Results. Three studies were selected. Only one was considered of high-quality, albeit with low statistical power. The review resulted in inconclusive data, since the best quality study showed no significant differences between groups, while others showed increased risk of infections in patients using anti-TNF medications. Conclusion. It is unclear whether patients with RA using anti-TNF medications are at increased risk of surgical site infections. Randomized controlled trials or new high quality observational studies are needed to clarify the issue. PMID:22500176

  3. Promoting teamwork and surgical optimization: combining TeamSTEPPS with a specialty team protocol.

    PubMed

    Tibbs, Sheila Marie; Moss, Jacqueline

    2014-11-01

    This quality improvement project was a 300-day descriptive preintervention and postintervention comparison consisting of a convenience sample of 18 gynecology surgical team members. We administered the Team Strategies & Tools to Enhance Performance and Patient Safety (TeamSTEPPS®) Teamwork Perception Questionnaire to measure the perception of teamwork. In addition, we collected data regarding rates of compliance (ie, huddle, time out) and measurable surgical procedure times. Results showed a statistically significant increase in the number of team members present for each procedure, 2.34 μ before compared with 2.61 μ after (P = .038), and in the final time-out (FTO) compliance as a result of a clarification of the definition of FTO, 1.05 μ before compared with 1.18 μ after (P = .004). Additionally, there was improvement in staff members' perception of teamwork. The implementation of team training, protocols, and algorithms can enhance surgical optimization, communication, and work relationships.

  4. US Army Two-Surgeon Teams Operating in Remote Afghanistan - An Evaluation of Split-Based Forward Surgical Team Operations

    DTIC Science & Technology

    2009-04-01

    rotator) Orthopedic surgeon (6-mo rotator) Nurse anesthetist Nurse anesthetist (6-mo rotator) Critical care registered nurse Emergency medicine... nurse anesthetist , the detachment ser- geants, and the critical care nurse all had previous experience in combat medical care. These key personnel...registered nurse Licensed practical nurse Operating room registered nurse Surgical technician Licensed practical nurse Surgical technician Licensed

  5. Surgically assisted-rapid orthopedic lengthening of the maxilla in primates--relapse following distraction osteogenesis.

    PubMed

    Altuna, G; Walker, D A; Freeman, E

    1995-01-01

    A recent study has shown that the maxilla in primates can be successfully lengthened (0.5 mm every other day up to 6.0 mm) by means of surgically assisted-rapid orthopedic movement, using the principles of distraction osteogenesis. The present study was designed to determine if the maxilla can be advanced at a faster rate and if relapse would occur after removal of the orthodontic appliance. Metallic markers were placed in the cranial base and maxilla of two Cynomolgus primates, and cephalometric radiographs were taken. Bilateral horizontal and interdental osteotomies were created between in the first premolars and the canines, and the anterior segment was completely mobilized. An orthodontic appliance was bonded to the teeth and the screw was closed, compressing the osteotomy site. One week postoperatively the appliance was opened four quarter turns every day until the anterior segment was advanced by 10 mm. Cephalometric radiographs were taken at 6, 8, and 12 weeks postadvancement. At 12 weeks, the orthodontic appliance was removed, and at that time and 2, 4, and 6 weeks later, cephalometric radiographs were taken and study models fabricated. At the end of the postretention period, the animals were sacrificed, and the maxillae were evaluated by light microscopy. Results showed that the maxilla can be successfully advanced at a faster rate and for longer distances, and that the advanced maxilla does not relapse during the 6-week postretention period.

  6. Prevention and management of postoperative delirium among older patients on an orthopedic surgical unit: a best practice implementation project.

    PubMed

    Sykes, Pamela K

    2012-01-01

    Delirium is an acute state of confusion that is often seen in older patients after major orthopedic surgical procedures. It is associated with increased costs of care, morbidity, delayed functional recovery, and prolonged hospital stay. Identification of predictive risk factors, early diagnosis and treatment, and implementation of environmental controls can minimize the impact of postoperative delirium. This project measured pre- and post intervention compliance with best practice in the prevention and management of postoperative delirium.

  7. The role of the surgical care practitioner within the surgical team.

    PubMed

    Quick, Julie

    Changes to the surgical workforce and the continued development of health policy have perpetuated the requirement for innovative perioperative roles. The surgical care practitioner is a nurse or allied health professional who works within a surgical team and has advanced perioperative skills, including the ability to undertake surgical interventions.With only limited literature evaluating this role, any benefits of their inclusion to a surgical team are largely anecdotal. This article presents the findings of an autoethnographic inquiry that explored the experiences of surgical team members who worked with the nurse researcher in her role as surgical care practitioner. Surgeons identified the provision of a knowledgeable, competent assistant and operator who enhanced patient care, helped maintain surgical services and supported the training of junior doctors. The professional, ethical and legal obligations of advanced perioperative practice were upheld. Interprofessional collaboration was improved, as was service provision. This further enhanced the patient experience. The traditional viewpoint that nurses who undertake tasks previously associated with medicine should be working to the standard of a doctor is challenged but requires further examination.

  8. The right team at the right time - Multidisciplinary approach to multi-trauma patient with orthopedic injuries.

    PubMed

    Bach, John A; Leskovan, John J; Scharschmidt, Thomas; Boulger, Creagh; Papadimos, Thomas J; Russell, Sarah; Bahner, David P; Stawicki, Stanislaw P A

    2017-01-01

    Integrated, multidisciplinary team approach to the multiply injured patient can help optimize care, minimize morbidity, and reduce mortality. It also provides a framework for accelerated postinjury rehabilitation course. The characteristics and potential benefits of this approach, including team dynamics and interactions, are discussed in this brief review. Emphasis is placed on synergies provided by specialty teams working together in the framework of care coordination, timing of surgical and nonsurgical interventions, and injury/physiologic considerations.

  9. Rapid Response Team Activations in Pediatric Surgical Patients.

    PubMed

    Acker, Shannon N; Wathen, Beth; Roosevelt, Genie E; Hill, Lauren R S; Schubert, Anna; Reese, Jenny; Bensard, Denis D; Kulungowski, Ann M

    2017-02-01

    Introduction The rapid response team (RRT) is a multidisciplinary team who evaluates hospitalized patients for concerns of nonemergent clinical deterioration. RRT evaluations are mandatory for children whose Pediatric Early Warning System (PEWS) score (assessment of child's behavior, cardiovascular and respiratory status) is ≥4. We aimed to determine if there were differences in characteristics of RRT calls between children who were admitted primarily to either medical or surgical services. We hypothesized that RRT activations would be called for less severely ill children with lower PEWS score on surgical services compared with children admitted to a medical service. Materials and Methods We performed a retrospective review of all children with RRT activations between January 2008 and April 2015 at a tertiary care pediatric hospital. We evaluated the characteristics of RRT calls and made comparisons between RRT calls made for children admitted primarily to medical or surgical services. Results A total of 2,991 RRT activations were called, and 324 (11%) involved surgical patients. Surgical patients were older than medical patients (median: 7 vs. 4 years; p < 0.001). RRT evaluations were called for lower PEWS score in surgical patients compared with medical (median: 3 vs. 4, p < 0.001). Surgical patients were more likely to remain on the inpatient ward following the RRT (51 vs. 39%, p < 0.001) and were less likely to require an advanced airway than medical patients (0.9 vs. 2.1%; p = 0.412). RRT evaluations did not differ between day and night shifts (52% day vs. 48% night; p = 0.17). All surgical patients and all but one medical patient survived the event; surgical patients were more likely to survive to hospital discharge (97 vs. 91%, p < 0.001) Conclusions RRT activations are rare events among pediatric surgical patients. When compared with medical patients, RRT evaluation is requested for surgical patients with a lower PEWS

  10. Porous orthopedic steel implant as an antibiotic eluting device: prevention of post-surgical infection on an ovine model.

    PubMed

    Gimeno, Marina; Pinczowski, Pedro; Vázquez, Francisco J; Pérez, Marta; Santamaría, Jesús; Arruebo, Manuel; Luján, Lluís

    2013-08-16

    Traumatology and orthopedic surgery can benefit from the use of efficient local antibiotic-eluting systems to avoid bacterial contamination of implanted materials. In this work a new percutaneous porous-wall hollow implant was successfully used as a local antibiotic-eluting device both in vitro and in vivo. The implant is a macroporous 316 L stainless steel filter tube with a nominal filtration cut-off size of 200 nm with one open end which was used to load the synthetic antibiotic linezolid and an opposite blind end. The antibiotic release kinetics from the device on a simulated biological fluid under in vitro conditions demonstrated an increased concentration during the first five days that subsequently was sustained for at least seven days, showing a kinetic close to a zero order release. Antibiotic-loaded implants were placed in the tibia of four sheep which were trans-surgically experimentally infected with a biofilm forming strain of Staphylococcus aureus. After 7 and 9 days post infection, sheep did not show any evidence of infection as demonstrated by clinical, pathological and microbiological findings. These results demonstrate the capability of such an antibiotic-loaded implant to prevent infection in orthopedic devices in vivo. Further research is needed to assess its possible use in traumatology and orthopedic surgery.

  11. The surgical team and outcomes management: focus on postoperative ileus.

    PubMed

    Carter, Susan

    2006-04-01

    Postoperative ileus (POI) is defined as the impairment of bowel motility that occurs almost universally after major open abdominal procedures, as well as other abdominal and nonabdominal procedures. For the majority of affected patients, POI generally lasts approximately three to five days, but longer duration is not uncommon. The causes of POI are multifactorial, but can be broadly categorized into two groups: those related to the surgical procedure and those related to pharmacologic interventions (opioids). The fact that POI is generally transient and therefore self-limited should not deter the surgical team from seeking improved ways to mitigate its associated adverse effects, which can be substantial and immensely uncomfortable for the patient, and can have far-reaching implications regarding overall hospitalization costs for many types of surgeries. Optimization of POI management and prevention efforts is a responsibility of all members of the surgical team and can drastically affect the overall clinical outcome of major abdominal surgery. Depending on the individual team member's role, different perspectives and strategies may be used to achieve improved outcomes, including but not limited to hospitalization costs related to care and length of stay, resource utilization, and, perhaps most critically, patient quality of life not only immediately after surgery but also after discharge. The ability to reliably and significantly decrease the duration of POI should be readily recognized as an important objective in the management of this condition. Opioids will continue to be a mainstay of postoperative care regimens, but new agents such as peripherally acting mu-opioid-receptor antagonists may offer a unique clinical advantage by helping to reduce the adverse gastrointestinal effects of opioids while preserving their desired benefits for postoperative analgesia.

  12. Surgical teams: role perspectives and role dynamics in the operating room.

    PubMed

    Leach, Linda Searle; Myrtle, Robert C; Weaver, Fred A

    2011-05-01

    Observations of surgical teams in the operating room (OR) and interviews with surgeons, circulating registered nurses (RNs), anaesthesiologists and surgical technicians reveal the importance of leadership, team member competencies and an enacted environment that encourages feelings of competence and cooperation. Surgical teams are more loosely coupled than intact and bounded. Team members tend to rely on expected role behaviours to bridge lack of familiarity. While members of the surgical team identified technical competence and preparation as critical factors affecting team performance, they had differing views over the role behaviours of other members of the surgical team that lead to surgical team performance. Observations revealed that the work climate in the OR can shape interpersonal relations and begins to be established when the room is being set up for the surgical case, and evolves as the surgical procedure progresses. The leadership and supervisory competencies of the circulating RNs establish the initial work environment. Both influenced the degree of cooperation and support that was observed, which had an effect on the interactions and relationships between other members of the surgical team. As the surgery unfolds, the surgeon's behaviours and interpersonal relations modify this environment and ultimately influence the degree of team work, team satisfaction and team performance.

  13. Brucella abortus Exposure during an Orthopedic Surgical Procedure—New Mexico, 2010

    PubMed Central

    Nichols, Megin; Thompson, Deborah; Carothers, Joshua T.; Klauber, Judy; Stoddard, Robyn A.; Guerra, Marta A.; Benoit, Tina J.; Traxler, Rita M.

    2015-01-01

    We describe a periprosthetic Brucella abortus infection in a case-patient undergoing hip replacement revision surgery, and the subsequent investigation of laboratory and surgical staff exposures. Although exposures are rare, it is important to have infection prevention recommendations for surgical procedures among patients with suspected or unidentified Brucella spp. infection. PMID:25026630

  14. Training forward surgical teams for deployment: the US Army Trauma Training Center.

    PubMed

    Valdiri, Linda A; Andrews-Arce, Virginia E; Seery, Jason M

    2015-04-01

    Since the late 1980s, the US Army has been deploying forward surgical teams to the most intense areas of conflict to care for personnel injured in combat. The forward surgical team is a 20-person medical team that is highly mobile, extremely agile, and has relatively little need of outside support to perform its surgical mission. In order to perform this mission, however, team training and trauma training are required. The large majority of these teams do not routinely train together to provide patient care, and that training currently takes place at the US Army Trauma Training Center (ATTC). The training staff of the ATTC is a specially selected 10-person team made up of active duty personnel from the Army Medical Department assigned to the University of Miami/Jackson Memorial Hospital Ryder Trauma Center in Miami, Florida. The ATTC team of instructors trains as many as 11 forward surgical teams in 2-week rotations per year so that the teams are ready to perform their mission in a deployed setting. Since the first forward surgical team was trained at the ATTC in January 2002, more than 112 forward surgical teams and other similar-sized Department of Defense forward resuscitative and surgical units have rotated through trauma training at the Ryder Trauma Center in preparation for deployment overseas.

  15. Rabbit orthopedic surgery.

    PubMed

    Rich, Gregory A

    2002-01-01

    Orthopedic surgery in rabbits poses several unique parameters for the veterinary surgeon. It is imperative for the veterinarian to be knowledgeable about the anatomic features of the surgical repair site and to become familiar with a rabbit's pain and discomfort often associated with orthopedic injuries. Handling the perioperative and postoperative pain and potential GI disturbances are crucial for a successful outcome of the surgical case. This article is designed to help the veterinary surgeon prepare for the orthopedic surgical procedure and the peripheral physiologic needs of the rabbit from presentation through recovery.

  16. Ensuring the safety of surgical teams when managing casualties of a radiological dirty bomb.

    PubMed

    Williams, Geraint; O'Malley, Michael; Nocera, Antony

    2010-09-01

    The capacity for surgical teams to ensure their own safety when dealing with the consequences caused by the detonation of a radiological dirty bomb is primarily determined by prior knowledge, familiarity and training for this type of event. This review article defines the associated radiological terminology with an emphasis on the personal safety of surgical team members in respect to the principles of radiological protection. The article also describes a technique for use of hand held radiation monitors and will discuss the identification and management of radiologically contaminated patients who may pose a significant danger to the surgical team.

  17. Battlefield Lessons: The Forward Air Surgical Team (FAST) Response

    DTIC Science & Technology

    2011-02-24

    Decompression Craniotomy , Thoracotomy, and Surgical Airway. 23 The MFST personnel and equipment may be transported by fixed wing aircraft or helicopter. The...41 Frank Navarette, “State of Arizona Emergency Response and Recovery Plan,” Arizona Department of Emergency Management. (December, 2003), 8-5-2

  18. A question of professionalism: leading forward the surgical team.

    PubMed Central

    de Cossart, Linda

    2005-01-01

    Surgical practice must be driven by wise professional judgements, involving complex deliberation, in the interests of ensuring the safe care of patients. Large amounts of energy are now being concentrated in training doctors in skills (competencies) in the belief that this will reduce risk to patients. Little thought is being given to developing in the young, wise professional judgement which is at the heart of being a good doctor and a good surgeon. PMID:16053680

  19. Surgical team member assessment of the safety of surgery practice in 38 South Carolina hospitals.

    PubMed

    Singer, Sara J; Jiang, Wei; Huang, Lyen C; Gibbons, Lorri; Kiang, Mathew V; Edmondson, Lizabeth; Gawande, Atul A; Berry, William R

    2015-06-01

    We assessed surgical team member perceptions of multiple dimensions of safe surgical practice in 38 South Carolina hospitals participating in a statewide initiative to implement surgical safety checklists. Primary data were collected using a novel 35-item survey. We calculated the percentage of 1,852 respondents with strongly positive, positive, and neutral/negative responses about the safety of surgical practice, compared results by hospital and professional discipline, and examined how readiness, teamwork, and adherence related to staff perception of care quality. Overall, 78% of responses were positive about surgical safety at respondent's hospitals, but in each survey dimension, from 16% to 40% of responses were neutral/negative, suggesting significant opportunity to improve surgical safety. Respondents not reporting they would feel safe being treated in their operating rooms varied from 0% to 57% among hospitals. Surgeons responded more positively than nonsurgeons. Readiness, teamwork, and practice adherence related directly to staff perceptions of patient safety (p < .001).

  20. Diabetic foot infections: a team-oriented review of medical and surgical management

    PubMed Central

    Capobianco, Claire M; Stapleton, John J

    2010-01-01

    As the domestic and international incidence of diabetes and metabolic syndrome continues to rise, health care providers need to continue improving management of the long-term complications of the disease. Emergency department visits and hospital admissions for diabetic foot infections are increasingly commonplace, and a like-minded multidisciplinary team approach is needed to optimize patient care. Early recognition of severe infections, medical stabilization, appropriate antibiotic selection, early surgical intervention, and strategic plans for delayed reconstruction are crucial components of managing diabetic foot infections. The authors review initial medical and surgical management and staged surgical reconstruction of diabetic foot infections in the inpatient setting. PMID:22396806

  1. Sentinel node biopsy in the surgical management of breast cancer: experience in a general hospital with a dedicated surgical team.

    PubMed

    Merson, M; Fenaroli, P; Gianatti, A; Virotta, G; Giuliano, L G; Bonasegale, A; Bambina, S; Pericotti, S; Guerra, U; Tondini, C

    2004-06-01

    The aims of this study were to analyse the feasibility and accuracy of the sentinel lymph node biopsy (SLNB) procedure as performed in a general hospital compared with the literature results; to report on the organizational aspects of planning surgical time with higher accuracy of pathological analysis; and to verify that there is a real advantage of SLNB in the surgical management of breast cancer. From October 1999 to September 2000, 371 consecutive patients with T1-2N0 breast lesions underwent SLNB. The immunoscintigraphic method of sentinel node identification was the main one used, the blue dye method being used only when the lymphoscintigraphic method was unsuccessful in identifying sentinel nodes. SLNB was done under either general or local anaesthesia, depending on how the surgical procedure was organized and clinically planned. SLNB was successful in 99% of these T1-2N0 breast cancer cases, and in 71% no metastases were found in the sentinel node. In 47% of cases with axillary metastasis only the sentinel node was involved. Nodal involvement was not present in any case of microinvasive or in situ carcinoma. In T1 cancers nodal involvement was present in 21%; in T2 cases the corresponding rate reached 51%. The results obtained with the SLNB procedure at Bergamo Hospital are similar to the literature data. When a dedicated surgical team, the nuclear medicine department and the pathology department work together, a general hospital can provide breast cancer patients with appropriate surgical treatment.

  2. Lasers in orthopedics

    NASA Astrophysics Data System (ADS)

    Sherk, Henry H.; Rhodes, Anthony L.; Meller, Menachem M.

    1990-06-01

    Orthopedic Surgery is that surgical discipline which deals with the musculoskeletal system. Orthopedists therefore operate on joints, the spine and long bones and engage in such subsecialities as sports medicine, hand surgery, trauma surgery, and joint replacements. Since they must cut and shape bone, cartilage, tendon, and ligament, orthopedists have developed a number of mechanical techniques to achieve these ends and surgical lasers have found few applications in orthopedics because until now they have not been useful for cutting bone. In the past several years, however, there has been considerable interest in several areas within the field of orthopedic surgery that do not entail actual bone surgery and it is expected that as newer and more powerful lasers become available laser osteotomy may become feasible and even routine.

  3. [Technical orthopedics. Importance in an increasingly operatively oriented faculty].

    PubMed

    Greitemann, B; Maronna, U

    2013-10-01

    The foundation of the German Society for Orthopedics in 1901 was due to a separation from the faculty of surgery because a surgical approach alone did not adequately deal with the symptoms. Orthopedists were initially considered as a fringe group. The conservative treatment approach was initially at the forefront and operative measures were a side line. The main aim was the rehabilitation of patients into a normal life as best as possible. In the conservative area treatment with orthopedic technical aids and appliances rapidly came to play an important role and a great multitude of technical appliances were developed with sometimes very different possible applications. Despite the clearly improved operative treatment approaches in orthopedics and trauma surgery, technical orthopedics still plays a substantial role even today. Healing and supportive aids and appliances are of decisive importance for the treatment of a multitude of diseases and handicaps. They stabilize and improve operative treatment results and often result in new approaches. This depends on cooperation between technicians, therapists and physicians in a team, even in the scientific field. Evidence-based studies on the effectiveness of technical aids are currently still uncommon but recently some clear evidence for effectiveness could be shown. Scientifically this is a very varied field of work. The demographic development presents new requirements which must be dealt with. Technical solutions are often very promising especially in this field. Technical orthopedics remains an important component of the specialty of orthopedics and trauma surgery and with an increasing tendency due to more recent research and development.

  4. Orthopedic management in myelomeningocele.

    PubMed

    Karol, L A

    1995-04-01

    Paralysis, muscle imbalance, and spasticity resulting from myelomeningocele produce orthopedic deformities that often require surgical correction. Spinal deformities in myelomeningocele are nearly universal, and are difficult to treat because of the absence of posterior elements. Hip dislocations frequently occur, but rarely require treatment. Severe foot deformities are seen in up to 80% of children.

  5. Regional anesthesia or patient-controlled analgesia and compartment syndrome in orthopedic surgical procedures: a systematic review

    PubMed Central

    Driscoll, Elizabeth BS; Maleki, Ana Hosseinzadeh; Jahromi, Leila; Hermecz, Brittany Nelson; Nelson, Lauren E; Vetter, Imelda L; Evenhuis, Spencer; Riesenberg, Lee Ann

    2016-01-01

    A systematic review of the literature on the use of regional anesthesia (RA) and patient-controlled analgesia (PCA) was conducted in patients who require orthopedic extremity procedures to determine whether either analgesic technique contributes to a delayed diagnosis of compartment syndrome (CS). A total of 34 relevant articles (28 case reports and six research articles) were identified. Of all case report articles published after 2009, the majority (75%) concluded that RA does not put the patient at an increased risk of a delayed diagnosis of CS. Of these, only two relevant prospective research studies focusing on RA or PCA and their relationship to CS were identified. Neither study resulted in any cases of CS. However, both had relatively small sample sizes. Given the lack of evidence identified in this systematic review, prospective studies or large-scale retrospective data reviews are needed to more strongly advocate the use of one modality of analgesia over the other in this patient population. PMID:27785097

  6. The Effects of Postoperative Activity on Subcuranious Tissue Oxygen Tension and Blood Flow in Orthopedic Surgical Patients

    DTIC Science & Technology

    1993-06-01

    killing common surgical infection organisms as Staphylococcus aureus, E coli, Serratia marcescens, Klebsiella pneumoniae, Proteus vulgaris , and...healing of wounded tissue is the maintenance of adequate tissue oxygenation. Abundant molecular oxygen must be present for cellular processes of oxidative

  7. Determining the need for team-based training in delirium management: A needs assessment of surgical healthcare professionals.

    PubMed

    Sockalingam, Sanjeev; Tehrani, Hedieh; Kacikanis, Anna; Tan, Adrienne; Hawa, Raed; Anderson, Ruthie; Okrainec, Allan; Abbey, Susan

    2015-01-01

    The high incidence of delirium in surgical units is a serious quality concern, given its impact on morbidity and mortality. While successful delirium management depends upon interdisciplinary care, training needs for surgical teams have not been studied. A needs assessment of surgical units was conducted to determine perceived comfort in managing delirium, and interprofessional training needs for team-based care. We administered a survey to 106 General Surgery healthcare professionals (69% response rate) with a focus on attitudes towards delirium and team management. Although most respondents identified delirium as important to patient outcomes, only 61% of healthcare professionals indicated that a team-based approach was always observed in practice. Less than half had a clear understanding of their role in delirium care, while just over half observed team communication of delirium care plans during handover. This is the first observation of clear gaps in perceived team performance in a General Surgery setting.

  8. A Practical Tool for Surveillance of Surgical-Site Infections: A 5-Year Experience in Orthopedic Surgeries.

    PubMed

    Benenson, Shmuel; Moses, Allon E; Cohen, Matan J; Brezis, Meir; Minster, Naomi; Schwartz, Carmela; Kandel, Leonid; Liebergall, Meir; Mattan, Yoav

    2017-01-10

    Continuous surveillance of surgical-site infection (SSI) is labor intensive. We developed a semiautomatic surveillance system partly assisted by surgeons. Most patients who developed postdischarge SSI were readmitted, which allowed us to limit postdischarge surveillance to this group. This procedure significantly reduced workload while maintaining high sensitivity and specificity for SSI diagnosis. Infect Control Hosp Epidemiol 2017;1-4.

  9. Orthopedic evaluation

    NASA Technical Reports Server (NTRS)

    Walden, T.

    1978-01-01

    The clinical performance of the Lixiscope in orthopedics was compared with routine radiography. Portability and size were the major advantages of the Lixiscope. The main disadvantage at this point in time was the Lixiscope's inability to study large areas.

  10. EVALUATION OF THE KNOWLEDGE ON COST OF ORTHOPEDIC IMPLANTS AMONG ORTHOPEDIC SURGEONS

    PubMed Central

    Arliani, Gustavo Gonçalves; Sabongi, Rodrigo Guerra; Batista, Alysson Ferreira; Astur, Diego Costa; Falotico, Guilherme Guadagnini; Cohen, Moises

    2016-01-01

    ABSTRACT Objective: To determine the knowledge of Brazilian Orthopedic Surgeons on the costs of orthopedic surgical devices used in surgical implants. Methods: A questionnaire was applied to Brazilian Orthopedic Surgeons during the 46th Brazilian Congress on Orthopedics and Traumatology. Results: Two hundred and one Orthopedic Surgeons completely filled out the questionnaire. The difference between the average prices estimated by the surgeons and the average prices provided by the supplier companies was 47.1%. No differences were found between the orthopedic specialists and other subspecialties on the prices indicated for specific orthopedic implants. However, differences were found among orthopedic surgeons who received visits from representatives of implant companies and those who did not receive those visits on prices indicated for shaver and radiofrequency device. Correlation was found between length of orthopedic experience and prices indicated for shaver and interference screw, and higher the experience time the lower the price indicated by Surgeons for these materials. Conclusion: The knowledge of Brazilian Orthopedic Surgeons on the costs of orthopedic implants is precarious. Reduction of cost of orthopedics materials depends on a more effective communication and interaction between doctors, hospitals and supplier companies with solid orientation programs and awareness for physicians about their importance in this scenario.Level of Evidence III, Cross-Sectional Study. PMID:28243178

  11. Orthopedic services

    MedlinePlus

    ... MedlinePlus GO GO About MedlinePlus Site Map FAQs Customer Support Health Topics Drugs & Supplements Videos & Tools Español You Are Here: Home → Medical Encyclopedia → Orthopedic services URL of this page: //medlineplus.gov/ency/article/ ...

  12. Sarcopenia in Orthopedic Surgery.

    PubMed

    Bokshan, Steven L; DePasse, J Mason; Daniels, Alan H

    2016-01-01

    Sarcopenia is a loss of skeletal muscle mass in the elderly that is an independent risk factor for falls, disability, postoperative complications, and mortality. Although its cause is not completely understood, sarcopenia generally results from a complex bone-muscle interaction in the setting of chronic disease and aging. Sarcopenia cannot be diagnosed by muscle mass alone. Diagnosis requires 2 of the following 3 criteria: low skeletal muscle mass, inadequate muscle strength, and inadequate physical performance. Forty-four percent of elderly patients undergoing orthopedic surgery and 24% of all patients 65 to 70 years old are sarcopenic. Although dual-energy x-ray absorptiometry and bioelectrical impedance analysis may be used to measure sarcopenia and are relatively inexpensive and accessible, they are generally considered less specific for sarcopenia compared with computed tomography and magnetic resonance imaging. Sarcopenia has been shown to predict poor outcomes within the medical and surgical populations and has been directly correlated with increases in taxpayer costs. Strengthening therapy and nutritional supplementation have become the mainstays of sarcopenia treatment. Specifically, the American Medical Directors Association has released guidelines for nutritional supplementation. Although sarcopenia frequently occurs with osteoporosis, it is an independent predictor of fragility fractures. Initiatives to diagnose, treat, and prevent sarcopenia in orthopedic patients are needed. Further investigation must also explore sarcopenia as a predictor of surgical outcomes in orthopedic patients.

  13. Human Factors and the Cardiac Surgical Team: A Role for Simulation

    PubMed Central

    Merry, Alan F.

    2007-01-01

    Abstract: Human factors play an important role in determining the outcome of cardiac surgery. The interaction of humans with their equipment, and with each other in teams, is critical to success. Simulation provides a means of teaching and assessing the technical and non-technical skills of clinicians and can facilitate research into interventions to improve safety. Simulation in anesthesia has taken much from aviation and provides a model that could be extended to perfusion. The cost of setting up a simulation center (or even of adding a perfusion simulator to an existing center) is relatively high, but the potential return on this investment is also substantial, particularly at a time when access to patients for teaching and research is becoming harder. Different degrees of complexity and fidelity in simulation lend themselves to different objectives, whether in teaching, assessment, or research. In the longer term, comprehensive simulations of cardiac surgical procedures involving all participants in meaningful simulated roles may be possible. PMID:18293815

  14. An Overview of the History of Orthopedic Surgery.

    PubMed

    Swarup, Ishaan; O'Donnell, Joseph F

    Orthopedic surgery has a long and rich history. While the modern term orthopedics was coined in the 1700s, orthopedic principles were beginning to be developed and used during primitive times. The Egyptians continued these practices, and described ways to recognize and manage common orthopedic conditions. The Greeks and Romans subsequently began to study medicine in a systematic manner, and greatly improved our understanding of orthopedic anatomy and surgical technique. After a period of little progress during the Middle Ages, rapid advancement was noted during the Renaissance, including the description of various injuries, improvements in surgical technique, and development of orthopedic hospitals. Collectively, these advances provided the foundation for modern orthopedics. Currently, orthopedic surgery is a rapidly developing field that has benefited from the works of numerous scholars and surgeons. It is important to recognize the successes and failures of the past, in order to advance research and practice as well as improve patient care and clinical outcomes.

  15. Handheld computers and the 21st century surgical team: a pilot study

    PubMed Central

    Aziz, Omer; Panesar, Sukhmeet S; Netuveli, Gopalakrishnan; Paraskeva, Paraskevas; Sheikh, Aziz; Darzi, Ara

    2005-01-01

    Background The commercial development and expansion of mobile phone networks has led to the creation of devices combining mobile phones and personal digital assistants, which could prove invaluable in a clinical setting. This pilot study aimed to look at how one such device compared with the current pager system in facilitating inter-professional communication in a hospital clinical team. Methods The study looked at a heterogeneous team of doctors (n = 9) working in a busy surgical setting at St. Mary's Hospital in London and compared the use of a personal digital assistant with mobile phone and web-browsing facilities to the existing pager system. The primary feature of this device being compared to the conventional pager was its use as a mobile phone, but other features evaluated included the ability to access the internet, and reference data on the device. A crossover study was carried out for 6 weeks in 2004, with the team having access to the personal digital assistant every alternate week. The primary outcome measure for assessing efficiency of communication was the length of time it took for clinicians to respond to a call. We also sought to assess the ease of adoption of new technology by evaluating the perceptions of the team (n = 9) to personal digital assistants, by administering a questionnaire. Results Doctors equipped with a personal digital assistant rather than a pager, responded more quickly to a call and had a lower of failure to respond rate (RR: 0.44; 95%CI 0.20–0.93). Clinicians also found this technology easy to adopt as seen by a significant reduction in perceptions of nervousness to the technology over the six-week study period (mean (SD) week 1: 4.10 (SD 1.69) vs. mean (SD) week 6: 2.20 (1.99); p = 0.04). Conclusion The results of this pilot study show the possible effects of replacing the current hospital pager with a newer, more technologically advanced device, and suggest that a combined personal digital assistant and mobile phone

  16. Factors Surgical Team Members Perceive Influence Choices of Wearing or Not Wearing Personal Protective Equipment during Operative/Invasive Procedures

    ERIC Educational Resources Information Center

    Cuming, Richard G.

    2009-01-01

    Exposure to certain bloodborne pathogens can prematurely end a person's life. Healthcare workers (HCWs), especially those who are members of surgical teams, are at increased risk of exposure to these pathogens. The proper use of personal protective equipment (PPE) during operative/invasive procedures reduces that risk. Despite this, some HCWs fail…

  17. Developments in ambulatory surgery in orthopedics in France in 2016.

    PubMed

    Hulet, C; Rochcongar, G; Court, C

    2017-02-01

    Under the new categorization introduced by the Health Authorities, ambulatory surgery (AS) in France now accounts for 50% of procedures, taking all surgical specialties together. The replacement of full hospital admission by AS is now well established and recognized. Health-care centers have learned, in coordination with the medico-surgical and paramedical teams, how to set up AS units and the corresponding clinical pathways. There is no single model handed down from above. The authorities have encouraged these developments, partly by regulations but also by means of financial incentives. Patient eligibility and psychosocial criteria are crucial determining factors for the success of the AS strategy. The surgeons involved are strongly committed. Feedback from many orthopedic subspecialties (shoulder, foot, knee, spine, hand, large joints, emergency and pediatric surgery) testify to the rise of AS, which now accounts for 41% of all orthopedic procedures. Questions remain, however, concerning the role of the GP in the continuity of care, the role of innovation and teaching, the creation of new jobs, and the attractiveness of AS for surgeons. More than ever, it is the patient who is "ambulatory", within an organized structure in which surgical technique and pain management are well controlled. Not all patients can be eligible, but the AS concept is becoming standard, and overnight stay will become a matter for medical and surgical prescription.

  18. Diagnostic imaging in bovine orthopedics.

    PubMed

    Kofler, Johann; Geissbühler, Urs; Steiner, Adrian

    2014-03-01

    Although a radiographic unit is not standard equipment for bovine practitioners in hospital or field situations, ultrasound machines with 7.5-MHz linear transducers have been used in bovine reproduction for many years, and are eminently suitable for evaluation of orthopedic disorders. The goal of this article is to encourage veterinarians to use radiology and ultrasonography for the evaluation of bovine orthopedic disorders. These diagnostic imaging techniques improve the likelihood of a definitive diagnosis in every bovine patient but especially in highly valuable cattle, whose owners demand increasingly more diagnostic and surgical interventions that require high-level specialized techniques.

  19. TEAM.

    ERIC Educational Resources Information Center

    National Highway Traffic Safety Administration (DOT), Washington, DC.

    This document presents materials covering the television campaign against drunk driving called "TEAM" (Techniques for Effective Alcohol Management). It is noted that TEAM's purpose is to promote effective alcohol management in public facilities and other establishments that serve alcoholic beverages. TEAM sponsors are listed, including…

  20. Perception of the nursing team of a Surgical Center regarding Hospital Accreditation at a University Hospital.

    PubMed

    Fernandes, Hellen Maria de Lima Graf; Peniche, Aparecida de Cássia Giani

    2015-02-01

    Objective To analyze the perception of nursing teams at a surgical center regarding the process of hospital accreditation, in the evaluative aspects of structure, process, and result. Method The study takes a quantitative and exploratory-descriptive approach, carried out at a university hospital. Result The population consisted of 69 nursing professionals, and the data collection was performed in the months of January and February 2014 by way of a questionnaire, utilizing the Likert scale. The methodology used a Cronbach's Alpha equal to 0.812. In the comparison of the three aspects, the one with the highest favorability score was "result", with an average of 47.12 (dp±7.23), and the smallest was "structure," with an average of 40.70 (dp±5.19). Conclusion This situational diagnostic can assist in the restructuring of the vulnerable areas evaluated in these three aspects, mainly in the aspect of structure, with a goal of level 2 accreditation by the ONA (Brazilian's National Organization for Accreditation) defended by the Institution.

  1. [The role of multi-disciplinary team in the surgical area--at present and in future].

    PubMed

    Tomita, Michiko; Sakamoto, Suga

    2010-07-01

    This article describes four particular tasks of nursing profession and identifies the contribution of nurses within a multi-professional team in the surgical area. The four tasks involve; triage nursing in Emergency Room; allocation of surgical beds; provision of patients' information on a course of surgical treatment prior to hospital admission; and participation in Diagnosis Related Group (DRG). Being responsible for each of these tasks, the nurses play a significant role as mediators between patients and health professionals as well as between the health professionals in order to respond to their patients' needs. This contributes to alleviation of suffering through the diagnosis and surgical treatment, leading to the best ways to recover from major trauma the patients had. In recent years, expanding nursing responsibilities for decision-making in patients' care has been in discussion. However, it is clear that with certain levels of education and practice, nursing profession is able to fill the important roles within the multi-professional team in the surgical area.

  2. Greening of orthopedic surgery.

    PubMed

    Lee, Rushyuan J; Mears, Simon C

    2012-06-01

    Every year, 4 billion pounds of waste are produced by health care facilities, and the amount continues to increase annually. In response, a movement toward greening health care has been building, with a particular focus on the operating room. Between 20% and 70% of health care waste originates from a hospital's operating room, and up to 90% of operating room waste is improperly sorted and sent for costly and unneeded hazardous waste processing. Recent successful changes include segregation of hospital waste, substitution of the ubiquitous polypropylene plastic wrap used for the sterilization and handling of surgical equipment with metal cases, and the reintroduction of reusable surgical gowns. Orthopedic-related changes include the successful reprocessing and reuse of external fixators, shavers, blades, burs, and tourniquets. These changes have been shown to be environmentally and economically beneficial. Early review indicates that these changes are feasible, but a need exists for further evaluation of the effect on the operating room and flow of the surgical procedure and of the risks to the surgeons and operating room staff. Other key considerations are the effects of reprocessed and reused equipment on patient care and outcome and the role of surgeons in helping patients make informed decisions regarding surgical care. The goals of this study were to summarize the amount and types of waste produced in hospitals and operating rooms, highlight the methods of disposal used, review disposal methods that have been developed to reduce waste and improve recycling, and explore future developments in greening health care.

  3. The surgical prebrief as part of a five-point comprehensive approach to improving pediatric cardiac surgical team communication.

    PubMed

    Hoganson, David M; Boston, Umar S; Manning, Peter B; Eghtesady, Pirooz

    2014-10-01

    Communication is essential to the safe conduct of any critical task including cardiac surgery. After inspiration by airline crew resource management training, a communication system for the care plans of pediatric cardiac patients was developed and refined over time that encompasses the entire heart center team. Five distinct communication points are used to ensure preoperative, intraoperative, and postoperative care, which is transitioned efficiently and maintained at the highest level.

  4. Qualitative study exploring surgical team members' perception of patient safety in conflict-ridden Eastern Democratic Republic of Congo

    PubMed Central

    Labat, Francoise; Sharma, Anjali

    2016-01-01

    Objective To identify potential barriers to patient safety (PS) interventions from the perspective of surgical team members working in an operating theatre in Eastern Democratic Republic of Congo (DRC). Design In-depth interviews were conducted and analysed using qualitative content analysis. Setting Governmental referral teaching hospital in Eastern DRC. Participants We purposively selected 2–4 national and expatriate surgical team members from each specialisation. Of the 31 eligible surgical health workers (HWs), 17 volunteered to be interviewed. Results Economics issues affected PS throughout the entire health system, from human resources and hospital management, to access to healthcare for patients. Surgical team members seemed embedded in a paternalistic organisational structure and blame culture accompanied by perceived inefficient support services and low salaries. The armed conflict did not only worsen these system failures, it also carried direct threats to patients and HWs, and resulted in complex indirect consequences compromising PS. The increased corruption within health organisations, and population impoverishment and substance abuse among health staff adversely altered safe care. Simultaneously, HWs’ reported resilience and resourcefulness to address barrier to PS. Participants had varying views on external aid depending on its relevance. Conclusions The complex links between war and PS emphasise the importance of a comprehensive approach including occupational health to strengthen HWs' resilience, external clinical audits to limit corruption, and educational programmes in PS to support patient-centred care and address blame culture. Finally, improvement of equity in the health financing system seems essential to ensure access to healthcare and safe perioperative outcomes for all. PMID:27113232

  5. Dream Team--The Case of an Undergraduate Surgical Talent Development Project

    ERIC Educational Resources Information Center

    Jensen, Rune Dall; Ljungmann, Ken; Christensen, Mette Krogh; Møldrup, Ulla; Grøndal, Anne Krogh; Mogensen, Mads Filtenborg; Seyer-Hansen, Mikkel

    2016-01-01

    To be successful, a surgeon must master a variety of skills. To meet the high demand for surgical expertise, an extracurricular undergraduate project was launched. The extracurricular project consists of hands-on laparoscopic training and a mentorship programme. The project aims to find the best surgical talents among fourth-year medical students.…

  6. [Child orthopedics].

    PubMed

    Hvid, Ivan

    2002-05-13

    Children's fractures are a challenge to the treatment system, in that 17,000 children are treated in Denmark each year. The true burden on patients and society is unknown. It is estimated that 1000 new-born infants are treated for hip instability in Denmark per year, and 30 are diagnosed late. Ultrasound scanning is recommended for secondary screening and selective screening of children at risk. Identification of acetabular dysplasia followed by surgical correction could be an important prophylactic measure, with a potential reduction in expenses to society. To some extent, congenital clubfoot is hereditary. Environmental factors are important, maternal smoking being one. Early operative treatment yields good results. There is a need for prospective registration. Perthes' disease is an idiopathic necrosis of the capital femoral epiphysis. Passive smoking is a significant factor. A young age (< 7 years) and limited necrosis carry a good prognosis, and active treatment can improve the prognosis for the other patients.

  7. [Dream Team--a pre-graduate surgical talent development project].

    PubMed

    Jensen, Rune Dall; Christensen, Mette Krogh; Seyer-Hansen, Mikkel

    2014-08-04

    In 2009 surgeons from Aarhus University Hospital founded an extracurricular talent development project based on a skill-acquisition training programme for medical students at Aarhus University. The training program, named Dream Team, provides medical students with the opportunity to pursue a career in surgery. This paper presents and discusses the organizational and pedagogical framework of the concept Dream Team, as well as the results from two inquiries: a survey and an exploratory observational study. The inquiries were conducted in summer 2013.

  8. Use of the nursing intervention classification for identifying the workload of a nursing team in a surgical center1

    PubMed Central

    Possari, João Francisco; Gaidzinski, Raquel Rapone; Lima, Antônio Fernandes Costa; Fugulin, Fernanda Maria Togeiro; Herdman, Tracy Heather

    2015-01-01

    Objective: to analyze the distribution of nursing professionals' workloads, according to the Nursing Intervention Classification (NIC), during the transoperative period at a surgical center specializing in oncology. Methods: this was an observational and descriptive cross-sectional study. The sample consisted of 11 nurses, 25 nursing technicians who performed a variety of roles within the operating room, 16 nursing technicians who worked with the surgical instrumentation and two nursing technicians from patient reception who worked in the surgical center during the transoperative period. An instrument was developed to collect data and the interventions were validated according to NIC taxonomy. Results: a total of 266 activities were identified and mapped into 49 nursing interventions, seven domains and 20 classes of the NIC. The most representative domains were Physiological-Complex (61.68%) and Health System (22.12%), while the most frequent interventions were Surgical Care (30.62%) and Documentation (11.47%), respectively. The productivity of the nursing team reached 95.34%. Conclusions: use of the Nursing Intervention Classification contributes towards the discussion regarding adequate, professional nursing staffing levels, because it shows the distribution of the work load. PMID:26487126

  9. Evaluating a specialist nurse's role in a general paediatric surgical team.

    PubMed

    Quick, Julie

    2014-10-01

    A surgical care practitioner (SCP) is a registered nurse or allied health professional who, following specific education and competency training, carries out pre- and post-operative treatment and some surgical interventions under the supervision of a consultant surgeon, contributing to the maintenance of surgical services and the enhancement of patient care. With a cohesive approach, the SCP can do much to ensure continuity of care and mutual understanding and concordance between staff, child and family. Costs can be reduced and the surgical training of junior doctors supported. The results of this audit show that, with the inclusion of an SCP, higher quality general children's surgery can be provided at a medium-sized district general hospital, so that patients can be seen locally.

  10. 'Achieving ensemble': communication in orthopaedic surgical teams and the development of situation awareness--an observational study using live videotaped examples.

    PubMed

    Bleakley, Alan; Allard, Jon; Hobbs, Adrian

    2013-03-01

    Focused dialogue, as good communication between practitioners, offers a condition of possibility for development of high levels of situation awareness in surgical teams. This has been termed "achieving ensemble". Situation awareness grasps what is happening in time and space with regard to one's own unfolding work in relation to that of colleagues, and is necessary to maintain patient safety throughout a surgical list. We refined a typology, initially developed for use in studying the dynamics of teams in aviation safety, of 10 kinds of communication within two broad areas: 'Reports', or authoritative acts of communication setting up a monological or authoritative climate; and 'Requests', or facilitative acts of communication setting up a dialogical or participatory climate. We systematically mapped how orthopaedic surgical teams use verbal communication through analysis of videotaped operations using the typology. We asked: 'do orthopaedic surgical teams set up the conditions of possibility for the emergence of situation awareness through effective communication?' We found that orthopaedic surgical teams tend to produce monological rather than dialogical climates. Dialogue increases with more complex cases, but in routine work, communication levels are depressed and one-way, influenced by surgeons working within a traditionally hierarchical and authoritative culture. We suggest that such a monological climate inhibits development of situation awareness and then compromises patient safety. The same teams, however, generate potentially rich educational climates through exchange of profession-specific knowledge and skills, and we suggest that where technical skill exchange is good, non-technical or interpersonal communication skill levels can follow.

  11. Erythromycin Seromadesis in Orthopedic Surgery

    PubMed Central

    Salgado, Martin; Fernández, Felipe; Avilés, Carolina; Cordova, Cecilia

    2016-01-01

    Introduction: The presence of postoperative seromadesis is common, corresponding to the presence of serum in the subcutaneous tissue post a surgical event. Erythromycin has been reported as sclerosing, although not in orthopedic surgery. We report a case of erythromycin seromadesis in orthopedic surgery. Case Presentation: We present a case of a 63-year-old woman having undergone femoral prosthesis surgery and total hip replacement with a subfacial seroma without findings of infection, refractory to standard treatment of compression bandages, massage and cleaning surgery in two oportunities. A literature review was undertaken to obtain the therapeutic alternatives where erythromycin seromadesis is chosen with excellent response. Conclusion: Erythromycin sclerotherapy should be considered as an effective and safe option in the treatment of seroma in general surgery and traumatology. More studies are necessary to get a better evidence. We believe that this is the first study of use of erythromycin as sclerotherapy in a traumatology case. PMID:27703947

  12. In situ simulation-based team training for post-cardiac surgical emergency chest reopen in the intensive care unit.

    PubMed

    Nunnink, L; Welsh, A M; Abbey, M; Buschel, C

    2009-01-01

    Emergency chest reopen of the post cardiac surgical patient in the intensive care unit is a high-stakes but infrequent procedure which requires a high-level team response and a unique skill set. We evaluated the impact on knowledge and confidence of team-based chest reopen training using a patient simulator compared with standard video-based training. We evaluated 49 medical and nursing participants before and after training using a multiple choice questions test and a questionnaire of self-reported confidence in performing or assisting with emergency reopen. Both video- and simulation-based training significantly improved results in objective and subjective domains. Although the post-test scores did not differ between the groups for either the objective (P = 0.28) or the subjective measures (P = 0.92), the simulation-based training produced a numerically larger improvement in both domains. In a multiple choice question out of 10, participants improved by a mean of 1.9 marks with manikin-based training compared to 0.9 with video training (P = 0.03). On a questionnaire out of 20 assessing subjective levels of confidence, scores improved by 3.9 with manikin training compared to 1.2 with video training (P = 0.002). Simulation-based training appeared to be at least as effective as video-based training in improving both knowledge and confidence in post cardiac surgical emergency resternotomy.

  13. Fabrication of Minerals Substituted Porous Hydroxyapaptite/Poly(3,4-ethylenedioxy pyrrole-co-3,4-ethylenedioxythiophene) Bilayer Coatings on Surgical Grade Stainless Steel and Its Antibacterial and Biological Activities for Orthopedic Applications.

    PubMed

    Subramani, Ramya; Elangomannan, Shinyjoy; Louis, Kavitha; Kannan, Soundarapandian; Gopi, Dhanaraj

    2016-05-18

    Current strategies of bilayer technology have been aimed mainly at the enhancement of bioactivity, mechanical property and corrosion resistance. In the present investigation, the electropolymerization of poly(3,4-ethylenedioxypyrrole-co-3,4-ethylenedioxythiophene) (P(EDOP-co-EDOT)) with various feed ratios of EDOP/EDOT on surgical grade stainless steel (316L SS) and the successive electrodeposition of strontium (Sr(2+)), magnesium (Mg(2+)) and cerium (Ce(3+)) (with 0.05, 0.075 and 0.1 M Ce(3+)) substituted porous hydroxyapatite (M-HA) are successfully combined to produce the bioactive and corrosion resistance P(EDOP-co-EDOT)/M-HA bilayer coatings for orthopedic applications. The existence of as-developed coatings was confirmed by Fourier transform-infrared spectroscopy (FT-IR), X-ray diffraction (XRD), proton nuclear magnetic resonance spectroscopy ((1)H NMR), high resolution scanning electron microscopy (HRSEM), energy dispersive X-ray analysis (EDAX) and atomic force microscopy (AFM). Also, the mechanical and thermal behavior of the bilayer coatings were analyzed. The corrosion resistance of the as-developed coatings and also the influence of copolymer (EDOP:EDOT) feed ratio were studied in Ringer's solution by electrochemical techniques. The as-obtained results are in accord with those obtained from the chemical analysis using inductively coupled plasma atomic emission spectrometry (ICP-AES). In addition, the antibacterial activity, in vitro bioactivity, cell viability and cell adhesion tests were performed to substantiate the biocompatibility of P(EDOP-co-EDOT)/M-HA bilayer coatings. On account of these investigations, it is proved that the as-developed bilayer coatings exhibit superior bioactivity and improved corrosion resistance over 316L SS, which is potential for orthopedic applications.

  14. Arthroscopic training resources in orthopedic resident education.

    PubMed

    Koehler, Ryan; John, Tamara; Lawler, Jeffrey; Moorman, Claude; Nicandri, Gregg

    2015-02-01

    The purpose of this study was to determine the frequency of use, perceived effectiveness, and preference for arthroscopic surgical skill training resources. An electronic survey was sent to orthopedics residents, residency program directors, and orthopedic sports medicine attending physicians in the United States. The frequency and perceived effectiveness of 10 types of adjunctive arthroscopic skills training was assessed. Residents and faculty members were asked to rate their confidence in resident ability to perform common arthroscopic procedures. Surveys were completed by 40 of 152 (26.3%) orthopedic residency program directors, 70 of 426 (16.4%) sports medicine faculty, and 235 of 3,170 (7.4%) orthopedic residents. The use of adjunctive methods of training varied from only 9.8% of programs with virtual reality training to 80.5% of programs that used reading of published materials to develop arthroscopic skill. Practice on cadaveric specimens was viewed as the most effective and preferred adjunctive method of training. Residents trained on cadaveric specimens reported increased confidence in their ability to perform arthroscopic procedures. The resources for developing arthroscopic surgical skill vary considerably across orthopedic residency programs in the United States. Adjunctive training methods were perceived to be effective at supplementing traditional training in the operating room.

  15. Leading article: how can I optimise my role as a leader within the surgical team?

    PubMed

    Green, B; Mitchell, D A; Stevenson, P; Kane, T; Reynard, J; Brennan, P A

    2016-10-01

    Leadership is uncommonly taught formally at any level in surgical training, and is not often evaluated formally either within assessment programmes or during appraisal. Good leadership skills in oral and maxillofacial surgery (OMFS) include professionalism, technical competence, motivation, innovation, ability to communicate, resilience, and effective teaching. They also include the recognition of when and how to "follow" when appropriate. Such skills can be developed through experience, observation, and education using a framework that can include mentoring, coaching, and feedback. This review provides some guidance in how to improve leadership skills in OMFS, which we hope will to improve the quality of training and care of patients.

  16. ORTHOPEDIC SURGERY AMONG THE ELDERLY: CLINICAL CHARACTERISTICS

    PubMed Central

    Leme, Luiz Eugênio Garcez; Sitta, Maria do Carmo; Toledo, Manuella; da Silva Henriques, Simone

    2015-01-01

    Care for elderly patients undergoing orthopedic surgery, particularly for those requiring emergency surgery, needs to take into account an analysis of physical capacity and risks specific to elderly individuals, in an attempt to reduce the risks. Nevertheless, these remain high in this group. Despite the risks, procedures developed promptly have a positive effect on these patients’ evolution. Coordinated care, composed of teams of specialists within clinical medicine, geriatrics, orthopedics, anesthesiology and critical care, along with other healthcare professionals, may be highly beneficial for this group of patients. PMID:27027017

  17. Billing and coding knowledge: a comparative survey of professional coders, practicing orthopedic surgeons, and orthopedic residents.

    PubMed

    Wiley, Kevin F; Yousuf, Tariq; Pasque, Charles B; Yousuf, Khalid

    2014-06-01

    Medical knowledge and surgical skills are necessary to become an effective orthopedic surgeon. To run an efficient practice, the surgeon must also possess a basic understanding of medical business practices, including billing and coding. In this study, we surveyed and compared the level of billing and coding knowledge among current orthopedic residents PGY3 and higher, academic and private practice attending orthopedic surgeons, and orthopedic coding professionals. According to the survey results, residents and fellows have a similar knowledge of coding and billing, regardless of their level of training or type of business education received in residency. Most residents would like formal training in coding, billing, and practice management didactics; this is consistent with data from previous studies.

  18. Impact of Robotic Surgery on Decision Making: Perspectives of Surgical Teams

    PubMed Central

    Randell, Rebecca; Alvarado, Natasha; Honey, Stephanie; Greenhalgh, Joanne; Gardner, Peter; Gill, Arron; Jayne, David; Kotze, Alwyn; Pearman, Alan; Dowding, Dawn

    2015-01-01

    There has been rapid growth in the purchase of surgical robots in both North America and Europe in recent years. Whilst this technology promises many benefits for patients, the introduction of such a complex interactive system into healthcare practice often results in unintended consequences that are difficult to predict. Decision making by surgeons during an operation is affected by variables including tactile perception, visual perception, motor skill, and instrument complexity, all of which are changed by robotic surgery, yet the impact of robotic surgery on decision making has not been previously studied. Drawing on the approach of realist evaluation, we conducted a multi-site interview study across nine hospitals, interviewing 44 operating room personnel with experience of robotic surgery to gather their perspectives on how robotic surgery impacts surgeon decision making. The findings reveal both potential benefits and challenges of robotic surgery for decision making. PMID:26958244

  19. Impact of Robotic Surgery on Decision Making: Perspectives of Surgical Teams.

    PubMed

    Randell, Rebecca; Alvarado, Natasha; Honey, Stephanie; Greenhalgh, Joanne; Gardner, Peter; Gill, Arron; Jayne, David; Kotze, Alwyn; Pearman, Alan; Dowding, Dawn

    2015-01-01

    There has been rapid growth in the purchase of surgical robots in both North America and Europe in recent years. Whilst this technology promises many benefits for patients, the introduction of such a complex interactive system into healthcare practice often results in unintended consequences that are difficult to predict. Decision making by surgeons during an operation is affected by variables including tactile perception, visual perception, motor skill, and instrument complexity, all of which are changed by robotic surgery, yet the impact of robotic surgery on decision making has not been previously studied. Drawing on the approach of realist evaluation, we conducted a multi-site interview study across nine hospitals, interviewing 44 operating room personnel with experience of robotic surgery to gather their perspectives on how robotic surgery impacts surgeon decision making. The findings reveal both potential benefits and challenges of robotic surgery for decision making.

  20. Preoperative screening/decolonization for Staphylococcus aureus to prevent orthopedic surgical site infection: prospective cohort study with 2-year follow-up.

    PubMed

    Rao, Nalini; Cannella, Barbara A; Crossett, Lawrence S; Yates, Adolph J; McGough, Richard L; Hamilton, Cindy W

    2011-12-01

    We quantified surgical site infections (SSIs) after preoperative screening/selective decolonization before elective total joint arthroplasty (TJA) with 2-year follow-up and 2 controls. Concurrent controls (n = 2284) were patients of surgeons not participating in screening/decolonization. Preintervention controls (n = 741) were patients of participating surgeons who underwent TJA the previous year. Staphylococcus aureus nasal carriers (321/1285 [25%]) used intranasal mupirocin and chlorhexidine baths as outpatients. Staphylococcal SSIs occurred in no intervention patients (0/321) and 19 concurrent controls. If all SSIs occurred in carriers and 25% of controls were carriers, staphylococcal SSI rate would have been 3.3% in controls (19/571; P = .001). Overall SSI rate decreased from 2.7% (20/741) in preintervention controls to 1.2% (17/1440) in intervention patients (P = .009). Preoperative screening/selective decolonization was associated with fewer SSIs after elective TJA.

  1. "Achieving Ensemble": Communication in Orthopaedic Surgical Teams and the Development of Situation Awareness--An Observational Study Using Live Videotaped Examples

    ERIC Educational Resources Information Center

    Bleakley, Alan; Allard, Jon; Hobbs, Adrian

    2013-01-01

    Focused dialogue, as good communication between practitioners, offers a condition of possibility for development of high levels of situation awareness in surgical teams. This has been termed "achieving ensemble". Situation awareness grasps what is happening in time and space with regard to one's own unfolding work in relation to that of…

  2. Nanotechnology in orthopedics.

    PubMed

    Garimella, Roja; Eltorai, Adam E M

    2017-03-01

    Nanotechnology has revolutionized science and consumer products for several decades. Most recently, its applications to the fields of medicine and biology have improved drug delivery, medical diagnostics, and manufacturing. Recent research of this modern technology has demonstrated its potential with novel forms of disease detection and intervention, particularly within orthopedics. Nanomedicine has transformed orthopedics through recent advances in bone tissue engineering, implantable materials, diagnosis and therapeutics, and surface adhesives. The potential for nanotechnology within the field of orthopedics is vast and much of it appears to be untapped, though not without accompanying obstacles.

  3. [Thermoformed orthopedic splints].

    PubMed

    Amoric, M

    1990-12-01

    Initially used to make simple splints, thermoforming has led to the development of a new means of application of orthopedic forces. Here we have presented splints which allow the treatment of Class III, Class II and cases of endomaxillitis.

  4. Idiopathic Hand and Arm Pain: Delivering Cognitive Behavioral Therapy as Part of a Multidisciplinary Team in a Surgical Practice

    ERIC Educational Resources Information Center

    Vranceanu, Ana-Maria.; Ring, David; Kulich, Ronald; Zhao, Meijuan; Cowan, James; Safren, Steven

    2008-01-01

    Cognitive behavioral therapists may have a unique and growing role in orthopedics departments. In helping patients cope with pain, particularly where there is no specific biomedical treatment or cure, cognitive behavioral practitioners can help prevent, early on, the transition from an acute pain complaint to a costly, disabling, and interfering…

  5. Vascular Injury in Orthopedic Trauma.

    PubMed

    Mavrogenis, Andreas F; Panagopoulos, George N; Kokkalis, Zinon T; Koulouvaris, Panayiotis; Megaloikonomos, Panayiotis D; Igoumenou, Vasilios; Mantas, George; Moulakakis, Konstantinos G; Sfyroeras, George S; Lazaris, Andreas; Soucacos, Panayotis N

    2016-07-01

    Vascular injury in orthopedic trauma is challenging. The risk to life and limb can be high, and clinical signs initially can be subtle. Recognition and management should be a critical skill for every orthopedic surgeon. There are 5 types of vascular injury: intimal injury (flaps, disruptions, or subintimal/intramural hematomas), complete wall defects with pseudoaneurysms or hemorrhage, complete transections with hemorrhage or occlusion, arteriovenous fistulas, and spasm. Intimal defects and subintimal hematomas with possible secondary occlusion are most commonly associated with blunt trauma, whereas wall defects, complete transections, and arteriovenous fistulas usually occur with penetrating trauma. Spasm can occur after either blunt or penetrating trauma to an extremity and is more common in young patients. Clinical presentation of vascular injury may not be straightforward. Physical examination can be misleading or initially unimpressive; a normal pulse examination may be present in 5% to 15% of patients with vascular injury. Detection and treatment of vascular injuries should take place within the context of the overall resuscitation of the patient according to the established principles of the Advanced Trauma Life Support (ATLS) protocols. Advances in the field, made mostly during times of war, have made limb salvage the rule rather than the exception. Teamwork, familiarity with the often subtle signs of vascular injuries, a high index of suspicion, effective communication, appropriate use of imaging modalities, sound knowledge of relevant technique, and sequence of surgical repairs are among the essential factors that will lead to a successful outcome. This article provides a comprehensive literature review on a subject that generates significant controversy and confusion among clinicians involved in the care of trauma patients. [Orthopedics. 2016; 39(4):249-259.].

  6. 21 CFR 878.3300 - Surgical mesh.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... GENERAL AND PLASTIC SURGERY DEVICES Prosthetic Devices § 878.3300 Surgical mesh. (a) Identification... acetabular and cement restrictor mesh used during orthopedic surgery. (b) Classification. Class II....

  7. 21 CFR 878.3300 - Surgical mesh.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... GENERAL AND PLASTIC SURGERY DEVICES Prosthetic Devices § 878.3300 Surgical mesh. (a) Identification... acetabular and cement restrictor mesh used during orthopedic surgery. (b) Classification. Class II....

  8. 21 CFR 878.3300 - Surgical mesh.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... GENERAL AND PLASTIC SURGERY DEVICES Prosthetic Devices § 878.3300 Surgical mesh. (a) Identification... acetabular and cement restrictor mesh used during orthopedic surgery. (b) Classification. Class II....

  9. [Orthopedic Problems in Overweight and Obese Children].

    PubMed

    Hoffmann, S; Stücker, R; Rupprecht, M

    2016-03-01

    Overweight and obesity in children and adolescents is a growing problem with an increasing number of patients presenting with comorbidities to pediatricians and orthopedic surgeons. This overview summarizes the most common orthopedic problems in overweight children and obesity and highlights the treatment options in addition to weight reduction and physiotherapy leaded activation. In early infancy a persitent genu varum may be seen as a sign of Blount disease. In the school ages flat feet or persistent knock-knees has a higher incidence in overweight children. The incidence for back pain and osteoporosis are related with overweight and obese. At puberty, the slipped capital epiphysis, which always needs a surgical management, is mostly related to overweight/obese. A symptomatic retroversion of the femur can cause discomfort and lead to a surgical therapy himself.

  10. Orthopedic Implant Waste: Analysis and Quantification.

    PubMed

    Payne, Ashley; Slover, James; Inneh, Ifeoma; Hutzler, Lorraine; Iorio, Richard; Bosco, Joseph A

    2015-12-01

    The steadily increasing demand for orthopedic surgeries and declining rates of reimbursement by Medicare and other insurance providers have led many hospitals to look for ways to control the cost of these surgeries. We reviewed administrative records for a 1-year period and recorded total number of surgical cases, number of cases in which an implant was wasted, and cost of each wasted implant. We determined cost incurred because of implant waste, percentage of cases that involved waste, percentage of total implant cost wasted, and average cost of waste per case. We then analyzed the data to determine if case volume or years in surgical practice affected amount of implant waste. Results showed implant waste represents a significant cost for orthopedic procedures within all subspecialties and is an important factor to consider when developing cost-reduction strategies.

  11. Three-Dimensional Printing in Orthopedic Surgery.

    PubMed

    Eltorai, Adam E M; Nguyen, Eric; Daniels, Alan H

    2015-11-01

    Three-dimensional (3D) printing is emerging as a clinically promising technology for rapid prototyping of surgically implantable products. With this commercially available technology, computed tomography or magnetic resonance images can be used to create graspable objects from 3D reconstructed images. Models can enhance patients' understanding of their pathology and surgeon preoperative planning. Customized implants and casts can be made to match an individual's anatomy. This review outlines 3D printing, its current applications in orthopedics, and promising future directions.

  12. Split Forward Surgical Teams

    DTIC Science & Technology

    2008-06-13

    testing a unit’s ability to evacuate casualties. Some training centers grant extensions over one hour for casualties that have had medical treatment...equipment. The problem with this equipment is that it has not been tested for ruggedness or durability in unimproved settings, which the approved MTOE...equipment has been tested for durability and ruggedness. Additionally, the approved equipment was compatible with the other deployable medical

  13. Orthopedic surgery and its complication in systemic lupus erythematosus

    PubMed Central

    Mak, Anselm

    2014-01-01

    Systemic lupus erythematosus (SLE) is a multi-systemic immune-complex mediated autoimmune condition which chiefly affects women during their prime year. While the management of the condition falls into the specialty of internal medicine, patients with SLE often present with signs and symptoms pertaining to the territory of orthopedic surgery such as tendon rupture, carpal tunnel syndrome, osteonecrosis, osteoporotic fracture and infection including septic arthritis, osteomyelitis and spondylodiscitis. While these orthopedic-related conditions are often debilitating in patients with SLE which necessitate management by orthopedic specialists, a high index of suspicion is necessary in diagnosing these conditions early because lupus patients with potentially severe orthopedic conditions such as osteomyelitis frequently present with mild symptoms and subtle signs such as low grade fever, mild hip pain and back tenderness. Additionally, even if these orthopedic conditions can be recognized, complications as a result of surgical procedures are indeed not uncommon. SLE per se and its various associated pharmacological treatments may pose lupus patients to certain surgical risks if they are not properly attended to and managed prior to, during and after surgery. Concerted effort of management and effective communication among orthopedic specialists and rheumatologists play an integral part in enhancing favorable outcome and reduction in postoperative complications for patients with SLE through thorough pre-operative evaluation, careful peri-operative monitoring and treatment, as well as judicious postoperative care. PMID:24653977

  14. Orthopedic trauma in pregnancy.

    PubMed

    Desai, Pratik; Suk, Michael

    2007-11-01

    Trauma sustained during pregnancy can trigger uncertainty and anxiety for patient and orthopedic surgeon alike. In particular, orthopedic-related injuries raise concerns about preoperative, intraoperative, and postoperative care. In this article, we review common concerns about radiation exposure, leukemia, pain management, anticoagulation, and anesthesia. One finding is that radiation risk is minimal when obtaining x-rays for operative planning, provided that the cumulative dose is within 5 rad. We also address safety concerns about patient positioning and staff radiation exposure. In addition, we found that most anesthetics used in pregnancy are category C (ie, safe). Perioperative opioid use for pain management is recommended with little risk. Regarding anticoagulation, low-molecular-weight heparin and fondaparinux are the safest choices. Last, pregnancy is not a contraindication to operative management of pelvic and acetabular fractures.

  15. Nurses' Perceptions of Role, Team Performance, and Education Regarding Resuscitation in the Adult Medical-Surgical Patient.

    PubMed

    O'Donoghue, Sharon C; DeSanto-Madeya, Susan; Fealy, Natalie; Saba, Christine R; Smith, Stacey; McHugh, Allison T

    2015-01-01

    The purpose of this study was to explore nurses' perception of their roles, team performance, and educational needs during resuscitation using an electronic survey. Findings provide direction for clinical practice, nursing education, and future research to improve resuscitation care.

  16. Orthopedic Manifestations of Mobius Syndrome: Case Series and Survey Study

    PubMed Central

    McClure, Philip; Booy, David; Katarincic, Julia; Eberson, Craig

    2016-01-01

    Background. Mobius Syndrome is a rare disease defined by bilateral congenital 7th nerve palsy. We focus on reporting the prevalence of orthopedic disease in this population. Methods. Twenty-three individuals with Mobius Syndrome underwent orthopedic physical examination, and additional 96 patients filled out a survey for self-reported orthopedic diagnoses. Results. Clubfoot was present in 60% of individuals in the physical exam series and 42% of those in the survey. Scoliosis was present in 26% and 28%, respectively. Poland's Syndrome was present in 17% and 30%. In addition to these findings, 27% of patients reported having difficulty with anesthesia, including difficulty in intubation and airway problems. Conclusion. An increased prevalence of scoliosis, clubfoot, transverse limb deficiencies, and Poland's Syndrome is identified in the setting of Mobius Syndrome. In the setting of several deformities often requiring surgical correction, a high incidence of anesthetic difficulty is noted and should be discussed with patients and other providers during surgical planning. PMID:26977161

  17. Accelerating surgical training and reducing the burden of surgical disease in Haiti before and after the earthquake.

    PubMed

    DeGennaro, Vincent A; DeGennaro, Vincent A; Kochhar, Amit; Nathan, Nirmal; Low, Christopher; Avashia, Yash J; Thaller, Seth R

    2012-11-01

    In general, university-based global health initiatives have tended to focus on expanding access to primary care. In the past, surgical programs may have been characterized by sporadic participation with little educational focus. However, there have been some notable exceptions with plastic surgery volunteer missions. We offer another model of regularly scheduled surgical trips to rural Haiti in plastic and general surgery. The goal of these trips is to reduce the burden of surgical disease and ultimately repair every cleft lip/palate in Haiti. Another principal objective is to accelerate the training of American residents through increased case load and personal interaction with attending surgeons in a concentrated period. Diversity of the case load and the overall number of surgeries performed by residents in a typical surgical trip outpaces the experiences available during a typical week in an American hospital setting. More importantly, we continue to provide ongoing training to Haitian nurses and surgeons in surgical techniques and postoperative care. Our postoperative complication rate has been relatively low. Our follow-up rates have been lower than 70% despite intensive attempts to maintain continued communication with our patients. Through our experiences in surgical care in rural Haiti, we were able to quickly ramp up our trauma and orthopedic surgical care immediately after the earthquake. Project Medishare and the University of Miami continue to operate a trauma and acute care hospital in Port au Prince. The hospital provides ongoing orthopedic, trauma, and neurosurgical expertise from the rotating teams of American surgeons and training of Haitian surgeons in modern surgical techniques. We believe that surgical residencies in the United States can improve their training programs and reduce global surgical burden of disease through consistent trips and working closely with country partners.

  18. Development of an orthopedic surgery trauma patient handover checklist

    PubMed Central

    LeBlanc, Justin; Donnon, Tyrone; Hutchison, Carol; Duffy, Paul

    2014-01-01

    Background In surgery, preoperative handover of surgical trauma patients is a process that must be made as safe as possible. We sought to determine vital clinical information to be transferred between patient care teams and to develop a standardized handover checklist. Methods We conducted standardized small-group interviews about trauma patient handover. Based on this information, we created a questionnaire to gather perspectives from all Canadian Orthopaedic Association (COA) members about which topics they felt would be most important on a handover checklist. We analyzed the responses to develop a standardized handover checklist. Results Of the 1106 COA members, 247 responded to the questionnaire. The top 7 topics felt to be most important for achieving patient safety in the handover were comorbidities, diagnosis, readiness for the operating room, stability, associated injuries, history/mechanism of injury and outstanding issues. The expert recommendations were to have handover completed the same way every day, all appropriate radiographs available, adequate time, all appropriate laboratory work and more time to spend with patients with more severe illness. Conclusion Our main recommendations for safe handover are to use standardized checklists specific to the patient and site needs. We provide an example of a standardized checklist that should be used for preoperative handovers. To our knowledge, this is the first checklist for handover developed by a group of experts in orthopedic surgery, which is both manageable in length and simple to use. PMID:24461220

  19. Applications of Metal Additive Manufacturing in Veterinary Orthopedic Surgery

    NASA Astrophysics Data System (ADS)

    Harrysson, Ola L. A.; Marcellin-Little, Denis J.; Horn, Timothy J.

    2015-03-01

    Veterinary medicine has undergone a rapid increase in specialization over the last three decades. Veterinarians now routinely perform joint replacement, neurosurgery, limb-sparing surgery, interventional radiology, radiation therapy, and other complex medical procedures. Many procedures involve advanced imaging and surgical planning. Evidence-based medicine has also become part of the modus operandi of veterinary clinicians. Modeling and additive manufacturing can provide individualized or customized therapeutic solutions to support the management of companion animals with complex medical problems. The use of metal additive manufacturing is increasing in veterinary orthopedic surgery. This review describes and discusses current and potential applications of metal additive manufacturing in veterinary orthopedic surgery.

  20. The practicing orthopedic surgeon's guide to managing long bone metastases.

    PubMed

    Cheung, Felix H

    2014-01-01

    Long bone skeletal metastases are common in the United States, with more than 280,000 new cases every year. Most of these will be managed by the on-call orthopedic surgeon. A practical primer is offered for the evaluation and surgical management for the practicing orthopedist, including questions to ask during the history, pertinent physical examination findings, appropriate imaging requests, proper laboratory work, and biopsy options. Finally, 7 scenarios are presented to encompass most situations a practicing orthopedic surgeon will encounter, and guidelines for treatment and referral are offered.

  1. Orthopedic Injury in Pregnancy.

    PubMed

    Gross, Gilad A; George, James W

    2016-09-01

    There are many reasons why a woman's pregnancy can put her at risk for orthopedic pain and injury. Given the high percentage of pregnant patients experiencing some degree of musculoskeletal pain, it is surprising that this is not an area of wider study. This chapter takes an evidence based approach to help the reader understand the implications of the numerous anatomic and physiologic changes associated with the gravid state, and how they act to promote both discomfort and injury. One-third of pregnant women in America are obese, further increasing risk. Exercise in most pregnancies is recommended and regarded as safe and thus obstetric care providers need to understand risk, diagnostic techniques and treatments.

  2. Superelastic Orthopedic Implant Coatings

    NASA Astrophysics Data System (ADS)

    Fournier, Eric; Devaney, Robert; Palmer, Matthew; Kramer, Joshua; El Khaja, Ragheb; Fonte, Matthew

    2014-07-01

    The demand for hip and knee replacement surgery is substantial and growing. Unfortunately, most joint replacement surgeries will fail within 10-25 years, thereby requiring an arduous, painful, and expensive revision surgery. To address this issue, a novel orthopedic implant coating material ("eXalt") has been developed. eXalt is comprised of super elastic nitinol wire that is knit into a three-dimensional spacer fabric structure. eXalt expands in vivo to conform to the implantation site and is porous to allow for bone ingrowth. The safety and efficacy of eXalt were evaluated through structural analysis, mechanical testing, and a rabbit implantation model. The results demonstrate that eXalt meets or exceeds the performance of current coating technologies with reduced micromotion, improved osseointegration, and stronger implant fixation in vivo.

  3. Management of the complications of traditional bone setting for upper extremity fractures: the experiences of a French Forward Surgical Team in Chad.

    PubMed

    Mathieu, L; Bertani, A; Chaudier, P; Charpail, C; Rongiéras, F; Chauvin, F

    2014-04-01

    The practice of traditional bone setting (TBS) in sub-Saharan Africa often leads to severe complications after upper extremity fracture. The purpose of this study was to evaluate the management of these complications by a French Forward Surgical Team deployed in Chad. An observational, prospective study was conducted over a six-month period between 2010 and 2011. During this period 28 patients were included. There were 20 males and 8 females with a mean age of 30.6 years (range 5-65 years). Thirteen patients (47%) had mal-union of their fracture, nine had non-union (32%), three children (10.5%) presented gangrene and three patients (10.5%) suffered from other complications. Fifteen (54%) patients did not undergo a corrective procedure either because it was not indicated or because they declined. Only 13 (46%) patients were operated on. Twelve of these patients were reviewed with a mean follow-up of 2.4 months. All of them were satisfied with conventional treatment. The infection seemed to be under control in every septic patient. Bone union could not be evaluated in most patients because of the short follow-up. Management of TBS complications is always challenging, even in a deployed Western medical treatment facility. Surgical expectations should be low because of the severity of the sequelae and the uncertainty of patient follow-up. Prevention remains the best treatment.

  4. Surgical hand antisepsis: the evidence.

    PubMed

    Tanner, Judith

    2008-08-01

    For 150 years members of the surgical team have been washing their hands with solutions designed to remove micro-organisms and therefore reduce surgical site infections in patients. This article discusses the evidence surrounding aspects of surgical hand antisepsis.

  5. Symptomatic lumbar osteochondroma treated via a multidisciplinary military surgical team: case report and review of the literature.

    PubMed

    Rymarczuk, George N; Dirks, Michael S; Whittaker, David R; Neal, Chris J

    2015-01-01

    The authors describe the case of a giant osteochondroma emanating from the L5 vertebral body and extending into the retroperitoneum of a 40-year-old man, causing low back pain. Osteochondromas are benign bony tumors that typically occur within the appendicular skeleton, although in the sporadic form, up to 4% occur in the spine. A review of the English language literature has returned 44 cases of lumbar osteochondroma, including the present example. The lesions were sporadic in 81% of cases. Mean age of presentation overall is 39.5 years, with a mean age of 18.4 years (range 8-34 years) for hereditary cases and 45.7 years (range 11-81 years) for solitary lesions. Of the instances where gender was reported, 64% were male. The most common level of origin was L4 (38%). The most common anatomic site of origin was the inferior articular process (one-third). Of those lesions treated operatively, 46% underwent simple decompression, with 22% requiring decompression and fusion. This particular lesion was resected via a transperitoneal approach performed by a multidisciplinary team of neurosurgeons, vascular surgeons, and urologists. The bony tumor measured 6.1 × 7.8 × 7.7 cm. Removal of the lesion resulted in a significant improvement of the patient's symptoms.

  6. Computer-Assisted Orthopedic Surgery: Current State and Future Perspective

    PubMed Central

    Zheng, Guoyan; Nolte, Lutz P.

    2015-01-01

    Introduced about two decades ago, computer-assisted orthopedic surgery (CAOS) has emerged as a new and independent area, due to the importance of treatment of musculoskeletal diseases in orthopedics and traumatology, increasing availability of different imaging modalities, and advances in analytics and navigation tools. The aim of this paper is to present the basic elements of CAOS devices and to review state-of-the-art examples of different imaging modalities used to create the virtual representations, of different position tracking devices for navigation systems, of different surgical robots, of different methods for registration and referencing, and of CAOS modules that have been realized for different surgical procedures. Future perspectives will also be outlined. PMID:26779486

  7. Computer-Assisted Orthopedic Surgery: Current State and Future Perspective.

    PubMed

    Zheng, Guoyan; Nolte, Lutz P

    2015-01-01

    Introduced about two decades ago, computer-assisted orthopedic surgery (CAOS) has emerged as a new and independent area, due to the importance of treatment of musculoskeletal diseases in orthopedics and traumatology, increasing availability of different imaging modalities, and advances in analytics and navigation tools. The aim of this paper is to present the basic elements of CAOS devices and to review state-of-the-art examples of different imaging modalities used to create the virtual representations, of different position tracking devices for navigation systems, of different surgical robots, of different methods for registration and referencing, and of CAOS modules that have been realized for different surgical procedures. Future perspectives will also be outlined.

  8. RAPID MANUFACTURING SYSTEM OF ORTHOPEDIC IMPLANTS

    PubMed Central

    Relvas, Carlos; Reis, Joana; Potes, José Alberto Caeiro; Fonseca, Fernando Manuel Ferreira; Simões, José Antonio Oliveira

    2015-01-01

    This study, aimed the development of a methodology for rapid manufacture of orthopedic implants simultaneously with the surgical intervention, considering two potential applications in the fields of orthopedics: the manufacture of anatomically adapted implants and implants for bone loss replacement. This work innovation consists on the capitation of the in situ geometry of the implant by direct capture of the shape using an elastomeric material (polyvinylsiloxane) which allows fine detail and great accuracy of the geometry. After scanning the elastomeric specimen, the implant is obtained by machining using a CNC milling machine programmed with a dedicated CAD/CAM system. After sterilization, the implant is able to be placed on the patient. The concept was developed using low cost technology and commercially available. The system has been tested in an in vivo hip arthroplasty performed on a sheep. The time increase of surgery was 80 minutes being 40 minutes the time of implant manufacturing. The system developed has been tested and the goals defined of the study achieved enabling the rapid manufacture of an implant in a time period compatible with the surgery time. PMID:27004181

  9. Distraction osteogenesis: application to dentofacial orthopedics.

    PubMed

    Yen, S L

    1997-12-01

    Distraction osteogenesis is a surgical-orthopedic method for lengthening bone by separating or distracting a fracture callus. This technique has a long history in limb lengthening and has recently been used to lengthen mandibles and maxillae in human patients. Distraction osteogenesis represents a powerful method of producing unlimited quantities of living bone which can be formed along any plane of space. Because this method uses local host tissue, it offers many advantages over bone grafting. In the author's experience, large (10-22 mm) antero-posterior and vertical corrections of mandibles can be achieved using this technique. The purpose of this article is to review its biological basis and discuss recent clinical applications. This article reviews the history, theory, current management, and limitations of distraction osteogenesis in treating craniofacial anomalies.

  10. Animal models of orthopedic implant infection.

    PubMed

    An, Y H; Friedman, R J

    1998-01-01

    Prosthetic infection following total joint replacement can have catastrophic results both physically and psychologically for patients, leading to complete failure of the arthroplasty, possible amputation, prolonged hospitalization, and even death. Although with the use of prophylactic antibiotics and greatly improved operating room techniques the infection rate has decreased markedly during the years, challenges still remain for better preventive and therapeutic measures. In this review the in vivo experimental methods for studies of prosthetic infection are discussed, concentrating on (1) the animal models that have been established and the use of these animal models for studies of pathogenesis of bacteria, behavior of biofilm, effect of biomaterials on prosthetic infection rate, and the effect of infection on biomaterial surfaces, and (2) how to design and conduct an animal model of orthopedic prosthetic infection including animal selection, implant fabrication, bacterial inoculation, surgical technique, and the methods for evaluating the results.

  11. Moral Dilemmas in Pediatric Orthopedics.

    PubMed

    Mercuri, John J; Vigdorchik, Jonathan M; Otsuka, Norman Y

    2015-12-01

    All orthopedic surgeons face moral dilemmas on a regular basis; however, little has been written about the moral dilemmas that are encountered when providing orthopedic care to pediatric patients and their families. This article aims to provide surgeons with a better understanding of how bioethics and professionalism apply to the care of their pediatric patients. First, several foundational concepts of both bioethics and professionalism are summarized, and definitions are offered for 16 important terms within the disciplines. Next, some of the unique aspects of pediatric orthopedics as a subspecialty are reviewed before engaging in a discussion of 5 common moral dilemmas within the field. Those dilemmas include the following: (1) obtaining informed consent and assent for either surgery or research from pediatric patients and their families; (2) performing cosmetic surgery on pediatric patients; (3) caring for pediatric patients with cognitive or physical impairments; (4) caring for injured pediatric athletes; and (5) meeting the demand for pediatric orthopedic care in the United States. Pertinent considerations are reviewed for each of these 5 moral dilemmas, thereby better preparing surgeons for principled moral decision making in their own practices. Each of these dilemmas is inherently complex with few straightforward answers; however, orthopedic surgeons have an obligation to take the lead and better define these kinds of difficult issues within their field. The lives of pediatric patients and their families will be immeasurably improved as a result.

  12. Treatment of severe orthopedic infections.

    PubMed

    Dernell, W S

    1999-09-01

    Severe infections are uncommon following orthopedic surgery, yet they can be frustrating for the veterinarian and owner to treat and can result in devastating consequences for the patient. This article reviews the common causes for postoperative infection, reviews established treatment, and introduces newer methods for treatment and control. A thorough understanding of the pathogenesis, application of appropriate diagnostic procedures, the institution of aggressive treatment regimens, with adherence to established principles, will often result in satisfactory outcomes even with severe orthopedic infections. For those more refractory to treatment, the use of newer treatment methods, specifically locally implantable materials for sustained release of antimicrobials can improve success in the treatment of these more difficult cases.

  13. Decision making in ruminant orthopedics.

    PubMed

    Fessler, J F; Adams, S B

    1996-03-01

    Decision making in ruminant orthopedics is determined by many factors, the most of important of which is age, size, and value of the patient, the nature of the injury, the prognosis for effective treatment and satisfactory healing, the intentions of the client, and the experiences of the veterinarian. Ruminant orthopedics currently is expanding to include the treatment of llamas and small ruminants as companion animals in addition to the treatment of valuable livestock. The future promises increasing sophistication in treatments and an ever higher quality of patient care.

  14. Orthopedic Management of Spina Bifida

    ERIC Educational Resources Information Center

    Thomson, Jeffrey D.; Segal, Lee S.

    2010-01-01

    The management of orthopedic problems in spina bifida has seen a dramatic change over the past 10 years. The negative effects of spasticity, poor balance, and the tethered cord syndrome on ambulatory function are better appreciated. There is less emphasis on the hip radiograph and more emphasis on the function of the knee and the prevention of…

  15. Orthopedic disorders of the knee in hemophilia: A current concept review

    PubMed Central

    Rodriguez-Merchan, E Carlos; Valentino, Leonard A

    2016-01-01

    The knee is frequently affected by severe orthopedic changes known as hemophilic arthropathy (HA) in patients with deficiency of coagulation factor VIII or IX and thus this manuscript seeks to present a current perspective of the role of the orthopedic surgeon in the management of these problems. Lifelong factor replacement therapy (FRT) is optimal to prevent HA, however adherence to this regerous treatment is challenging leading to breakthrough bleeding. In patients with chronic hemophilic synovitis, the prelude to HA, radiosynovectomy (RS) is the optimal to ameliorate bleeding. Surgery in people with hemophilia (PWH) is associated with a high risk of bleeding and infection, and must be performed with FRT. A coordinated effort including orthopedic surgeons, hematologists, physical medicine and rehabilitation physicians, physiotherapists and other team members is key to optimal outcomes. Ideally, orthopedic procedures should be performed in specialized hospitals with experienced teams. Until we are able to prevent orthopedic problems of the knee in PWH will have to continue performing orthopedic procedures (arthrocentesis, RS, arthroscopic synovectomy, hamstring release, arthroscopic debridement, alignment osteotomy, and total knee arthroplasty). By using the aforementioned procedures, the quality of life of PWH will be improved. PMID:27335812

  16. Orthopedics coding and funding.

    PubMed

    Baron, S; Duclos, C; Thoreux, P

    2014-02-01

    The French tarification à l'activité (T2A) prospective payment system is a financial system in which a health-care institution's resources are based on performed activity. Activity is described via the PMSI medical information system (programme de médicalisation du système d'information). The PMSI classifies hospital cases by clinical and economic categories known as diagnosis-related groups (DRG), each with an associated price tag. Coding a hospital case involves giving as realistic a description as possible so as to categorize it in the right DRG and thus ensure appropriate payment. For this, it is essential to understand what determines the pricing of inpatient stay: namely, the code for the surgical procedure, the patient's principal diagnosis (reason for admission), codes for comorbidities (everything that adds to management burden), and the management of the length of inpatient stay. The PMSI is used to analyze the institution's activity and dynamism: change on previous year, relation to target, and comparison with competing institutions based on indicators such as the mean length of stay performance indicator (MLS PI). The T2A system improves overall care efficiency. Quality of care, however, is not presently taken account of in the payment made to the institution, as there are no indicators for this; work needs to be done on this topic.

  17. Length of stay, wait time to surgery and 30-day mortality for patients with hip fractures after the opening of a dedicated orthopedic weekend trauma room

    PubMed Central

    Taylor, Michel; Hopman, Wilma; Yach, Jeff

    2016-01-01

    Background In September 2011, Kingston General Hospital (KGH) opened a dedicated orthopedic weekend trauma room. Previously, 1 weekend operating room (OR) was used by all surgical services. We assessed the impact this dedicated weekend trauma room had on hospital length of stay (LOS), time to surgery and 30-day mortality for patients with hip fractures. Methods Patients admitted between Oct. 1, 2009, and Sept. 30, 2012, were identified through our trauma registry, representing the 2 years before and 1 year after the opening of the orthopedic weekend trauma room. We documented type of fracture, mode of fixation, age, sex, American Society of Anesthesiologists (ASA) score, time to OR, LOS, discharge disposition and 30-day mortality. We excluded patients with multiple fractures, open fractures and those requiring trauma team activation. Results Our study included 609 patients (405 pre- and 204 post–trauma room opening). Mean LOS decreased from 11.6 to 9.4 days (p = 0.005) and there was a decreasing trend in mean time to OR from 31.5 to 28.5 hours (p = 0.16). There was no difference in 30-day mortality (p = 0.24). The LOS decreased by an average of 2 days following opening of the weekend trauma room (p = 0.031) and by an average of 2.2 additional days if the patient was admitted on the weekend versus during the week (p = 0.024). Conclusion The weekend trauma OR at KGH significantly decreased the LOS and appears to have decreased wait times to surgery. Further analysis is needed to assess the cost-effectiveness of the current strategy, the long-term outcome of this patient population and the impact the additional orthopedic weekend trauma room has had on other surgical services (i.e., general surgery) and their patients. PMID:27668332

  18. Potential utility of liposome bupivacaine in orthopedic surgery.

    PubMed

    Lonner, Jess H; Scuderi, Giles R; Lieberman, Jay R

    2015-03-01

    Management of postsurgical analgesia is an important consideration in orthopedic procedures, including joint arthroplasty. Inadequate postsurgical analgesia is associated with increased hospital length of stay, delayed ambulation, and reduced exercise capacity. In this article, we review the potential contribution of a prolonged-release liposomal formulation of bupivacaine as part of a multimodal analgesic regimen after orthopedic surgery. Controlled studies across multiple surgical settings have demonstrated that, compared with placebo and bupivacaine HCl, liposome bupivacaine in a single administration provides postsurgical analgesia for up to 72 hours, delays use of rescue medication, and reduces postsurgical opioid consumption. Liposome bupivacaine has been well tolerated in clinical studies and has had a low rate of treatment-related adverse events. To date, there has been no signal of cardiac toxicity, chondrolysis, or delayed wound healing associated with liposome bupivacaine.

  19. Orthopedic Management of Patients with Pompe Disease: A Retrospective Case Series of 8 Patients

    PubMed Central

    Forst, Jürgen; Forst, Raimund

    2014-01-01

    Introduction. Pompe disease (PD), a lysosomal storage disease as well as a neuromuscular disorder, is a rare disease marked by progressive muscle weakness. Enzyme replacement therapy (ERT) in recent years allowed longer survival but brought new problems to the treatment of PD with increasing affection of the musculoskeletal system, particularly with a significantly higher prevalence of scoliosis. The present paper deals with the orthopedic problems in patients with PD and is the first to describe surgical treatment of scoliosis in PD patients. Patients and Methods. The orthopedic problems and treatment of eight patients with PD from orthopedic consultation for neuromuscular disorders are retrospectively presented. We analyzed the problems of scoliosis, hip dysplasia, feet deformities, and contractures and presented the orthopedic treatment options. Results. Six of our eight PD patients had scoliosis and two young patients were treated by operative spine stabilization with benefits for posture and sitting ability. Hip joint surgery, operative contracture release, and feet deformity correction were performed with benefits for independent activity. Conclusion. Orthopedic management gains importance due to extended survival and musculoskeletal involvement under ERT. Surgical treatment is indicated in distinct cases. Further investigation is required to evidence the effect of surgical spine stabilization in PD. PMID:24523658

  20. Orthopedic Surgery Resident Debt Load and Its Effect on Career Choice.

    PubMed

    Johnson, Joey P; Cassidy, Dale B; Tofte, Josef N; Bariteau, Jason T; Daniels, Alan H

    2016-05-01

    Student loan debt has become a topic of discussion and debate among physicians and legislators. This study seeks to assess the level of debt of orthopedic surgery residents and to determine whether debt burden affects the career choice of orthopedic trainees. A 26-question, anonymous survey was distributed via email to resident trainees enrolled in different medical and surgical specialty training programs across the United States. Orthopedic trainees were compared with trainees in other specialties using comparative statistics. Of the approximately 13,503 residents who were sent the survey, a total of 3076 responded, including 167 of an estimated 580 orthopedic residents, for approximate response rates of 22.8% and 28.8%, respectively. On average, orthopedic surgery residents were at a later post-graduate year than overall respondents (P<.025). When asked if student loan debt would influence the next step in their career, nonorthopedic residents were statistically more likely to respond "yes" compared with orthopedic surgery residents (57.21% vs 49.08%, respectively; P=.041). More than 50% of all respondents agreed that student loan debt would affect their type or location of practice. The majority of orthopedic residents take student loan debt into consideration when determining their final location and type of practice, although less so for orthopedic trainees compared with other specialties. As medical education continues to become more expensive and the threat of dropping physician reimbursement looms on the horizon, student debt may become a primary driving factor for young American physicians' career plans. [Orthopedics. 2016; 39(3):e438-e443.].

  1. [The construction of a medical discipline and its challenges: Orthopedics in Switzerland during the 19th and 20th centuries].

    PubMed

    Kaba, Mariama

    2015-07-01

    During the 19th century, numerous figures, with different qualifications, claimed to practice orthopedics: doctors, surgeons, inventors of equipment and instruments, and other empiricists. They performed certain types of techniques, massages, surgical operationsand/or fitted prostheses. The polysemous notion of orthopedics had created conflicts of interest that would reach their height at the end of the 19th century. The integration of orthopedics into the training at the university level enhanced its proximity to surgery, a discipline that has dominated the so-called modern medicine. During the 20th century, various medical branches defend the legitimacy of certain orthopedic practices, thereby threating to a degree the title itself of this specialization. By examining the challenges that have shaped the history of orthopedics in Switzerland, this article also seeks to shed light on the strategies that were implemented in adopting a medical and technical discipline within a transforming society.

  2. Orthopedic aspects of competitive swimming.

    PubMed

    Richardson, A B

    1987-07-01

    Orthopedic problems related to competitive swimming are rarely disabling, but can be problematic in preventing training and competition. Most problems are related to the shoulder and knee. Treatment is primarily nonsurgical and directed at relieving symptoms and allowing the athlete to continue with swimming practice. Treatment aids such as ice packing, anti-inflammatory medications, muscle stimulation and electrogalvanic stimulation, strengthening exercises, and static stretching are encouraged; upper arm bands and patellar-stabilizing supports can be adapted to training routines.

  3. Orthopedic Gene Therapy in 2008

    PubMed Central

    Evans, Christopher H; Ghivizzani, Steven C; Robbins, Paul D

    2008-01-01

    Orthopedic disorders, although rarely fatal, are the leading cause of morbidity and impose a huge socioeconomic burden. Their prevalence will increase dramatically as populations age and gain weight. Many orthopedic conditions are difficult to treat by conventional means; however, they are good candidates for gene therapy. Clinical trials have already been initiated for arthritis and the aseptic loosening of prosthetic joints, and the development of bone-healing applications is at an advanced, preclinical stage. Other potential uses include the treatment of Mendelian diseases and orthopedic tumors, as well as the repair and regeneration of cartilage, ligaments, and tendons. Many of these goals should be achievable with existing technologies. The main barriers to clinical application are funding and regulatory issues, which in turn reflect major safety concerns and the opinion, in some quarters, that gene therapy should not be applied to nonlethal, nongenetic diseases. For some indications, advances in nongenetic treatments have also diminished enthusiasm. Nevertheless, the preclinical and early clinical data are impressive and provide considerable optimism that gene therapy will provide straightforward, effective solutions to the clinical management of several common debilitating disorders that are otherwise difficult and expensive to treat. PMID:19066598

  4. E-learning in orthopedic surgery training: A systematic review.

    PubMed

    Tarpada, Sandip P; Morris, Matthew T; Burton, Denver A

    2016-12-01

    E-learning is the use of internet-based resources in education. In the field of surgical education, this definition includes the use of virtual patient cases, digital modeling, online tutorials, as well as video recordings of surgical procedures and lectures. In recent years, e-learning has increasingly been considered a viable alternative to traditional teaching within a number of surgical fields. Here we present (1) a systematic review of literature assessing the efficacy of e-learning modules for orthopedic education and (2) a discussion of their relevance. A systematic search of PubMed, Embase, Web of Science, and the Cochrane Library was conducted according to the guidelines defined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement (PRISMA). The search yielded a total of 255 non-duplicate citations that were screened using predetermined inclusion/exclusion criteria. A total of 9 full text articles met inclusion criteria, which included the use of an objective outcome measure to evaluate an orthopedic e-learning module. Six studies assessed knowledge using a multiple-choice test and 4 assessed skills using a clinical exam. All studies showed positive score improvement pre- to post-intervention, and a majority showed greater score improvement than standard teaching methods in both knowledge (4/6 studies) and clinical skills (3/4 studies). E-learning represents an effective supplement or even alternative to standard teaching techniques within orthopedic education for both medical students and residents. Future work should focus on validating specific e-learning programs using standardized outcome measures and assessing long-term knowledge retention using e-learning platforms.

  5. Orthopedic Surgery in Rural American Hospitals: A Survey of Rural Hospital Administrators

    ERIC Educational Resources Information Center

    Weichel, Derek

    2012-01-01

    Rural American residents prefer to receive their medical care locally. Lack of specific medical services in the local community necessitates travel to a larger center which is less favorable. This study was done to identify how rural hospitals choose to provide orthopedic surgical services to their communities. Methods: All hospitals in 5 states…

  6. Diagnosis and management of reptile orthopedic injuries.

    PubMed

    Mitchell, Mark A

    2002-01-01

    As veterinarians expand their understanding of the specific husbandry requirements for captive reptiles, nutritionally associated orthopedic injuries should decrease. Orthopedic injuries in wild reptiles, however, will continue to increase as new infrastructure encroaches on the habitats of these animals. Research should be pursued that focuses on improving our understanding of pain management in reptiles, on developing techniques to expedite bone healing, and on creating new orthopedic techniques that provide rigid stabilization without the use of temperature-sensitive materials.

  7. [Team and team work].

    PubMed

    Richer, E

    1990-01-01

    The coordinator draws conclusions on the symposium day devoted to the teams. After defining "team" he gives several thoughts on the team's work its advantages and its difficulties. During this day the teams talked about their questions and their certainties in the various fields of their work. They also discussed their hard ships and their need of psychological support which the hospital departments do not have the means to satisfy.

  8. The dedicated orthopedic trauma operating room.

    PubMed

    Min, William; Wolinsky, Philip R

    2011-08-01

    The development and implementation of a dedicated orthopedic trauma operating room (OTOR) that is used for the treatment of orthopedic trauma patients has changed and improved the practice of orthopedic trauma surgery. Advantages noted with OTOR implementation include improvements in morbidity and complication rates, enhancements in the professional and personal lifestyles of the on-call surgeon, and increased physician recruitment and retention in orthopedic traumatology. However, the inappropriate use of the OTOR, which can waste valuable resources and delay the treatment of emergent cases, must be monitored and avoided.

  9. Variability in Trauma Case Volume in Orthopedic Surgery Residents

    PubMed Central

    Blood, Travis D.; Gil, Joseph A.; Born, Christopher T.; Daniels, Alan H.

    2017-01-01

    Orthopedic trauma surgery is a critical component of resident education. Surgical case logs obtained from the Accreditation Council of Graduate Medical Students from 2009 to 2013 for orthopedic surgery residents were examined for variability between the 90th and 10th percentiles in regards to the volume of cases performed. There was an upward trend in the mean number of cases performed by senior residents from 484.4 in 2009 to 534.5 in 2013, representing a 10.3% increase. There was a statistically significant increase in the number of cases performed for humerus/elbow, forearm/wrist, and pelvis/hip during this period (P<0.05). Although the difference between the 10th and 90th percentile case volumes narrowed over the study period, the difference between these groups remained significant in 2013 (P=0.02). In 2013, all categories of trauma cases had a greater than 2.2-fold difference between the 10th and 90th percentile of residents for numbers of trauma cases performed. Although case volume is not the sole determinant of residency education and competency, evidence suggests that case volume plays a crucial role in surgeon confidence and efficiency in performing surgery. Further studies are needed to better understand the effect of this variability seen among residents performing orthopedic trauma surgery. PMID:28286621

  10. [Prophylaxis of venous thromboembolic disease in high-risk orthopedic surgery].

    PubMed

    Meza Reyes, Gilberto Eduardo; Esquivel Gómez, Ricardo; Martínez del Campo Sánchez, Antonio; Espinosa-Larrañaga, Francisco; Martínez Guzmán, Miguel Ángel Enrique; Torres González, Rubén; de la Fuente Zuno, Juan Carlos; Méndez Huerta, Juan Vicente; Villalobos Garduño, Enrique; Cymet Ramírez, José; Ibarra Hirales, Efrén; Díaz Borjón, Efraín; Aguilera Zepeda, José Manuel; Valles Figueroa, Juan Francisco; Majluf-Cruz, Abraham

    2012-01-01

    Venous thromboembolism (VTE) is a worldwide public health problem, with an annual incidence of 1-2 cases/1,000 individuals in the general population and a 1-5% associated mortality. Orthopedic surgery is a major surgical risk factor for VTE, but the problem is more important for patients with hip and knee joint replacement, multiple traumatisms, severe damage to the spine, or large fractures. Thromboprophylaxis is defined as the strategy and actions necessary to diminish the risk of VTE in high-risk orthopedic surgery. Antithrombotics may prevent VTE. At the end of this paper, we describe a proposal of thromboprophylaxis actions for patients requiring high-risk orthopedic surgery, based on the opinion of specialists in Orthopedics and Traumatology who work with high-risk orthopedic surgery patients. A search for evidence about this kind of surgery was performed and a 100-item inquiring instrument was done in order to know the opinions of the participants. Then, recommendations and considerations were built. In conclusion, this document reviews the problem of VTE in high-risk orthopedic surgery patients and describes the position of the Colegio Mexicano de Ortopedia y Traumatología related to VTE prevention in this setting.

  11. Wholistic orthopedics: Is this the right way to treat geriatric orthopedic patients?

    PubMed Central

    Ebnezar, John; Bali, Yogita; John, Rakesh

    2017-01-01

    Geriatric orthopedic problems poses different challenges in their management. Conventional treatment methods like drugs, physiotherapy and surgeries are inadequate. A Geriatric orthopedic patient suffers as a whole and not in isolation. This article highlights the importance of managing geriatric orthopedic patients as a whole and outlines the various steps of wholistic management. PMID:28149067

  12. Locking mechanism for orthopedic braces

    NASA Technical Reports Server (NTRS)

    Chao, J. I.; Epps, C. H., Jr.

    1981-01-01

    An orthopedic brace locking mechanism is described which under standing or walking conditions cannot be unlocked, however under sitting conditions the mechanism can be simply unlocked so as to permit bending of the patient's knee. Other features of the device include: (1) the mechanism is rendered operable, and inoperable, dependent upon the relative inclination of the brace with respect to the ground; (2) the mechanism is automatically locked under standing or walking conditions and is manually unlocked under sitting conditions; and (3) the mechanism is light in weight and is relatively small in size.

  13. Orthopedic surgery in ancient Egypt

    PubMed Central

    Blomstedt, Patric

    2014-01-01

    Background — Ancient Egypt might be considered the cradle of medicine. The modern literature is, however, sometimes rather too enthusiastic regarding the procedures that are attributed an Egyptian origin. I briefly present and analyze the claims regarding orthopedic surgery in Egypt, what was actually done by the Egyptians, and what may have been incorrectly ascribed to them. Methods — I reviewed the original sources and also the modern literature regarding surgery in ancient Egypt, concentrating especially on orthopedic surgery. Results — As is well known, both literary sources and the archaeological/osteological material bear witness to treatment of various fractures. The Egyptian painting, often claimed to depict the reduction of a dislocated shoulder according to Kocher’s method, is, however, open to interpretation. Therapeutic amputations are never depicted or mentioned in the literary sources, while the specimens suggested to demonstrate such amputations are not convincing. Interpretation — The ancient Egyptians certainly treated fractures of various kinds, and with varying degrees of success. Concerning the reductions of dislocated joints and therapeutic amputations, there is no clear evidence for the existence of such procedures. It would, however, be surprising if dislocations were not treated, even though they have not left traces in the surviving sources. Concerning amputations, the general level of Egyptian surgery makes it unlikely that limb amputations were done, even if they may possibly have been performed under extraordinary circumstances. PMID:25140982

  14. Surgical Management of Fractures and Tendons.

    PubMed

    Pentecost, Rebecca; Niehaus, Andrew J; Anderson, David E

    2016-11-01

    Long bone fractures and disorders of tendons and ligaments represent a significant proportion of surgical orthopedic cases presented to ruminant veterinarians. The presentation of these patients, their diagnostic work-up, surgical treatment, and expected outcome will be discussed. The outcome of these cases depends largely on the presenting problem; however, accurate diagnosis and prompt surgical intervention can greatly improve the outcome of many of these cases.

  15. [Joint position statement of the Mexican College of Orthopedics and Traumatology: prophylaxis for venous thromboembolic disease in high-risk orthopedic surgery].

    PubMed

    Meza-Reyes, G E; Cymet-Ramírez, J; Esquivel-Gómez, R; del Campo-Sánchez, Martínez A; Martínez-Guzmán, M A E; Espinosa-Larrañaga, F; Majluf-Cruz, A; Torres-González, R; De la Fuente-Zuno, J C; Villalobos-Garduño, E; Méndez-Huerta, J V; Ibarra-Hirales, E; Valles-Figueroa, J F; Aguilera-Zepeda, J M; Díaz-Borjón, E

    2011-01-01

    Venous thromboembolic disease (VTED) is a public health problem worldwide. In the United States it causes 2 million annual cases. Its annual incidence is 1-2 cases per 1,000 individuals in the general population. It is a disease frequently associated with life threatening complications and its mortality rate is 1-5% of cases. Due to its high complication rate, its slow recovery, and the need for prolonged disability, it is considered as a high-cost disease. VTED may occur in both surgical and medical patients; the known associated risk factors include prolonged rest, active cancer, congestive heart failure, atrial fibrillation, and stroke, among the major medical conditions. Orthopedic surgery represents the main surgical risk factor for VTED, including mainly hip and knee replacements, as well as polytraumatized patients with severe spinal lesions, and major fractures. VTED may be prevented with the appropriate use of antithrombotics. The participants in this consensus defined thromboprophylaxis as the strategy and actions undertaken to reduce the risk of VTED in patients undergoing high risk orthopedic surgery. The position of the Mexican College of Orthopedics and Traumatology regarding the prevention of VTED in orthopedic surgery is described herein.

  16. Using Aerospace Technology To Design Orthopedic Implants

    NASA Technical Reports Server (NTRS)

    Saravanos, D. A.; Mraz, P. J.; Davy, D. T.

    1996-01-01

    Technology originally developed to optimize designs of composite-material aerospace structural components used to develop method for optimizing designs of orthopedic implants. Development effort focused on designing knee implants, long-term goal to develop method for optimizing designs of orthopedic implants in general.

  17. Strategies for achieving orthopedic service line success.

    PubMed

    Lang, Stacey; Powers, Kristi

    2013-12-01

    Healthcare finance leaders can work with orthopedic surgeons to support better outcomes, clinically and financially, by: Establishing innovative partnerships among hospital leaders, orthopedic surgeons, and implant vendors. Developing and enforcing expectations around contracting and vendor behavior. Establishing a forum for open communication. Building a bundled payment structure. Finding ways to differentiate from the competition.

  18. Orthopedic evaluation and surgical treatment of the spastic shoulder.

    PubMed

    Namdari, Surena; Baldwin, Keith; Horneff, John G; Keenan, Mary Ann

    2013-10-01

    The spastic shoulder can often result from brain injury that causes disruption in the upper motor neuron inhibitory pathways. Patients develop dyssynergic muscle activation, muscle weakness, and contractures and often present with fixed adduction and internal rotation deformity to the limb. This article reviews the importance of a comprehensive preoperative evaluation and discusses appropriate treatment strategies based on preoperative evaluation.

  19. [Surgical treatment of spinal tuberculosis: an orthopedic service experience].

    PubMed

    Soares do Brito, Joaquim; Batista, Nuno; Tirado, António; Fernandes, Pedro

    2013-01-01

    Introdução: A espondilodiscite de etiologia tuberculosa é responsável por mais de 40% do universo destas infeções. Enquanto a quimioterapia tuberculostática se mantém como gold-standard da terapêutica desta patologia, o tratamento cirúrgico tem lugar em situações muito específicas. Neste trabalho apresentam-se os resultados de 33 doentes com espondilodiscite tuberculosa operados no nosso serviço durante os últimos 15 anos.Objetivo: Avaliar retrospetivamente doentes com diagnóstico de espondilodiscite tuberculosa operados num período de 15 anos(1996 a 2011); avaliar opções cirúrgicas tomadas e respetivos resultados relativamente à resolução da infeção, controlo da deformidade e evolução da lesão neurológica.Material e Métodos: Análise retrospetiva dos processos clínicos e avaliações imagiológicas de doentes com diagnóstico de espondilodiscite tuberculosa operados entre 1996 e 2011. Foram identificados 33 doentes com idade média de 46,7 anos; 17 doentes apresentavam infeção torácica, 11 lombar e cinco toraco-lombar. O abcesso paravertebral foi identificado em 26 dos casos estudados, existindo extensão intracanalar em 16 doentes. Nove dos doentes avaliados apresentavam lesão neurológica. A abordagem cirúrgica por via anterior foi utilizada em sete casos, a via posterior em 11 e a abordagem combinada foi a preferida em 15 ocasiões. A quimioterapia antibacilar foi mantida em média por 14 meses, com seguimento médio de 24 meses.Resultados: Verificámos cura da infeção em todos os doentes, sendo documentados critérios de fusão óssea, em média, 10,6 meses pós-cirurgia. A abordagem anterior isolada não permitiu obter correção da deformidade inicial, enquanto a via posterior permitiu uma correção média de 12,7º e a via combinada uma correção média de 8,7º. Cinco dos doentes com lesão neurológica melhoraram 2 a 3 níveis na escala ASIA durante o seguimento pós-operatório. Como complicações referem-se 2 casos de infeção superficial da ferida operatória.Discussão e Conclusão: A terapêutica com antibacilares constitui a terapêutica de primeira linha no tratamento da espondilodiscite tuberculosa, existindo indicações específicas para realização de cirurgia. A intervenção cirúrgica, quando indicada, permite corrigir a deformidade assim como a fusão óssea, sendo preferencialmente realizada por via combinada ou posterior. A taxa de complicações foi pouco significativa apesar da introdução de material de osteossíntese.

  20. Hepatitis C virus infection: review and implications for the orthopedic surgeon.

    PubMed

    McGrory, B J; Kilby, A E

    2000-04-01

    Hepatitis C virus (HCV), a single-stranded ribonucleic acid virus identified in 1989, is estimated to have infected 1%-2% of the United States population. The incidence of HCV in patients requiring orthopedic surgery may be as high as 5%. Surgeons and operating room personnel are at risk for blood-borne diseases transmitted during surgery. The orthopedic surgeon must be aware of viral infection with this pathogen for the safety of the entire operating room team. Further, screening for HCV is routinely done when a patient donates autologous blood prior to elective surgery, and the orthopedic surgeon is often the first or only physician informed of a positive result. The surgeon should know how to interpret the result, advise the patient, and incorporate the diagnosis of HCV into the plan for the proposed surgery. We will review the natural history, transmission, evaluation of, and current treatment for infection with this blood-borne virus.

  1. Applied Nanotechnology and Nanoscience in Orthopedic Oncology.

    PubMed

    Savvidou, Olga D; Bolia, Ioanna K; Chloros, George D; Goumenos, Stavros D; Sakellariou, Vasileios I; Galanis, Evanthia C; Papagelopoulos, Panayiotis J

    2016-09-01

    Nanomedicine is based on the fact that biological molecules behave similarly to nanomolecules, which have a size of less than 100 nm, and is now affecting most areas of orthopedics. In orthopedic oncology, most of the in vitro and in vivo studies have used osteosarcoma or Ewing sarcoma cell lineages. In this article, tumor imaging and treatment nanotechnology applications, including nanostructure delivery of chemotherapeutic agents, gene therapy, and the role of nano-selenium-coated implants, are outlined. Finally, the potential role of nanotechnology in addressing the challenges of drug and radiotherapy resistance is discussed. [Orthopedics. 2016; 39(5):280-286.].

  2. OrthoEvidence™: A Clinical Resource for Evidence-Based Orthopedics

    PubMed Central

    Sprague, Sheila; Smith, Chris; Bhandari, Mohit

    2015-01-01

    The prevalence of musculoskeletal issues in clinical practice, and the limited focus placed upon musculoskeletal conditions by current electronic summary resources, highlights the need for a resource that provides access to simple and concise summaries of top-quality orthopedic literature for orthopedic surgeons and allied healthcare professionals. OrthoEvidence™ is an online clinical resource that addresses the paucity of adequate evidence-based summary tools in the field of orthopedic surgery. OrthoEvidence™ uses a rigorous, transparent, and unique process to review, evaluate, and summarize high quality research studies and their implications for orthopedic clinical practice. Randomized controlled trials and meta-analyses are identified and reviewed by an expert medical writing team, who prepare Advanced Clinical Evidence (ACETM) reports: one or two detailed pages including critical appraisals and synopses of key research. These timely and targeted reports provide a clear understanding about the quality of evidence associated with each summarized study, and can be organized by users to identify trending information. OrthoEvidence™ allows members to use their time efficiently and to stay current by having access to a breadth of timely, high-quality research output. OrthoEvidence™ is easily accessible through the internet and is available at the point-of-care, which allows treating orthopedic surgeons and allied health professionals to easily practice the principles of evidence-based medicine within their clinical practices.. PMID:26330990

  3. [Surgical management of primary bone cancer].

    PubMed

    Anract, Philippe

    2009-01-01

    Patients with primary bone malignancies must be treated by specialized multidisciplinary teams composed of pathologists, surgeons, orthopedists, oncologists, radiologists and radiotherapists, all with experience in the diagnosis and treatment of these tumors. If a malignancy is suspected, the biopsy must also be performed in such a center. Biopsy is part of the treatment and must be done by a senior surgeon, before starting specific treatment. Indeed, inappropriate biopsy can compromise the patient's functional prognosis and sometimes the vital outcome. The biopsy can be done percutaneously under radiological control with a True-cut needle or a trocart to obtain cores of pathological tissue. The pathologist must be well-versed in bone disorders. Open surgical biopsy is preferable for primary bone tumors, especially when a cartilaginous tumor is suspected. A short incision is used, situated on the same approach as that which will be used for surgical resection of the tumor, so that the biopsy scar is excised along with the tumor, in a single block. Surgical treatment of primary bone malignancies requires extensive resection, i.e. excision of the affected bone segment and any invaded soft tissues, as a single block, without breaching the tumor, and preserving a peripheral margin of healthy tissue. In most cases, reconstruction is necessary to preserve the function of the resected region. It is based on standard orthopedic techniques, namely osteosynthesis, bone grafts (autografts and allografts), prostheses of variable size, or a combination of prostheses and allografts (composite reconstruction). Amputation is only indicated if conservative resection is impossible. It has been shown that conservative resection, now possible in about 80% of cases, does not reduce the survival chances of patients with osteosarcoma. The indications for amputation include massive tumors invading vessels and nerves, resection of which would leave the limb non functional, as sell as tumor

  4. Carbon nanostructures for orthopedic medical applications.

    PubMed

    Yang, Lei; Zhang, Lijuan; Webster, Thomas J

    2011-09-01

    Carbon nanostructures (including carbon nanofibers, nanostructured diamond, fullerene materials and so forth) possess extraordinary physiochemical, mechanical and electrical properties attractive to bioengineers and medical researchers. In the past decade, numerous developments towards the fabrication and biological studies of carbon nanostructures have provided opportunities to improve orthopedic applications. Therefore, the aim of this article is to provide an up-to-date review on carbon nanostructure advances in orthopedic research. Orthopedic medical device applications of carbon nanotubes/carbon nanofibers and nanostructured diamond (including particulate nanodiamond and nanocrystalline diamond coatings) are emphasized here along with other carbon nanostructures that have promising potential. In addition, widely used fabrication techniques for producing carbon nanostructures in both the laboratory and in industry are briefly introduced. In conclusion, carbon nanostructures have demonstrated tremendous promise for orthopedic medical device applications to date, and although some safety, reliability and durability issues related to the manufacturing and implantation of carbon nanomaterials remain, their future is bright.

  5. [Lack of new trainees in trauma surgery and orthopedics. An approach to a solution].

    PubMed

    Thiele, K; Matziolis, D; Perka, C

    2010-12-01

    The reasons for a shortage of young people in trauma surgery and orthopedics have often been discussed. Atypical progression of medical operating levels, antisocial working hours and an inadequate financial compensation for on-call duties have been given as the reasons for a lack of interest in the discipline. Additionally a progressive feminization of the medical profession and rejection of surgical disciplines because of a mismatch with family interests and the demands of advanced surgical training have also been named. Surveys on the choice of medical specialization reveal that experiences during the course of studying have a great influence on future prospects and are immensely important for the further focusing on the future as a medical doctor. In order to increase the attractiveness of the specialization, programs for students were initiated by the heads of the Conventions of Higher Education Lecturers for Orthopedics and Trauma Surgery and the management of the German Society for Orthopedics and Trauma Surgery. Due to the enormous popularity auxiliary projects were demanded. Consequently a "Trauma Surgery and Orthopedic Day for Students" was organized on 16th February 2010 in the Musculoskeletal Centre of the Charité in Berlin. The aim was to convey practical skills and to inspire the choice of this specialization in the future.

  6. Antimicrobial technology in orthopedic and spinal implants.

    PubMed

    Eltorai, Adam Em; Haglin, Jack; Perera, Sudheesha; Brea, Bielinsky A; Ruttiman, Roy; Garcia, Dioscaris R; Born, Christopher T; Daniels, Alan H

    2016-06-18

    Infections can hinder orthopedic implant function and retention. Current implant-based antimicrobial strategies largely utilize coating-based approaches in order to reduce biofilm formation and bacterial adhesion. Several emerging antimicrobial technologies that integrate a multidisciplinary combination of drug delivery systems, material science, immunology, and polymer chemistry are in development and early clinical use. This review outlines orthopedic implant antimicrobial technology, its current applications and supporting evidence, and clinically promising future directions.

  7. Antimicrobial technology in orthopedic and spinal implants

    PubMed Central

    Eltorai, Adam EM; Haglin, Jack; Perera, Sudheesha; Brea, Bielinsky A; Ruttiman, Roy; Garcia, Dioscaris R; Born, Christopher T; Daniels, Alan H

    2016-01-01

    Infections can hinder orthopedic implant function and retention. Current implant-based antimicrobial strategies largely utilize coating-based approaches in order to reduce biofilm formation and bacterial adhesion. Several emerging antimicrobial technologies that integrate a multidisciplinary combination of drug delivery systems, material science, immunology, and polymer chemistry are in development and early clinical use. This review outlines orthopedic implant antimicrobial technology, its current applications and supporting evidence, and clinically promising future directions. PMID:27335811

  8. Dynamic Patterns of Expertise: The Case of Orthopedic Medical Diagnosis

    PubMed Central

    Marwan, Norbert; Neuman, Yair; Salai, Moshe; Rath, Ehud

    2016-01-01

    The aim of this study was to analyze dynamic patterns for scanning femoroacetabular impingement (FAI) radiographs in orthopedics, in order to better understand the nature of expertise in radiography. Seven orthopedics residents with at least two years of expertise and seven board-certified orthopedists participated in the study. The participants were asked to diagnose 15 anteroposterior (AP) pelvis radiographs of 15 surgical patients, diagnosed with FAI syndrome. Eye tracking data were recorded using the SMI desk-mounted tracker and were analyzed using advanced measures and methodologies, mainly recurrence quantification analysis. The expert orthopedists presented a less predictable pattern of scanning the radiographs although there was no difference between experts and non-experts in the deterministic nature of their scan path. In addition, the experts presented a higher percentage of correct areas of focus and more quickly made their first comparison between symmetric regions of the pelvis. We contribute to the understanding of experts’ process of diagnosis by showing that experts are qualitatively different from residents in their scanning patterns. The dynamic pattern of scanning that characterizes the experts was found to have a more complex and less predictable signature, meaning that experts’ scanning is simultaneously both structured (i.e. deterministic) and unpredictable. PMID:27414794

  9. Dynamic Patterns of Expertise: The Case of Orthopedic Medical Diagnosis.

    PubMed

    Assaf, Dan; Amar, Eyal; Marwan, Norbert; Neuman, Yair; Salai, Moshe; Rath, Ehud

    2016-01-01

    The aim of this study was to analyze dynamic patterns for scanning femoroacetabular impingement (FAI) radiographs in orthopedics, in order to better understand the nature of expertise in radiography. Seven orthopedics residents with at least two years of expertise and seven board-certified orthopedists participated in the study. The participants were asked to diagnose 15 anteroposterior (AP) pelvis radiographs of 15 surgical patients, diagnosed with FAI syndrome. Eye tracking data were recorded using the SMI desk-mounted tracker and were analyzed using advanced measures and methodologies, mainly recurrence quantification analysis. The expert orthopedists presented a less predictable pattern of scanning the radiographs although there was no difference between experts and non-experts in the deterministic nature of their scan path. In addition, the experts presented a higher percentage of correct areas of focus and more quickly made their first comparison between symmetric regions of the pelvis. We contribute to the understanding of experts' process of diagnosis by showing that experts are qualitatively different from residents in their scanning patterns. The dynamic pattern of scanning that characterizes the experts was found to have a more complex and less predictable signature, meaning that experts' scanning is simultaneously both structured (i.e. deterministic) and unpredictable.

  10. ADVANCES IN THE USE OF STEM CELLS IN ORTHOPEDICS

    PubMed Central

    Cristante, Alexandre Fogaça; Narazaki, Douglas Kenji

    2015-01-01

    Primordial cells or stem cells are multipotent undifferentiated cells with the capacity to originate any type of cell in the organism. They may have their origins in the blastocyst and thus are classified as embryonic, or tissues developed in fetuses, newborns or adults and thus are known as somatic stem cells. Bone marrow is one of the main locations for isolating primordial cells, and there are two lineages: hematopoietic and mesenchymal progenitor cells. There are several uses for these undifferentiated cells in orthopedics, going from cartilaginous lesions in osteoarthrosis, osteochondritis dissecans and patellar chondromalacia, to bone lesions like in pseudarthrosis or bone losses, or nerve lesions like in spinal cord trauma. Studying stem cells is probably the most promising field of study of all within medicine, and this is shortly going to revolutionize all medical specialties (both clinical and surgical) and thus provide solutions for diseases that today are difficult to deal with. PMID:27027022

  11. Blood utilization in orthopedic and trauma practice

    PubMed Central

    Tayara, Bader Kamal; Al-Faraidy, Moaad Hatim; Al-Sayel, Faisal Abdullah; Al-Omran, Abdallah S; Sadat-Ali, Mir

    2015-01-01

    Objectives: Very little is known about blood utilization in orthopedic and trauma surgery and there is no definite policy in this regard. Our objective is to perform an audit on our practice of blood utilization in the orthopedic department. Methods: We have retrospectively analyzed the data of patients who were admitted between January 2011 and December 2012 to the orthopedic male, female and pediatric wards for which blood products were requested. Results: Three hundred and eight patients were admitted for surgery during the study period. The average age was 35.12 ± 20.4 years and postsurgery they stayed in the hospital for 25.60 ± 10.5 days. Blood products were requested for 223 trauma surgeries. In elective orthopedic procedures, only 42.78% of the blood requested was utilized while in trauma patients it was 55.25%. Conclusions: A substantial amount of blood and its product was used in trauma and elective orthopedic surgeries. There was a major discrepancy between the blood requested and utilized and secondly in the majority single unit transfusion was utilized, which is not within the fundamentals of blood transfusion. PMID:26097818

  12. [Research and analysis to Shui nationality medicine treatment orthopedics & traumatology].

    PubMed

    Hu, Jian-Shan; Li, Pu; Yang, Yong; Chen, Xin-Chun; Lin, Li

    2013-05-01

    To investigated Shui nationality folk medicine's awareness to orthopedics & traumatology, the history of orthopedics & traumatology treatment, Shui nationality folk doctors' practicing medicine, heritage, diagnosis and treatment methods and tools, etc, through investigated drug resources category and distribution characteristics of Shui nationality medicine to orthopedics & traumatology treatment, explored and finished Shui nationality medicine orthopedics & traumatology treatment theoretical system. After more than 5 years' exploration and finishing, preliminarily formed the theoretical system framework and medicine application characteristics of Shui nationality medicine treating orthopedics & traumatology. Shui nationality medicine treatment orthopedics & traumatology has distinctive national style, and worthy to further exploration and research.

  13. Abortion - surgical

    MedlinePlus

    Suction curettage; Surgical abortion; Elective abortion - surgical; Therapeutic abortion - surgical ... Surgical abortion involves dilating the opening to the uterus (cervix) and placing a small suction tube into the uterus. ...

  14. Treatment of surgical wound dehiscence.

    PubMed

    Candido, Luiz Claudio

    2002-06-01

    Surgical exploration of cavities, sinuses, and specific antibiotic therapy are fundamental for the control fo cutaneous infection. Topical treatment will vary based on evaluation of the lesion, experience of the health care team, and the environment.

  15. [The metal tantalum in orthopedic applications].

    PubMed

    Deng, Juncai; Wang, Yue

    2011-04-01

    This paper describes the biological characteristics of the metal tantalum (Ts) and the application status of tantalum in artificial joints, bone necrosis, spine, defects of bone and other aspects of bone. The early clinical application results of tantalum in bone diseases were satisfactory, but it is necessary to do further study of tantalum in a deep going way, and further detailed comparison between the tantalum with other metals as orthopedics implants. The advantage of tantalum materials as orthopedic implants still needs to be verified by a great deal of clinical cases for a long period of time.

  16. Injectable biodegradable materials for orthopedic tissue engineering.

    PubMed

    Temenoff, J S; Mikos, A G

    2000-12-01

    The large number of orthopedic procedures performed each year, including many performed arthroscopically, have led to great interest in injectable biodegradable materials for regeneration of bone and cartilage. A variety of materials have been developed for these applications, including ceramics, naturally derived substances and synthetic polymers. These materials demonstrate overall biocompatibility and appropriate mechanical properties, as well as promote tissue formation, thus providing an important step towards minimally invasive orthopedic procedures. This review provides a comparison of these materials based on mechanical properties, biocompatibility and regeneration efficacy. Advantages and disadvantages of each material are explained and design criteria for injectable biodegradable systems are provided.

  17. Awareness campaign. Orthopedic Hospital of Oklahoma launches awareness campaign.

    PubMed

    2007-01-01

    The Orthopedic Hospital of Oklahoma is a 25-bed inpatient and outpatient center with one focus: Orthopedics. To acquaint people with its services and build brand awareness to drive market share, the hospital launched a print campaign featuring actual patients.

  18. Aging and orthopedics: how a lifespan development model can inform practice and research

    PubMed Central

    Gautreau, Sylvia; Gould, Odette N.; Forsythe, Michael E.

    2016-01-01

    Orthopedic surgical care, like all health care today, is in flux owing to an aging population and to chronic medical conditions leading to an increased number of people with illnesses that need to be managed over the lifespan. The result is an ongoing shift from curing acute illnesses to the management and care of chronic illness and conditions. Theoretical models that provide a useful and feasible vision for the future of health care and health care research are needed. This review discusses how the lifespan development model used in some disciplines within the behavioural sciences can be seen as an extension of the biopsychosocial model. We posit that the lifespan development model provides useful perspectives for both orthopedic care and research. We present key concepts and recommendations, and we discuss how the lifespan development model can contribute to new and evolving perspectives on orthopedic outcomes and to new directions for research. We also offer practical guidelines on how to implement the model in orthopedic practice. PMID:27240129

  19. Medical and orthopedic conditions and sports participation.

    PubMed

    Diokno, Eugene; Rowe, Dale

    2010-06-01

    The presence of certain medical or orthopedic conditions need not preclude adolescents from being physically active and participating in sports. The benefits of continued physical activity far outweigh any concerns for potential complications for most such conditions. This article reviews sport participation guidelines for adolescents with conditions that include juvenile chronic arthritis, eye injures, solitary kidney, skin conditions, scoliosis, and spondylolysis.

  20. Orthopedically Handicapped Children in Ohio Public Schools.

    ERIC Educational Resources Information Center

    Naples, Victor J.; Todd, Joseph H.

    The historical development of programs for orthopedically handicapped children, class units and hospital classes approved during 1967-68, and the number of therapy units established are presented. Tables give data on program population: enrollment for years 1962-68, percent of handicaps enrolled, and IQ distributions. Aspects of occupational…

  1. No evidence for race and socioeconomic status as independent predictors of 30-day readmission rates following orthopedic surgery.

    PubMed

    Hunter, Tracey; Yoon, Richard S; Hutzler, Lorraine; Band, Philip; Liublinksa, Victoria; Slover, James; Bosco, Joseph A

    2015-01-01

    The Centers for Medicare & Medicaid Services considers readmissions within 30 days of discharge to be a quality indicator. Hospitals' and eventually physicians' readmission rates will be used to determine payment for services. It is imperative that health care providers understand which patients are at risk for readmission so that they can apply the appropriate preventive interventions. The research team analyzed all orthopedic admissions and readmissions at their institution from September 2008 to April 2011 in this study. Preparing for the next stage in health care reform, identifying any preoperative factors that may place certain patients into a "high-risk" category for readmission following an orthopedic procedure is of paramount importance. This data analysis of more than 13 000 patients noted that race-based and income-based risk factors did not translate into significant risk factors or predictors of 30-day readmission following orthopedic admission.

  2. Orthopedic Practice Patterns Relating to Anterior Cruciate Ligament Reconstruction in Elite Athletes.

    PubMed

    Erickson, Brandon J; Harris, Joshua D; Fillingham, Yale A; Cvetanovich, Gregory L; Bush-Joseph, Charles; Cole, Brian J; Bach, Bernard R; Verma, Nikhil N

    2015-12-01

    We conducted an online survey of National Hockey League (NHL), Major League Soccer (MLS), and US Olympic/World Cup Ski/Snowboard (Olympic) team orthopedic surgeons to determine practice patterns relating to anterior cruciate ligament (ACL) reconstruction in elite athletes. Of the 94 team orthopedic surgeons surveyed, 47 (50%) responded. Mean (SD) experience as a team physician was 7.73 (5.33) years for NHL, 6.77 (6.64) years for MLS, and 1.14 (0.36) years for Olympic. Mean (SD) number of ACL reconstructions performed in 2012 was 101 (51) for NHL, 78 (38) for MLS, and 110 (105) for Olympic. Overall, 33 surgeons (70.2%) indicated they would use bone-patellar tendon-bone (BPTB) autograft to treat their starting athletes. Twenty-one (44.7%) drilled the femoral tunnel through a transtibial portal, 36.2% through an anteromedial portal, and 12.8% by a 2-incision technique. All the surgeons used a single-bundle technique. Thirty-three (70.2%) did not recommend a brace for their elite athletes during play on return to sport (RTS). Twenty-seven NHL and MLS surgeons (81.8%) recommended RTS only after an athlete has passed a series of RTS tests (eg, Vail, single-leg hop). Most of the NHL, MLS, and Olympic team orthopedic surgeons who were surveyed perform their ACL reconstructions using BPTB autograft, using a single-bundle technique, and through a transtibial portal, and do not require bracing for their athletes returning to sport. Most required their athletes to complete a series of RTS tests before resuming competitive play.

  3. Team Work.

    ERIC Educational Resources Information Center

    Frank, David

    1999-01-01

    Explains how a team cleaning approach can be cost-effective and efficient means of school maintenance. Assigning staffing responsibilities and work schedules are addressed and the advantages of using a team system are explained. (GR)

  4. Team Management.

    ERIC Educational Resources Information Center

    Lindelow, John

    Chapter 5 of a volume on school leadership, this chapter reviews the literature to define and explain management teams and to describe several successful management team arrangements. The author begins by noting that team management has recently enjoyed a resurgence as a response to collective negotiations, but beyond this function can have value…

  5. Surgical treatment in Osteogenesis Imperfecta – 10 years experience

    PubMed Central

    Georgescu, I; Vlad, C; Gavriliu, TȘ; Dan, S; Pârvan, AA

    2013-01-01

    Introduction. Osteogenesis imperfecta (OI) is a very rare disease compared to other afflictions, running the risk of social isolation for children and their parents, due to the problems specific to the disease. All the social, psychological and physical disadvantages must be removed or at least mitigated, all within the society’s limited resources. In Romania, this situation has led in the last couple of years to the selection of a number of extremely severe cases, which could not be solved by orthopedic and classic surgical treatment methods. These patients exhibit gracile long bones, which are distorted, often with cystic degeneration at the level of the extremities, pseudarthroses, limb length discrepancies, most of them being unable to walk, being condemned to sitting in a wheelchair. Aim. This paper deals with the experience of the Orthopedics Department of "Maria Sklodowska Curie" Clinical Emergency Hospital for Children, in Bucharest, in the field of surgical treatment for moderate and severe forms of OI, within the time frame of May 2002-May 2012. For the first time in Romania, on May 20, 2002, the team led by Professor Gh. Burnei, MD, has implanted telescopic rods in the femur and tibia of a patient with OI. One of the most important themes, of great interest in the orthopedic surgery, is the osteoarticular regularization and reconstruction in severe forms of OI, which should allow the patients to stand and walk. These cases are a challenge for the surgeon, who is in the position of applying new, complex procedures, or perfecting, modifying and adapting techniques that have already been established. The aim of the surgical treatment is the increase of the quality of life of these children and adolescents and of their social integration. Methods and results. In the above-mentioned period, from the OI patients who are in the evidence of our clinic, 32 were operated on, totaling 81 surgeries. Out of these, 28 patients, aged 2-27 years, have benefited from

  6. Orthopedic problems in geriatric dogs and cats.

    PubMed

    Beale, Brian S

    2005-05-01

    Senior dogs and cats with orthopedic injuries and diseases often require a treatment plan that differs from that of younger patients. Injured bone and soft tissues tend to heal more slowly in the geriatric patient. The older animal is likely to have a less competent immune system and may have compromised metabolic and endocrine function. Pre-existing musculoskeletal problems may make ambulation difficult for an animal convalescing from a new orthopedic problem. Special attention is often needed when treating these patients for fractures, joint instability, infection, and neoplasia. In general, issues that should be addressed in the geriatric patient include reducing intraoperative and anesthesia time, enhancing bone and soft tissue healing, return to early function, control of postoperative pain, physical therapy, and proper nutrition.

  7. Team Development of Virtual Teams

    ERIC Educational Resources Information Center

    Kim, Sooyoung

    2004-01-01

    Advanced technologies, globalization, the competitiveness of business, flexible working practices, and other rapid changes in the nature of work have all led to the booming of "virtual teams." This paper will provide an overview of virtual teams, including a description of their emergence, a definition and typology of the term "virtual team," an…

  8. Orthopedic workforce planning in Germany – an analysis of orthopedic accessibility

    PubMed Central

    Müller, Peter; Maier, Werner; Groneberg, David A.

    2017-01-01

    In Germany, orthopedic workforce planning relies on population-to-provider-ratios represented by the ‘official degree of care provision’. However, with geographic information systems (GIS), more sophisticated measurements are available. By utilizing GIS-based technologies we analyzed the current state of demand and supply of the orthopedic workforce in Germany (orthopedic accessibility) with the integrated Floating Catchment Area method. The analysis of n = 153,352,220 distances revealed significant geographical variations on national scale: 5,617,595 people (6.9% of total population) lived in an area with significant low orthopedic accessibility (average z-score = -4.0), whereas 31,748,161 people (39.0% of total population) lived in an area with significant high orthopedic accessibility (average z-score = 8.0). Accessibility was positively correlated with the degree of urbanization (r = 0.49; p<0.001) and the official degree of care provision (r = 0.33; p<0.001) and negatively correlated with regional social deprivation (r = -0.47; p<0.001). Despite advantages of simpler measures regarding implementation and acceptance in health policy, more sophisticated measures of accessibility have the potential to reduce costs as well as improve health care. With this study, significant geographical variations were revealed that show the need to reduce oversupply in less deprived urban areas in order to enable adequate care in more deprived rural areas. PMID:28178335

  9. Primary Payer Status is Associated with the Use of Nerve Block Placement for Ambulatory Orthopedic Surgery

    PubMed Central

    Tighe, Patrick J.; Brennan, Meghan; Moser, M.; Boezaart, Andre P.; Bihorac, Azra

    2012-01-01

    Introduction Although more than 30 million patients in the United States undergo ambulatory surgery each year, it remains unclear what percentage of these patients receive a perioperative nerve block. We reviewed data from the 2006 National Survey of Ambulatory Surgery (NSAS) to determine the demographic, socioeconomic, geographic, and clinical factors associated with the likelihood of nerve block placement for ambulatory orthopedic surgery. The primary outcome of interest was the association between primary method of payment and likelihood of nerve block placement. Additionally, we examined the association between type of surgical procedures, patient demographics, and hospital characteristics with the likelihood of receiving a nerve block. Methods This cross-sectional study reviewed 6,000 orthopedic anesthetics from the 2006 NSAS dataset, which accounted for over 3.9 million orthopedic anesthetics when weighted. The primary outcome of this study addressed the likelihood of receiving a nerve block for orthopedic ambulatory surgery according to the patient’s primary method of payment. Secondary endpoints included differences in demographics, surgical procedures, side effects, complications, recovery profile, anesthesia staffing model, and total perioperative charges in those with and without nerve block. Results Overall, 14.9% of anesthetics in this sample involved a peripheral nerve block. Length of time in postoperative recovery, total perioperative time, and total charges were less for those receiving nerve blocks. Patients were more likely to receive a nerve block if their procedures were performed in metropolitan service areas (OR 1.86, 95% CI 1.19-2.91, p=0.007) or freestanding surgical facilities (OR 2.27, 95% CI 1.74-2.96, p<0.0001), and if payment for their surgery was supported by government programs (OR 2.5, 95% CI 1.01-6.21, p=0.048) or private insurance (OR 2.62, 95% CI 1.12-6.13, p=0.03) versus self-pay or charity care. Conclusion For patients

  10. [Orthopedics and patients under national socialism dictatorship].

    PubMed

    Thomann, K D; Rauschmann, M

    2001-10-01

    The 12-year dictatorship of National Socialism represents a decisive event in the history of orthopedics in Germany. Treatment and care was limited to those patients whose prognosis promised their reintegration into the work force. Those orthopedic patients with mental and psychological handicaps no longer came under the care of orthopedists and were potential candidates for annihilation. Despite concerted efforts to the contrary, as can be gleaned from the lists of topics at the annual meetings, the prevailing political circumstances encumbered scientific activities. The almost total isolation from international contacts had a negative effect. Orthopedists were hindered in their work by the law on sterilization, which provided for sterilization in cases of severe physical deformity. Some orthopedists even considered the presence of hip dysplasia to be an indication. The roles played by Georg Hohmann, Hellmut Eckhardt, Lothar Kreuz, and other leading orthopedists are described in detail. It can be regarded as certain that Hohmann and Eckhardt were able to prevent dire consequences for their orthopedic patients and the profession by cautious tactics. The ethnical problems of involvement with National Socialism are thoroughly discussed.

  11. [Interdisciplinary orthodontic surgical treatment of children with cleft lip and palate from 9 to 20 years of age].

    PubMed

    Kuijpers-Jagtman, A M; Mink van der Molen, A B; Bierenbroodspot, F; Borstlap, W A

    2015-11-01

    Cleft lip and palate is a common congenital malformation with a prevalence of 1:600 newborns. Children with orofacial clefts are treated by an interdisciplinary team of specialists while parents and child play a key role in their own care process. The orthodontic and facial orthopedic treatment of a child with a cleft takes many years. Children often get bored of the long treatment and this can cause problems with compliance and oral hygiene. Therefore it is advisable to distinguish 5 well-defined stages in the orthodontic treatment and to attempt to have some 'orthodontics free' time in between. The 3 orthodontic treatment phases between the age of 9 and 20 years consist of orthodontic treatment concerning the closing of the cleft with a bone transplant, the treatment of the permanent dentition and, finally, a possible combined orthodontic surgical treatment at the end of the period of growth. Good interdisciplinary collaboration among the different dental disciplines is essential in this regard.

  12. Presurgical nasoalveolar molding: A boon to facilitate the surgical repair in infants with cleft lip and palate

    PubMed Central

    Attiguppe, Prabhakar Ramasetty; Karuna, Y. M.; Yavagal, Chandrashekar; Naik, Saraswathi V.; Deepak, B. M.; Maganti, Rekhamani; Krishna, Chaithanya G.

    2016-01-01

    Cleft lip and palate (CLP) is the most common congenital craniofacial anomaly. Rehabilitation of CLP generally requires a team approach. Alveolar and nasal reconstruction for these patients is a challenge for the reconstructive surgeon. Various procedures have been attempted to reduce the cleft gap, so as to obtain esthetic results postsurgically. The presurgical nasoalveolar molding (PNAM) technique, developed by Grayson, is a new approach to presurgical infant orthopedics. PNAM reduces the severity of the initial cleft alveolar and nasal deformity. Thus, it enables the surgeon and the patient to enjoy the benefits associated with repair of a cleft deformity that is minimal in severity. This article presents a brief insight into PNAM with a case series of three different cases (one unilateral and two bilateral) which underwent PNAM treatment and gave an excellent surgical prognosis. PMID:27994432

  13. [The clinical use of Hotz-type orthopedic plate].

    PubMed

    Kamegai, A; Matsuoka, Y; Shimamura, N; Muramatsu, Y; Tanabe, T; Kurenuma, S; Kimura, Y; Shibata, K; Naitoh, K; Kitajima, T

    1988-12-01

    In the present study a Hotz type orthopedic plate was used to improve feeding and physiological growth. In 2 patients with cleft lip it was used to improve feeding and swallowing. In 4 patients with cleft lip and palate it was used to normalize functions and aid physiological growth. The effects of the Hotz orthopedic plate were determined by recording body weight growth, milk volume per day, feeding time and comparison of the study model between before and after using Hotz orthopedic plate. Good physiological growth and improved feeding, were obtoincdinalmostall the patients who wore the Hotz type orthopedic plate correctly.

  14. Impact of a Musculoskeletal Clerkship on Orthopedic Surgery Applicant Diversity.

    PubMed

    London, Daniel A; Calfee, Ryan P; Boyer, Martin I

    Orthopedic surgery lacks racial and sexual diversity, which we hypothesized stems from absence of exposure to orthopedics during medical school. We conducted a study to determine whether diversity of matched orthopedic surgery residency applicants increased after introduction of a required third-year rotation. We compared 2 groups: precurriculum and postcurriculum. The postcurriculum group was exposed to a required 1-month musculoskeletal rotation during the third year of medical school. Comparisons were made of percentage of total students exposed to orthopedics, percentage who applied to and matched to orthopedic surgery, and proportion of women and underrepresented minorities. A prospective survey was used to determine when students chose orthopedics and what influenced their decisions. The required rotation increased the percentage of third-year students rotating on orthopedics (25%) with no change in application rate (6%). It also led to an 81% relative increase in the proportion of female applicants and a 101% relative increase in underrepresented minority applicants. According to survey data, 79% of students chose orthopedics during their third year, and 88% thought they were influenced by their rotation. A required third-year rotation exposes more medical students to orthopedics and increases the diversity of matching students.

  15. Orthopedic Lesions in Tethered Cord Syndrome: The Importance of Early Diagnosis and Treatment on Patient Outcome

    PubMed Central

    Gharedaghi, Mohammad; Samini, Fariborz; Mashhadinejad, Hosein; Khajavi, Mahdi; Samini, Mohammad

    2014-01-01

    Background: Many of the patients with tethered cord syndrome (TCS) are admitted because of neurological symptoms, while some are admitted because of their orthopedic, urologic, anorectal, and dermatologic manifestations. Consequently, this study aimed to evaluate the importance of early diagnosis and treatment of tethered cord syndrome on patient outcome. Methods: Fourty-three patients who underwent surgery because of tethered cord syndrome from 2006 to 2010 were studied. Many of these cases were referred by orthopedic surgeons. All of the findings were recorded and follow up was done twice (1 and 3 years after surgery). Results: Thirty-seven patients were less than 7 years old and 6 were between 17 to 33 years old. According to clinical and neurological exams, satisfactory results were achieved in both groups. Those with early surgical intervention, especially in their early follow up assessment, had the best results. Seventeen cases were referred by an orthopedic surgeon because of manifestations such as leg weakness and numbness, leg pain and spasticity, pes cavus, claw toes, and leg or foot length discrepancy. Cerebrospinal fluid leakage occurred in 3 cases after surgery and 1 showed pseudomeningocele formation. Conclusions: After one year of follow up, initially the results of the treatment were better in early operated cases, but in later follow up assessment (after 3 years) the results were almost the same in both of the groups. PMID:25207325

  16. Prevalence of musculoskeletal disorders among orthopedic trauma surgeons: an OTA survey

    PubMed Central

    AlQahtani, Saad M.; Alzahrani, Mohammad M.; Harvey, Edward J.

    2016-01-01

    Background Occupational injuries and hazards have gained increased attention in the surgical community in general and in the orthopedic literature specifically. The aim of this study was to assess prevalence and characteristics of musculoskeletal disorders among orthopedic trauma surgeons and the impact of these injuries on the surgeons’ practices. Methods We sent a modified version of the physical discomfort survey to surgeon members of the Orthopaedic Trauma Association (OTA) via email. Data were collected and descriptive statistics were analyzed. Results A total of 86 surgeons completed the survey during the period of data collection; 84.9% were men, more than half were 45 years or older and 40.6% were in practice for 10 years or more. More than 66% of respondents reported a musculoskeletal disorder that was related to work; the most common was low back pain (29.3%). The number of body regions involved and disorders diagnosed was associated with increasing age and number of years in practice (p = 0.033). Time off work owing to these disorders was associated with working in a private setting (p = 0.045) and working in more than 1 institute (p = 0.009). Conclusion To our knowledge, our study is the first to report a high percentage of orthopedic trauma surgeons sustaining occupational injuries some time in their careers. The high cost of management and rehabilitation of these injuries in addition to the related number of missed work days indicate the need for increased awareness and implementation of preventive measures. PMID:26812408

  17. Orthopedic Injuries and Their Treatment in Children During Earthquakes: A Systematic Review.

    PubMed

    Morelli, Ilaria; Sabbadini, Maria Grazia; Bortolin, Michelangelo

    2015-10-01

    Orthopedic injuries commonly affect children during earthquakes, but reports about them are rare. This setting may lead to different standards of care, but guidelines are still missing in this field. A systematic review was performed to: (1) assess type and body distribution of pediatric earthquake-related injuries, treatment performed, length of stay, and complications; and (2) identify starting points to define standards of care. PubMed database was researched for papers (1999-2014 period) in agreement with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement. Inclusion criteria were: English, French, Spanish, or Italian language and data reported about orthopedic lesions in children (≤18 years old). Reviews, letters, commentaries, editorials, and single case reports were excluded. Two independent reviewers selected articles after abstract and full-text reading. Traumatic injuries caused child hospital admissions ranging from 46.9% to 100.0%; 16% to 53% suffered fractures. Lower limbs mostly were involved. Soft-tissue injuries affected 55% of patients. Debridement and external fixation (EF) were the most frequent surgical treatments. Amputation rates varied from 5% to 11%. This study revealed that field hospitals should be prepared to: (1) treat mainly lower extremities fractures in children; and (2) use especially EF techniques. The presence of orthopedic surgeons familiar with pediatric traumatology should be considered.

  18. Infection Mitigation Efficacy of Photoactive Titania on Orthopedic Implant Materials

    PubMed Central

    Azad, Abdul-Majeed; Hershey, Ryan; Aboelzahab, Asem; Goel, Vijay

    2011-01-01

    In order to impede infection and achieve accelerated wound healing in the postorthopaedic surgery patients, a simple and benign procedure for creating nanotubular or nanofibrillar structure of photoactive TiO2 on the surface of Ti plates and wires is described. The nanoscale TiO2 films on titanium were grown by hydrothermal processing in one case and by anodization in the presence of dilute mineral acids under mild and benign conditions in the other. Confocal microscopy results demonstrated at least 50% reduction in the population of E. coli colonies (concentration 2.15 × 107 cells/mL) on TiO2-coated implants upon an IR exposure of up to 30 s; it required ∼20 min of exposure to UV beam for the same effect. These findings suggest the probability of eliminating wound infection during and after orthopedic surgical procedures by brief illumination of photoactive titania films on the implants with an IR beam. PMID:21994891

  19. Presurgical orthopedic premaxillary alignment in cleft lip and palate reconstruction.

    PubMed

    Papay, F A; Morales, L; Motoki, D S; Yamashiro, D K

    1994-11-01

    Premaxillary malposition is a difficult problem in cleft lip and palate repair. Orthopedic palatal devices are excellent in positioning the premaxilla, though they are somewhat cumbersome and require complex techniques in adjusting precisely the position of the premaxilla prior to repair. A new technique has been developed for premaxillary repositioning in conjunction with palatal shelf expansion and obturation. The procedure implements microplate fixation anterior to the premaxillary segment and linked to a palatal splint by adjustable elastics. The microplate is inserted through a nasal floor incision and secured by a tight submucosal tunnel through minimal dissection between the prolabium and premaxilla. The last hole of each microplate protrudes through the mucosa and is attached to a pin-retained palatal splint by an elastic chain. Differential tension is applied to the chains to allow gradual repositioning of the protruding maxilla while the splint expands and maintains positioning of the lateral palatal segments. These elastic retractors can be adjusted by staff in the outpatient office. During the past 2 years, this technique has been used successfully in 21 consecutive patients with unilateral or bilateral cleft lip and palate. Its technical ease and design allows simple adjustments to control premaxillary positioning and growth before definitive surgical closure.

  20. The role of student surgical interest groups and surgical Olympiads in anatomical and surgical undergraduate training in Russia.

    PubMed

    Dydykin, Sergey; Kapitonova, Marina

    2015-01-01

    Traditional department-based surgical interest groups in Russian medical schools are useful tools for student-based selection of specialty training. They also form a nucleus for initiating research activities among undergraduate students. In Russia, the Departments of Topographical Anatomy and Operative Surgery play an important role in initiating student-led research and providing learners with advanced, practical surgical skills. In tandem with department-led activities, student surgical interest groups prepare learners through surgical competitions, known as "Surgical Olympiads," which have been conducted in many Russian centers on a regular basis since 1988. Surgical Olympiads stimulate student interest in the development of surgical skills before graduation and encourage students to choose surgery as their postgraduate specialty. Many of the participants in these surgical Olympiads have become highly qualified specialists in general surgery, orthopedic surgery, neurosurgery, urology, gynecology, and emergency medicine. The present article emphasizes the role of student interest groups and surgical Olympiads in clinical anatomical and surgical undergraduate training in Russia.

  1. Team Teaching.

    ERIC Educational Resources Information Center

    Fisher, Stephen

    2003-01-01

    Recounts one Montessori teacher's experience team teaching in a secondary Montessori classroom. Illustrates how a conflict over decision making with a co-teacher helped to create better relationships with students in the classroom and better communication on the teaching team. Contends that resolving issues of conflict between teachers is vital…

  2. Yea, Team.

    ERIC Educational Resources Information Center

    Rinn, Fauneil J.; Weir, Sybil B.

    1984-01-01

    Four problems in higher education are identified: hardening curriculum, graying faculty, shrinking budget, and disappearing students. Team teaching is suggested as one solution. A conceptual framework for types of team teaching is presented and practical suggestions to those who want to work within that framework are provided. (Author/MLW)

  3. Team Handbook.

    ERIC Educational Resources Information Center

    Department of Education, Washington, DC.

    Experience shows that teamwork produces powerful results. Working in a team environment, however, presents its own set of challenges. This handbook provides U.S. Department of Education managers and employees with guidance to develop high-performing teams. Based on input from agency employees throughout the country, the handbook was designed to…

  4. Prevention of VTE in Orthopedic Surgery Patients

    PubMed Central

    Francis, Charles W.; Johanson, Norman A.; Curley, Catherine; Dahl, Ola E.; Schulman, Sam; Ortel, Thomas L.; Pauker, Stephen G.; Colwell, Clifford W.

    2012-01-01

    Background: VTE is a serious, but decreasing complication following major orthopedic surgery. This guideline focuses on optimal prophylaxis to reduce postoperative pulmonary embolism and DVT. Methods: The methods of this guideline follow those described in Methodology for the Development of Antithrombotic Therapy and Prevention of Thrombosis Guidelines: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines in this supplement. Results: In patients undergoing major orthopedic surgery, we recommend the use of one of the following rather than no antithrombotic prophylaxis: low-molecular-weight heparin; fondaparinux; dabigatran, apixaban, rivaroxaban (total hip arthroplasty or total knee arthroplasty but not hip fracture surgery); low-dose unfractionated heparin; adjusted-dose vitamin K antagonist; aspirin (all Grade 1B); or an intermittent pneumatic compression device (IPCD) (Grade 1C) for a minimum of 10 to 14 days. We suggest the use of low-molecular-weight heparin in preference to the other agents we have recommended as alternatives (Grade 2C/2B), and in patients receiving pharmacologic prophylaxis, we suggest adding an IPCD during the hospital stay (Grade 2C). We suggest extending thromboprophylaxis for up to 35 days (Grade 2B). In patients at increased bleeding risk, we suggest an IPCD or no prophylaxis (Grade 2C). In patients who decline injections, we recommend using apixaban or dabigatran (all Grade 1B). We suggest against using inferior vena cava filter placement for primary prevention in patients with contraindications to both pharmacologic and mechanical thromboprophylaxis (Grade 2C). We recommend against Doppler (or duplex) ultrasonography screening before hospital discharge (Grade 1B). For patients with isolated lower-extremity injuries requiring leg immobilization, we suggest no thromboprophylaxis (Grade 2B). For patients undergoing knee arthroscopy without a history

  5. Orthopedic resident anatomy review course: a collaboration between anatomists and orthopedic surgeons.

    PubMed

    DeFriez, Curtis B; Morton, David A; Horwitz, Daniel S; Eckel, Christine M; Foreman, K Bo; Albertine, Kurt H

    2011-01-01

    A challenge for new residents and senior residents preparing for board examinations is refreshing their knowledge of basic science disciplines, such as human gross anatomy. The Department of Orthopaedics at the University of Utah School of Medicine has for many years held an annual Orthopedic Resident Anatomy Review Course during the summer months for all of its residents. The primary purpose of the course is to renew competencies in basic science disciplines so that incoming residents more quickly reach a level of functional proficiency and to afford senior residents a platform to teach their junior colleagues. Before 2005, this course was conducted with minimal participation from anyone outside of the Department of Orthopaedics. Many of the residents voiced concerns that the educational benefits were not proportionate to the time invested. To improve the teaching of orthopedic-related anatomy, an educational collaboration between the Departments of Neurobiology and Anatomy and Orthopaedics was established in 2004 and continues to the present time. The major objectives of refining the course pedagogy, developing a Course Manual and Dissection Guide, and evaluating the results by administering a course survey questionnaire are described in this article. Implementation of all facets of the revised course has resulted in better participation by orthopedic faculty and more favorable reviews by the participating residents. Based on current levels of interest and positive comments from course participants, the Anatomy and Orthopedic faculty course directors plan to continue to develop course materials and pedagogy.

  6. Orthopedic Resident Anatomy Review Course: A Collaboration between Anatomists and Orthopedic Surgeons

    ERIC Educational Resources Information Center

    DeFriez, Curtis B.; Morton, David A.; Horwitz, Daniel S.; Eckel, Christine M.; Foreman, K. Bo; Albertine, Kurt H.

    2011-01-01

    A challenge for new residents and senior residents preparing for board examinations is refreshing their knowledge of basic science disciplines, such as human gross anatomy. The Department of Orthopaedics at the University of Utah School of Medicine has for many years held an annual Orthopedic Resident Anatomy Review Course during the summer months…

  7. Hunting stand-related injuries in orthopedics.

    PubMed

    Lebus, George F; Krueger, Chad A; Stinner, Daniel J; Mir, Hassan R

    2014-09-01

    Hunting remains an extremely popular recreational activity, with nearly 15 million Americans receiving a hunting license annually. Precautions have helped decrease accidents, but hunting-related injuries remain relatively common. The majority of severe, hunting-related accidents involve either a fall from a hunting platform or an accidental shooting. Both of these mechanisms frequently result in orthopedic injuries, many of which require operative care. Although firearms-associated injury has seemingly decreased, hunting platform falls and their sequelae are increasing. Understanding the mechanisms of these injuries and increasing awareness of them may minimize their morbidity and mortality or help prevent them altogether.

  8. Imaging of orthopedic trauma and surgery

    SciTech Connect

    Berquist, T.H.

    1985-01-01

    This book presents papers on imaging techniques for diagnosis of trauma of bones. A comparative evaluation is presented for planning of proper diagnosis and treatment. Various techniques discussed are routine radiography; computerized tomography, NMR imaging, angiography, ultrasonography; and use of radioisotopes. The mechanism of injury of bone joints of upper and lower limbs and spine is discussed after discussing the anatomy of each in the beginning of each paper. Topics titled are healing of fractures; fractures of pelvis; knee; shoulder; foot and ankle; fractures of humerus; stress fractures; and orthopedic radiology. Prosthesis use and plastic surgery of joints is also discussed.

  9. Virtuoso teams.

    PubMed

    Fischer, Bill; Boynton, Andy

    2005-01-01

    Managing a traditional team seems pretty straightforward: Gather up whoever's available, give them time and space to do their jobs, and make sure they all play nicely together. But these teams produce results that are often as unremarkable as the teams themselves. When big change and high performance are required, a virtuoso team is far more likely to deliver outstanding and innovative results. Virtuoso teams are fundamentally different from the garden-variety work groups that most organizations form to pursue more modest goals. They comprise the top experts in their particular fields, are specially convened for ambitious projects, work with frenetic rhythm, and emanate a discernible energy. Not surprisingly, however, the superstars who make up these teams are renowned for being elitist, temperamental, egocentric, and difficult to work with. As a result, many managers fear that if they force such people to interact on a high-stakes project, the group just might implode. In this article, Bill Fischer and Andy Boynton put the inner workings of highly successful virtuoso teams on full display through three examples: the creative group behind West Side Story, the team of writers for Sid Caesar's 1950s-era television hit Your Show of Shows, and the high-powered technologists who averted an investor-relations crisis for Norsk Hydro, the Norwegian energy giant. Each of these teams accomplished enormous goals and changed their businesses, their customers, even their industries. And they did so by breaking all the conventional rules of collaboration--from the way they recruited the best members to the way they enforced their unusual processes, and from the high expectations they held to the exceptional results they produced.

  10. Disparities in internet use among orthopedic outpatients.

    PubMed

    Walsh, Kenneth P; Rehman, Saqib; Goldhirsh, Jessie

    2014-02-01

    Internet access has lagged behind for patients with lower incomes and from certain ethnic groups. This study investigated the possible improvement of access to health-related information on the Internet for all patients in an urban outpatient setting, regardless of socioeconomic background. A 28-question survey was completed by 100 orthopedic outpatients evaluating associations between their age, ethnicity, income, or education level and their access to the Internet. The survey also examined how patients used the Internet to obtain information about their medical condition, their privacy concerns when conducting online research, and their use of mobile phones as a primary means of Internet access. The Internet was used by 57% of orthopedic outpatients in this urban setting. Internet access decreased with advancing age but increased with increasing income and education, findings consistent with similar studies. Despite the inability to identify an association between ethnicity and Internet access in this patient population, fewer Latinos (33%) than whites (67%) or African Americans (77%) sought information about their medical condition. Among patients who used a mobile phone as the primary method for online access, 74% were African American or Latino and 26% were white. This difference in mobile phone use for online access suggests that mobile phones have provided ethnic minorities with greater Internet access and thus may have narrowed the digital divide among the races.

  11. Improving Response Rates among Students with Orthopedic and Multiple Disabilities

    ERIC Educational Resources Information Center

    Wilkens, Christian P.; Kuntzler, Patrice M.; Cardenas, Shaun; O'Malley, Eileen; Phillips, Carolyn; Singer, Jacqueline; Stoeger, Alex; Kindler, Keith

    2014-01-01

    One challenge teachers of students with orthopedic and multiple disabilities face is providing sufficient time and opportunity to communicate. This challenge is universal across countries, schools, and settings: teachers want students to communicate because communication lies at the core of what makes us human. Yet students with orthopedic and…

  12. Colored Indicator Undergloves Increase the Detection of Glove Perforations by Surgeons During Small Animal Orthopedic Surgery: A Randomized Controlled Trial

    PubMed Central

    Gilman, Oliver P.; Parsons, Kevin J.; Burton, Neil J.; Langley‐Hobbs, Sorrel J.

    2016-01-01

    Objective To determine whether use of colored indicator gloves affects perforation detection rate and to identify risk factors for glove perforation during veterinary orthopedic surgery. Study Design Prospective randomized controlled trial. Sample Population 574 double pairs of gloves worn during 300 orthopedic surgical procedures (2,296 gloves). Methods Primary and assistant surgeons double‐gloved for all orthopedic surgical procedures. Type of inner glove (standard or colored indicator) was randomized for the first 360 double pairs of gloves worn by surgeons during 180 procedures. Perforations detected by surgeons were recorded and gloves changed if requested. For a further 120 procedures, indicator gloves were used exclusively. All gloves were leak‐tested after surgery to identify perforations. Association between potential risk factors and perforation was explored using multivariate logistical regression analysis. Results Glove perforations occurred during 43% of surgeries with a mean of 2.3 holes/surgery. Inner gloves were intact in 63% of glove pairs where an outer perforation occurred. Intraoperative perforation detection was improved when colored indicator gloves were worn (83% sensitivity) vs. standard gloves (34% sensitivity; P<.001). Independent risk factors for perforation were placement of plates and/or screws (P=.001; OR=2.4; 95% CI, 1.4–4.0), placement of an external skeletal fixator (P=.002; OR=7.0; 95% CI, 2.1–23.8), use of orthopedic wire (P=.011; OR=2.4; 95% CI, 1.2–4.7), and primary surgeon being board‐certified (P=.016; OR=1.9; 95% CI, 1.1–3.1). Conclusion Increased surgeon recognition of glove perforations through use of colored indicator gloves enables prompt change of gloves if perforation occurs and may reduce potential contamination of the surgical site. PMID:27412490

  13. Virtual Teams.

    ERIC Educational Resources Information Center

    Geber, Beverly

    1995-01-01

    Virtual work teams scattered around the globe are becoming a feature of corporate workplaces. Although most people prefer face-to-face meetings and interactions, reality often requires telecommuting. (JOW)

  14. Breastfeeding is early functional jaw orthopedics (an introduction).

    PubMed

    Page, D C

    2001-01-01

    Breastfeeding places beneficial orthopedic forces on the jaws, similar to the forces of Functional Jaw Orthopedics--the newest form of orthodontics. To date most breastfeeding benefits have been attributed to the content of mother's milk. The true orthopedic benefits of breastfeeding, suckling, deserve more definitive attention and research. Breastfeeding is early preventive Functional Jaw Orthopedics because breastfeeding forces impact the jaws during a very rapid period of infant jaw growth. Breast suckling aids proper development of the jaws which form the gateway to the human airway. Bottle, pacifier and digit sucking deform jaws and airways. Forward forces of suckling clearly oppose the backward forces of sucking. Dentists who understand the positive impact of forward orthopedic forces on the jaws should support and advocate exclusive breastfeeding for about 6 months.

  15. Aerobraking Teams

    NASA Technical Reports Server (NTRS)

    2002-01-01

    Group and team photos of Langely's Aerobraking teams. These photo's were taken right after the 75 day aerobraking phase. People in the photographs include: Paul V. Tartabini, Mary Kae Lockwood, Richard W. Powell, Eric M. Queen, Bob Tolson, Alicia Dwyer, Jill Hanna, Michelle Munk, Zack Q. Chavis, dick Wilmoth, Naru Takashima, Ruth Amundsen, John Aguirre, Allison Roberts, Loreyna Young, Charles W. Davis, John Dec, Joe Gasbarre, Scott Striepe, Paul Escalera and G. M. Keating.

  16. Verbal communication improves laparoscopic team performance.

    PubMed

    Shiliang Chang; Waid, Erin; Martinec, Danny V; Bin Zheng; Swanstrom, Lee L

    2008-06-01

    The impact of verbal communication on laparoscopic team performance was examined. A total of 24 dyad teams, comprised of residents, medical students, and office staff, underwent 2 team tasks using a previously validated bench model. Twelve teams (feedback groups) received instant verbal instruction and feedback on their performance from an instructor which was compared with 12 teams (control groups) with minimal or no verbal feedback. Their performances were both video and audio taped for analysis. Surgical backgrounds were similar between feedback and control groups. Teams with more verbal feedback achieved significantly better task performance (P = .002) compared with the control group with less feedback. Impact of verbal feedback was more pronounced for tasks requiring team cooperation (aiming and navigation) than tasks depending on individual skills (knotting). Verbal communication, especially the instructions and feedback from an experienced instructor, improved team efficiency and performance.

  17. Surgical mortality score: risk management tool for auditing surgical performance.

    PubMed

    Hadjianastassiou, Vassilis G; Tekkis, Paris P; Poloniecki, Jan D; Gavalas, Manolis C; Goldhill, David R

    2004-02-01

    Existing methods of risk adjustment in surgical audit are complex and costly. The present study aimed to develop a simple risk stratification score for mortality and a robust audit tool using the existing resources of the hospital Patient Administration System (PAS) database. This was an observational study for all patients undergoing surgical procedures over a two-year period, at a London university hospital. Logistic regression analysis was used to determine predictive factors of in-hospital mortality, the study outcome. Odds ratios were used as weights in the derivation of a simple risk-stratification model-the Surgical Mortality Score (SMS). Observed-to-expected mortality risk ratios were calculated for application of the SMS model in surgical audit. There were 11,089 eligible cases, under five surgical specialties (maxillofacial, orthopedic, renal transplant/dialysis, general, and neurosurgery). Incomplete data were 3.7% of the total, with no evidence of systematic underreporting. The SMS model was well calibrated [Hosmer-Lemeshow C-statistic: development set (3.432, p = 0.33), validation set (6.359, p = 0.10) with a high discriminant ability (ROC areas: development set [0.837, S.E.=0.013] validation set [0.816, S.E. = 0.016]). Subgroup analyses confirmed that the model can be used by the individual specialties for both elective and emergency cases. The SMS is an accurate risk- stratification model derived from existing database resources. It is simple to apply as a risk-management, screening tool to detect aberrations from expected surgical outcomes and to assist in surgical audit.

  18. Biomaterial systems for orthopedic tissue engineering

    NASA Astrophysics Data System (ADS)

    Spoerke, Erik David

    2003-06-01

    The World Health Organization has estimated that one out of seven Americans suffers from a musculoskeletal impairment, annually incurring 28.6 million musculoskeletal injuries---more than half of all injuries. Bone tissue engineering has evolved rapidly to address this continued health concern. In the last decade, the focus of orthopedic biomaterials design has shifted from the use of common engineering metals and plastics to smart materials designed to mimic nature and elicit favorable bioresponse. Working within this new paradigm, this thesis explores unique chemical and materials systems for orthopedic tissue engineering. Improving on current titanium implant technologies, porous titanium scaffolds were utilized to better approximate the mechanical and structural properties of natural bone. These foam scaffolds were enhanced with bioactive coatings, designed to enhance osteoblastic implant colonization. The biopolymer poly(L-lysine) was incorporated into both hydroxypatite and octacalcium phosphate mineral phases to create modified organoapatite and pLys-CP coatings respectively. These coatings were synthesized and characterized on titanium surfaces, including porous structures such as titanium mesh and titanium foam. In addition, in vitro osteoblastic cell culture experiments probed the biological influences of these coatings. Organoapatite (OA) accelerated preosteoblastic colonization of titanium mesh and improved cellular ingrowth into titanium foam. Alternatively, the thin, uniform pLys-CP coating demonstrated significant potential as a substrate for chemically binding biological molecules and supramolecular assemblies. Biologically, pLys-CP demonstrated enhanced cellular attachment over titanium and inorganic calcium phosphate controls. Supramolecular self-assembled nanofiber assemblies were also explored both as stand-alone tissue engineering gels and as titanium coatings. Self-supporting nanofiber gels induced accelerated, biomimetic mineralization

  19. Bioactive glass coatings for orthopedic metallic implants

    SciTech Connect

    Lopez-Esteban, Sonia; Saiz, Eduardo; Fujino, Sigheru; Oku, Takeo; Suganuma, Katsuaki; Tomsia, Antoni P.

    2003-06-30

    The objective of this work is to develop bioactive glass coatings for metallic orthopedic implants. A new family of glasses in the SiO2-Na2O-K2O-CaO-MgO-P2O5 system has been synthesized and characterized. The glass properties (thermal expansion, softening and transformation temperatures, density and hardness) are in line with the predictions of established empirical models. The optimized firing conditions to fabricate coatings on Ti-based and Co-Cr alloys have been determined and related to the glass properties and the interfacial reactions. Excellent adhesion to alloys has been achieved through the formation of 100-200 nm thick interfacial layers (Ti5Si3 on Ti-based alloys and CrOx on Co-Cr). Finally, glass coatings, approximately 100 mu m thick, have been fabricated onto commercial Ti alloy-based dental implants.

  20. Enhancing orthopedic implant bioactivity: refining the nanotopography.

    PubMed

    Wang, Guocheng; Moya, Sergio; Lu, ZuFu; Gregurec, Danijela; Zreiqat, Hala

    2015-01-01

    Advances in nanotechnology open up new possibilities to produce biomimetic surfaces that resemble the cell in vivo growth environment at a nanoscale level. Nanotopographical changes of biomaterials surfaces can positively impact the bioactivity and ossointegration properties of orthopedic and dental implants. This review introduces nanofabrication techniques currently used or those with high potential for use as surface modification of biomedical implants. The interactions of nanotopography with water, proteins and cells are also discussed, as they largely determine the final success of the implants. Due to the well-documented effects of surface chemistry and microtopography on the bioactivity of the implant, we here elaborate on the ability of the nanofabrication techniques to combine the dual (multi) modification of surface chemistry and/or microtopography.

  1. Correct coding for the orthopedic surgeon.

    PubMed

    Malek, M Mike; Friedman, Melvin M; Beach, William

    2002-04-01

    Coding accurately is one of the main principles of a successful practice. Some changes that we will see shortly include deletion of the term "separate procedure," deletion of the term "with and/or without," deletion of the term "any method," revision of the criteria for choosing E/M levels, and 52 new and revised Hand Surgery codes. Some other changes to come will be category II and category III codes. More changes are occurring as this is written, and the best advice is to stay tuned. It is obvious to the authors that coding is mainly for reimbursement purposes. The orthopedic surgeon must remain vigilant and must not pass this task on to someone else. Ignorance of coding methods is not an excuse [2]. We must all watch carefully and speak up when necessary. In this day of decreasing reimbursement, we can all increase our revenue stream without working any harder if we code our work properly, completely, and promptly.

  2. Team Learning and Team Composition in Nursing

    ERIC Educational Resources Information Center

    Timmermans, Olaf; Van Linge, Roland; Van Petegem, Peter; Elseviers, Monique; Denekens, Joke

    2011-01-01

    Purpose: This study aims to explore team learning activities in nursing teams and to test the effect of team composition on team learning to extend conceptually an initial model of team learning and to examine empirically a new model of ambidextrous team learning in nursing. Design/methodology/approach: Quantitative research utilising exploratory…

  3. A New Culture of Transparency: Industry Payments to Orthopedic Surgeons.

    PubMed

    Lopez, Joseph; Ahmed, Rizwan; Bae, Sunjae; Hicks, Caitlin W; El Dafrawy, Mostafa; Osgood, Greg M; Segev, Dorry L

    2016-11-01

    Under the Physician Payments Sunshine Act, "payments or transfers of value" by biomedical companies to physicians must be disclosed through the Open Payments Program. Designed to provide transparency of financial transactions between medication and device manufacturers and health care providers, the Open Payments Program shows financial relationships between industry and health care providers. Awareness of this program is crucial because its interpretation or misinterpretation by patients, physicians, and the general public can affect patient care, clinical practice, and research. This study evaluated nonresearch payments by industry to orthopedic surgeons. A retrospective cross-sectional review of the first wave of Physician Payments Sunshine Act data (August through December 2013) was performed to characterize industry payments to orthopedic surgeons by subspecialty, amount, type, origin, and geographic distribution. During this 5-month period, orthopedic surgeons (n=14,828) received $107,666,826, which included 3% of those listed in the Open Payments Program and 23% of the total amount paid. Of orthopedic surgeons who received payment, 45% received less than $100 and 1% received $100,000 or more. Median payment (interquartile range) was $119 ($34-$636), and mean payment was $7261±95,887. The largest payment to an individual orthopedic surgeon was $7,849,711. The 2 largest payment categories were royalty or license fees (68%) and consulting fees (13%). During the study period, orthopedic surgeons had substantial financial ties to industry. Of orthopedic surgeons who received payments, the largest proportion (45%) received less than $100 and only 1% received large payments (≥$100,000). The Open Payments Program offers insight into industry payments to orthopedic surgeons. [Orthopedics. 2016; 39(6):e1058-e1062.].

  4. Orthopedic intrusion of premaxilla with distraction devices before alveolar bone grafting in patients with bilateral cleft lip and palate.

    PubMed

    Liou, Eric Jein-Wein; Chen, Philip K T; Huang, C Shing; Chen, Y Ray

    2004-03-01

    Surgical repositioning of the downward displaced premaxilla in bilateral cleft lip and palate patients remains a controversial and perplexing issue because of its detrimental effects on the growth of the premaxilla. The purpose of this prospective clinical study was to introduce and evaluate the treatment results of an innovative technique for nonsurgically intruding the downward displaced premaxilla. Eight consecutive cases of bilateral cleft lip and palate at the age of mixed dentition were included for the correction of their premaxillary deformities. A pair of intraoral tooth-borne distraction devices was used for the orthopedic intrusion. Serial lateral and posteroanterior cephalometric radiographs were taken periodically for evaluating the growth of the premaxilla 1 year before the intrusion, changes during the intrusion, and growth/relapse up to 1 year after the intrusion. There was no overgrowth of the premaxilla or overeruption of the maxillary incisors during the 1-year observing period before the orthopedic intrusion. The treatment results revealed that the downward displaced premaxillae were all corrected within 1 month. Cephalometrically, 46 percent of the correction resulted from a true orthopedic intrusion and another 54 percent from a dentoalveolar effect in which the maxillary incisors were intruded and the premaxillary dentoalveolus was shortened. The cephalometric evaluations also implied that what occurred during the orthopedic intrusion was mostly the sutural contraction osteogenesis/osteolysis in the vomeropremaxillary suture combined with slightly mechanical upward displacement of the vomeronasal septum complex and nasal bones. The orthopedic intrusion of the premaxilla with distraction devices is an effective nonsurgical method for correcting the downward displaced premaxilla before alveolar bone grafting in patients with bilateral cleft lip and palate, and the results remained stable after 1 year.

  5. The surgical aspects of Role 2 Afloat.

    PubMed

    Tye, S; Carnie, R; Chambers, R; Doran, C M; Matthews, J J

    2013-01-01

    The current configuration of the surgical component of the Role 2 Afloat team is described, including an outline of the equipment available. The lessons learned from a recent exercise, where a Role 2 Afloat team was deployed on RFA CARDIGAN BAY are outlined and expanded, emphasising the difficulties of providing damage control surgery in the maritime environment.

  6. The Falklands war: Army field surgical experience.

    PubMed Central

    Jackson, D. S.; Batty, C. G.; Ryan, J. M.; McGregor, W. S.

    1983-01-01

    In the recent Falklands campaign four Army Field Surgical Teams were deployed in the two phases of the war. They functioned as Advanced Surgical Centres and operated on 233 casualties. There were 3 deaths. The patterns of wounding and the methods of casualty management are discussed and compared with other recent campaigns. Images Fig. 1 PMID:6614760

  7. Team building

    SciTech Connect

    Kane, C.

    1993-04-01

    Power plants are particularly complicated projects with abundant opportunities for disputes. Efforts are beginning in the power industry to change the way the industry does business. Key elements of a comprehensive team-building approach include partnering, constructability, use of incentives, and the disputes review board.

  8. Team Building

    ERIC Educational Resources Information Center

    Begg, Roddy

    2005-01-01

    A personal reminiscence of the events surrounding the establishment of Tertiary Education and Management (TEAM), the journal of the European Association for Institutional Research EAIR, the European Higher Education Society--and its development over its first decade, by the founding Editor, at the time of his retirement from the post.

  9. Orthopedic Health: Osteoarthritis— What You Should Know (quiz)

    MedlinePlus

    ... Bar Home Current Issue Past Issues Orthopedic Health Osteoarthritis— What You Should Know Past Issues / Spring 2009 ... Javascript on. How much do you know about osteoarthritis, its causes, and its therapies? Take this quiz ...

  10. Early bone grafting in complete cleft lip and palate cases following maxillofacial orthopedics. II. The soft tissue development from seven to thirteen years of age.

    PubMed

    Larson, O; Nordin, K E; Nylén, B; Eklund, G

    1983-01-01

    The subsequent effect of preoperative maxillofacial orthopedics and early bone grafting on the development of the soft tissue profile of the face was studied with roentgencephalometric analysis on cleft patients between 7 and 13 years of age. They were divided into two unilateral and one bilateral complete-cleft group, all having been bone grafted early with the "four-flap" technique. The two unilateral groups were one group of 39 children operated on between 1960 and 1965 without preoperative orthopedics and one group of 46 children operated on between 1965 and 1972 after preoperative orthopedics ("T-traction"). The bilateral group comprised 19 children operated on between 1960 and 1972 after premaxillary retropositioning pressure, combined when necessary, with outward rotation of the lateral maxillary segments. Comparisons of facial growth were made with U.S. non-grafted clefts and with nonclefts. The effect of the preoperative orthopedic management facilitated the subsequent surgical procedure by a narrowing of the cleft and replacement of the deviated maxillary and nasal structures. The results were within limits of the non-grafted cases, with the exception of the soft tissue overlying the subnasal region. The reduced prominence of that region was explained by the primary surgical procedure, which made the lip adherent to the alveolar crest. In comparison with nonclefts, all parameters indicated a reduced growth capacity.

  11. Back to basics: surgical attire and cleanliness.

    PubMed

    Spruce, Lisa

    2014-01-01

    A clean perioperative environment is beneficial for both patients and perioperative team members, and surgical attire is the foundation of cleanliness. Perioperative personnel should adhere to general hygiene and wear clean, facility-laundered surgical attire in the health care facility. Implementing a surgical attire policy can be challenging because attire is linked to personal preference and image. There are ways to achieve compliance with attire recommendations as well as to implement an attire policy. To help ensure success, perioperative nurses should be prepared to help educate other team members and participate in monitoring and compliance efforts.

  12. The impact of the increasing burden of trauma in Malawi on orthopedic trauma service priorities at Kamuzu Central Hospital

    PubMed Central

    Young, Sven; Banza, Leonard; Munthali, Boston S; Manda, Kumbukani G; Gallaher, Jared; Charles, Anthony

    2016-01-01

    Background and purpose — The burden of road traffic injuries globally is rising rapidly, and has a huge effect on health systems and development in low- and middle-income countries. Malawi is a small low-income country in southeastern Africa with a population of 16.7 million and a gross national income per capita of only 250 USD. The impact of the rising burden of trauma is very apparent to healthcare workers on the ground, but there are very few data showing this development. Patients and methods — The annual number of femoral fracture patients admitted to Kamuzu Central Hospital (KCH) in the Capital of Malawi, Lilongwe, from 2009 to 2014 was retrieved from the KCH trauma database. Linear regression curve estimation was used to project the growth in the burden of femoral fractures and the number of operations performed for femoral fractures over the same time period. Results — 992 patients with femoral fractures (26% of all admissions for fractures) presented at KCH from 2009 through 2014. In this period, there was a 132% increase in the annual number of femoral fractures admitted to KCH. In the same time period, the total number of operations more than doubled, but there was no increase in the number of operations performed for femoral fractures. Overall, there was a 7% mortality rate for patients with femoral fractures. Interpretation — The burden of femoral fractures in Malawi is rising rapidly, and the surgical resources available cannot keep up with this development. Limited funds for orthopedic trauma care in Malawi should be invested in central training hospitals, to develop a sustainable number of orthopedic surgeons and improve current infrastructure and equipment. The centralization of orthopedic surgical care delivery at the central training hospitals will lead to better access to surgical care and early return of patients to local district hospitals for rehabilitation, thus increasing surgical throughput and efficiency in a more cost

  13. Clearing the Air About Surgical Smoke: An Education Program.

    PubMed

    Chavis, Sherry; Wagner, Vicki; Becker, Melanie; Bowerman, Mercelita I; Jamias, Mary Shirley

    2016-03-01

    Evidence of the harmful effects of surgical smoke has been recognized in the literature and by professional organizations for many years, yet surgical smoke continues to pose a safety hazard for patients and perioperative personnel. A team of perioperative nurses and educators sought to improve compliance with policies and procedures for surgical smoke management in the OR. The team quantified smoke-evacuator use, assessed staff members' knowledge using a pre-education survey, and presented a three-part multimodal education program. The team conducted a posteducation survey that showed significant improvement in staff members' knowledge. Ninety-day postimplementation quantitative data showed a 14.6% increase in surgical smoke-evacuation use. This educational initiative increased staff members' awareness about reducing the presence of surgical smoke in the OR and helped ensure a safer environment for patients, staff members, and the surgical team.

  14. Biofilm Disrupting Technology for Orthopedic Implants: What's on the Horizon?

    PubMed

    Connaughton, Alexander; Childs, Abby; Dylewski, Stefan; Sabesan, Vani J

    2014-01-01

    The use of orthopedic implants in joints has revolutionized the treatment of patients with many debilitating chronic musculoskeletal diseases such as osteoarthritis. However, the introduction of foreign material into the human body predisposes the body to infection. The treatment of these infections has become very complicated since the orthopedic implants serve as a surface for multiple species of bacteria to grow at a time into a resistant biofilm layer. This biofilm layer serves as a protectant for the bacterial colonies on the implant making them more resistant and difficult to eradicate when using standard antibiotic treatment. In some cases, the use of antibiotics alone has even made the bacteria more resistant to treatment. Thus, there has been surge in the creation of non-antibiotic anti-biofilm agents to help disrupt the biofilms on the orthopedic implants to help eliminate the infections. In this study, we discuss infections of orthopedic implants in the shoulder then we review the main categories of anti-biofilm agents that have been used for the treatment of infections on orthopedic implants. Then, we introduce some of the newer biofilm disrupting technology that has been studied in the past few years that may advance the treatment options for orthopedic implants in the future.

  15. A robot-assisted orthopedic telesurgery system.

    PubMed

    Kong, M; Du, Z; Sun, L; Fu, L; Jia, Z; Wu, D

    2005-01-01

    A robot-assisted orthopedic telesurgery system, named HIT-RAOTS, has been developed according to Chinese conventional operation method. Its main function includes obtaining images with information of position and orientation of fracture, providing fracture information for doctors, assisting the doctors to complete the reposition of fracture and locking operation of intramedullary nail. In this system, a 6-dof force-reflecting master device, with a pantographic parallelogram mechanisms driven by harmonic DC servomotors, is used to control the slave manipulator movement and to translate the force from the operating room to the surgeon console; A slave robot system integrated a 6-dof force sensor, with a parallel manipulator actuated by six AC servomotors, is applied for the accurate repositioning; A virtual simulation system and human-machine interface are also developed. PI controller based on local network is used to realize the teleoperation. Only little irradiation is issued during the reposition. It can assist surgeons to perform bone-setting more safely by reducing irradiation damage to both surgeries and patients, more easily by releasing the surgeons from the heavy operation and more perfect by improving accuracy of reposition.

  16. Orthopedic rehabilitation using the "Rutgers ankle" interface.

    PubMed

    Girone, M; Burdea, G; Bouzit, M; Popescu, V; Deutsch, J E

    2000-01-01

    A novel ankle rehabilitation device is being developed for home use, allowing remote monitoring by therapists. The system will allow patients to perform a variety of exercises while interacting with a virtual environment (VE). These game-like VEs created with WorldToolKit run on a host PC that controls the movement and output forces of the device via an RS232 connection. Patients will develop strength, flexibility, coordination, and balance as they interact with the VEs. The device will also perform diagnostic functions, measuring the ankle's range of motion, force exertion capabilities and coordination. The host PC transparently records patient progress for remote evaluation by therapists via our existing telerehabilitation system. The "Rutgers Ankle" Orthopedic Rehabilitation Interface uses double-acting pneumatic cylinders, linear potentiometers, and a 6 degree-of-freedom (DOF) force sensor. The controller contains a Pentium single-board computer and pneumatic control valves. Based on the Stewart platform, the device can move and supply forces and torques in 6 DOFs. A proof-of-concept trial conducted at the University of Medicine and Dentistry of New Jersey (UMDNJ) provided therapist and patient feedback. The system measured the range of motion and maximum force output of a group of four patients (male and female). Future medical trials are required to establish clinical efficacy in rehabilitation.

  17. Computer-assisted surgery in orthopedic oncology

    PubMed Central

    Gerbers, Jasper G; Stevens, Martin; Ploegmakers, Joris JW; Bulstra, Sjoerd K; Jutte, Paul C

    2014-01-01

    Background and purpose — In orthopedic oncology, computer-assisted surgery (CAS) can be considered an alternative to fluoroscopy and direct measurement for orientation, planning, and margin control. However, only small case series reporting specific applications have been published. We therefore describe possible applications of CAS and report preliminary results in 130 procedures. Patients and methods — We conducted a retrospective cohort study of all oncological CAS procedures in a single institution from November 2006 to March 2013. Mean follow-up time was 32 months. We categorized and analyzed 130 procedures for clinical parameters. The categories were image-based intralesional treatment, image-based resection, image-based resection and reconstruction, and imageless resection and reconstruction. Results — Application to intralesional treatment showed 1 inadequate curettage and 1 (other) recurrence in 63 cases. Image-based resections in 42 cases showed 40 R0 margins; 16 in 17 pelvic resections. Image-based reconstruction facilitated graft creation with a mean reconstruction accuracy of 0.9 mm in one case. Imageless CAS was helpful in resection planning and length- and joint line reconstruction for tumor prostheses. Interpretation — CAS is a promising new development. Preliminary results show a high number of R0 resections and low short-term recurrence rates for curettage. PMID:25140984

  18. Orthopedic Management of Scoliosis by Garches Brace and Spinal Fusion in SMA Type 2 Children

    PubMed Central

    Catteruccia, Michela; Vuillerot, Carole; Vaugier, Isabelle; Leclair, Danielle; Azzi, Viviane; Viollet, Louis; Estournet, Brigitte; Bertini, Enrico; Quijano-Roy, Susana

    2015-01-01

    Background: Scoliosis is the most debilitating issue in SMA type 2 patients. No evidence confirms the efficacy of Garches braces (GB) to delay definitive spinal fusion. Objective: Compare orthopedic and pulmonary outcomes in children with SMA type 2 function to management. Method: We carried out a monocentric retrospective study on 29 SMA type 2 children who had spinal fusion between 1999 and 2009. Patients were divided in 3 groups: group 1-French patients (12 children) with a preventive use of GB; group 2-French patients (10 children) with use of GB after the beginning of the scoliosis curve; and group 3-Italian patients (7 children) with use of GB after the beginning of the scoliosis curve referred to our centre to perform orthopedic preoperative management. Results: Mean preoperative and postoperative Cobb angle were significantly lower in the group 1 of proactively braced than in group 2 or 3 (Anova p = 0.03; Kruskal Wallis test p = 0.05). Better surgical results were observed in patients with a minor preoperative Cobb angle (r = 0.92 p <  0.0001). Fewer patients in the group 1 proactively braced required trunk casts and/or halo traction and an additional anterior fusion in comparison with patients in the group 2 and 3. Moreover, major complications tend to be less in the group 1 proactively braced. No significant differences were found between groups in pulmonary outcome measures. Conclusions: A proactive orthotic management may improve orthopedic outcome in SMA type 2. Further prospective studies comparing SMA management are needed to confirm these results. Level of Evidence: Therapeutic Level III. See Instructions to Authors on jbjs.org for a complete description of levels of evidence (Retrospective comparative study). PMID:27858747

  19. The Use of Finite Element Analysis to Enhance Research and Clinical Practice in Orthopedics.

    PubMed

    Pfeiffer, Ferris M

    2016-02-01

    Finite element analysis (FEA) is a very powerful tool for the evaluation of biomechanics in orthopedics. Finite element (FE) simulations can effectively and efficiently evaluate thousands of variables (such as implant variation, surgical techniques, and various pathologies) to optimize design, screening, prediction, and treatment in orthopedics. Additionally, FEA can be used to retrospectively evaluate and troubleshoot complications or failures to prevent similar future occurrences. Finally, FE simulations are used to evaluate implants, procedures, and techniques in a time- and cost-effective manner. In this work, an overview of the development of FE models is provided and an example application is presented to simulate knee biomechanics for a specimen with medial meniscus insufficiency. FE models require the development of the geometry of interest, determination of the material properties of the tissues simulated, and an accurate application of a numerical solver to produce an accurate solution and representation of the field variables. The objectives of this work are to introduce the reader to the application of FEA in orthopedic analysis of the knee joint. A brief description of the model development process as well as a specific application to the investigation of knee joint stability in geometries with normal or compromised medial meniscal attachment is included. Significant increases in stretch of the anterior cruciate ligament were predicted in specimens with medial meniscus insufficiency (such behavior was confirmed in corresponding biomechanical testing). It can be concluded from this work that FE analysis of the knee can provide significant new information with which more effective clinical decisions can be made.

  20. Massive subacromial-subdeltoid bursitis with rice bodies secondary to an orthopedic implant.

    PubMed

    Urruela, Adriana M; Rapp, Timothy B; Egol, Kenneth A

    2012-09-01

    Both early and late complications following open reduction and internal fixation of proximal humerus fractures have been reported extensively in the literature. Although orthopedic implants are known to cause irritation and inflammation, to our knowledge, this is the first case report to describe a patient with rice bodies secondary to an orthopedic implant. Although the etiology of rice bodies is unclear, histological studies reveal that they are composed of an inner amorphous core surrounded by collagen and fibrin. The differential diagnosis in this case included synovial chondromatosis, infection, and the formation of a malignant tumor. Additional imaging studies, such as magnetic resonance imaging, and more specific tests were necessary to differentiate the rice bodies due to bursitis versus neoplasm, prior to excision. The patient presented 5 years following open reduction and internal fixation of a displaced proximal humerus fracture, with swelling in the area of the previous surgical site. Examination revealed a large, painless tumor-like mass on the anterior aspect of the shoulder. The patient's chief concern was the unpleasant aesthetic of the mass; no pain was reported. Upon excision of the mass, the patient's full, painless range of motion returned.

  1. Predicting postoperative vomiting among orthopedic patients receiving patient-controlled epidural analgesia using SVM and LR.

    PubMed

    Wu, Hsin-Yun; Gong, Cihun-Siyong Alex; Lin, Shih-Pin; Chang, Kuang-Yi; Tsou, Mei-Yung; Ting, Chien-Kun

    2016-06-01

    Patient-controlled epidural analgesia (PCEA) has been applied to reduce postoperative pain in orthopedic surgical patients. Unfortunately, PCEA is occasionally accompanied by nausea and vomiting. The logistic regression (LR) model is widely used to predict vomiting, and recently support vector machines (SVM), a supervised machine learning method, has been used for classification and prediction. Unlike our previous work which compared Artificial Neural Networks (ANNs) with LR, this study uses a SVM-based predictive model to identify patients with high risk of vomiting during PCEA and comparing results with those derived from the LR-based model. From January to March 2007, data from 195 patients undergoing PCEA following orthopedic surgery were applied to develop two predictive models. 75% of the data were randomly selected for training, while the remainder was used for testing to validate predictive performance. The area under curve (AUC) was measured using the Receiver Operating Characteristic curve (ROC). The area under ROC curves of LR and SVM models were 0.734 and 0.929, respectively. A computer-based predictive model can be used to identify those who are at high risk for vomiting after PCEA, allowing for patient-specific therapeutic intervention or the use of alternative analgesic methods.

  2. Back to basics: implementing the surgical checklist.

    PubMed

    Spruce, Lisa

    2014-11-01

    Surgery is complex and technically demanding for all team members. Surgical checklists have been implemented with different degrees of success in the perioperative setting. There is a wealth of evidence that they are effective at preventing patient safety events and helping team members master the complexities of modern health care. Implementation is key to successful use of the surgical checklist in all invasive procedural settings. Key strategies for successful checklist implementation include establishing a multidisciplinary team to implement the checklist, involving surgeon leaders, pilot testing the checklist, incorporating feedback from team members to improve the process, recognizing and addressing barriers to implementation, and offering coaching and continuous feedback to team members who use the checklist. Using these strategies will give the perioperative nurse, department leaders, and surgeons the tools to implement a successful checklist.

  3. Asteroid team

    NASA Technical Reports Server (NTRS)

    Matson, D. L.

    1988-01-01

    The purpose of this task is to support asteroid research and the operation of an Asteroid Team within the Earth and Space Sciences Division at the Jet Propulsion Laboratory (JPL). The Asteroid Team carries out original research on asteroids in order to discover, better characterize and define asteroid properties. This information is needed for the planning and design of NASA asteroid flyby and rendezvous missions. The asteroid Team also provides scientific and technical advice to NASA and JPL on asteroid related programs. Work on asteroid classification continued and the discovery of two Earth-approaching M asteroids was published. In the asteroid photometry program researchers obtained N or Q photometry for more than 50 asteroids, including the two M-earth-crossers. Compositional analysis of infrared spectra (0.8 to 2.6 micrometer) of asteroids is continuing. Over the next year the work on asteroid classification and composition will continue with the analysis of the 60 reduced infrared spectra which we now have at hand. The radiometry program will continue with the reduction of the N and Q bandpass data for the 57 asteroids in order to obtain albedos and diameters. This year the emphasis will shift to IRAS follow-up observations; which includes objects not observed by IRAS and objects with poor or peculiar IRAS data. As in previous year, we plan to give top priority to any opportunities for observing near-Earth asteroids and the support (through radiometric lightcurve observations from the IRTF) of any stellar occultations by asteroids for which occultation observation expeditions are fielded. Support of preparing of IRAS data for publication and of D. Matson for his participation in the NASA Planetary Astronomy Management and Operations Working Group will continue.

  4. Unilateral Ankylosis of Temporomandibular Joint (TMJ) with Contralateral Condylar Aplasia and Related Orthopedic Deformity - Syndromic or Nonsyndromic?

    PubMed

    Vijay, Pradkhshana; Pardhe, Nilesh; Sunil, Vsb; Bajpai, Manas; Chhibber, Neha

    2015-01-01

    Condylar aplasia which means "failure of development" is a rare condition and can be unilateral or bilateral. Mandibular condylar Aplasia without any association with syndrome is extremely rare. Temporomandibular joint (TMJ) ankylosis results from trauma, infection and inadequate surgical treatment of the condylar area. Congenital cases are very rare. We report case of congenital unilateral aplasia of left mandibular condyle with ankylosis of right condyle, with an associated orthopedic deformity in a nine-year-old male patient, which may be a part of some unreported syndrome that has not been mentioned so far in literature. As per our best knowledge, no other case including such clinical features has been reported.

  5. Maxillary protraction after surgically assisted maxillary expansion

    PubMed Central

    FURQUIM, Laurindo Zanco; JANSON, Guilherme; FURQUIM, Bruno D’Aurea; IWAKI FILHO, Liogi; HENRIQUES, José Fernando Castanha; FERREIRA, Geovane Miranda

    2010-01-01

    This case report describes the orthodontic treatment of a 32-year-old woman with a Class III malocclusion, whose chief compliant was her dentofacial esthetics. The pretreatment lateral cephalometric tracings showed the presence of a Class III dentoskeletal malocclusion with components of maxillary deficiency. After discussion with the patient, the treatment option included surgically assisted rapid maxillary expansion (SARME) followed by orthopedic protraction (Sky Hook) and Class III elastics. Patient compliance was excellent and satisfactory dentofacial esthetics was achieved after treatment completion. PMID:20857013

  6. [Importance of computer-based procedures. Planning and documentation in orthopedic surgery].

    PubMed

    Basad, E

    1999-03-01

    The demand for efficiency in OR management and increase in the necessity of surgical documentation require the use of software applications in hospitals. A client-server based OP-planning and documentation system has been in use in the department of orthopedic surgery in Giessen University since 1992 and is being continuously further developed. Aside from the lawful requirements, the demands of clinical doctors have been especially considered. The main functions are management of non medical patient data, scheduling and documentation of operations with coding of diagnoses and therapy, tissue banking, implant inventory, on call scheduling, storage of medical video images, clinical word processing and e-mail. With an integrated web-server, MedXS has the capabilities to offer functions accessible over any webbrowser (Netscape, Internet-Explorer) in the internet or intranet. Through the usage of this application clinical procedures could be more efficiently realized and better agreeing positions with the insurance companies could be reached.

  7. Referral to pediatric surgical specialists.

    PubMed

    Klein, Michael D

    2014-02-01

    The American Academy of Pediatrics, with the collaboration of the Surgical Sections of the American Academy of Pediatrics, has created referral recommendations intended to serve as voluntary practice parameters to assist general pediatricians in determining when and to whom to refer their patients for pediatric surgical specialty care. It is recognized that these recommendations may be difficult to implement, because communities vary in terms of access to major pediatric medical centers. Limited access does not negate the value of the recommendations, however, because the child who needs specialized surgical and anesthetic care is best served by the skills of the appropriate pediatric surgical team. Major congenital anomalies, malignancies, major trauma, and chronic illnesses (including those associated with preterm birth) in infants and children should be managed by pediatric medical subspecialists and pediatric surgical specialists at pediatric referral centers that can provide expertise in many areas, including the pediatric medical subspecialties and surgical specialties of pediatric radiology, pediatric anesthesiology, pediatric pathology, and pediatric intensive care. The optimal management of the child with complex problems, chronic illness, or disabilities requires coordination, communication, and cooperation of the pediatric surgical specialist with the child's primary care pediatrician or physician.

  8. Surgical videos for accident analysis, performance improvement, and complication prevention: time for a surgical black box?

    PubMed

    Gambadauro, Pietro; Magos, Adam

    2012-03-01

    Conventional audit of surgical records through review of surgical results provides useful knowledge but hardly helps identify the technical reasons lying behind specific outcomes or complications. Surgical teams not only need to know that a complication might happen but also how and when it is most likely to happen. Functional awareness is therefore needed to prevent complications, know how to deal with them, and improve overall surgical performance. The authors wish to argue that the systematic recording and reviewing of surgical videos, a "surgical black box," might improve surgical care, help prevent complications, and allow accident analysis. A possible strategy to test this hypothesis is presented and discussed. Recording and reviewing surgical interventions, apart from helping us achieve functional awareness and increasing the safety profile of our performance, allows us also to effectively share our experience with colleagues. The authors believe that those potential implications make this hypothesis worth testing.

  9. The Current Perspectives of Stem Cell Therapy in Orthopedic Surgery

    PubMed Central

    Akpancar, Serkan; Tatar, Oner; Turgut, Hasan; Akyildiz, Faruk; Ekinci, Safak

    2016-01-01

    Context Musculoskeletal injuries may be painful, troublesome, life limiting and also one of the global health problems. There has been considerable amount of interest during the past two decades to stem cells and tissue engineering techniques in orthopedic surgery, especially to manage special and compulsive injuries within the musculoskeletal system. Evidence Acquisition The aim of this study was to present a literature review regarding the most recent progress in stem cell procedures and current indications in orthopedics clinical care practice. The Medline and PubMed library databases were searched for the articles related with stem cell procedures in the field of orthopedic surgery and additionally the reference list of each article was also included to provide a comprehensive evaluation. Results Various sources of stem cells have been studied for orthopedics clinical care practice. Stem cell therapy has successfully used for major orthopedic procedures in terms of bone-joint injuries (fractures-bone defects, nonunion, and spinal injuries), osteoarthritis-cartilage defects, ligament-tendon injuries, femoral head osteonecrosis and osteogenesis imperfecta. Stem cells have also used in bone tissue engineering in combining with the scaffolds and provided faster and better healing of tissues. Conclusions Large amounts of preclinical studies have been made of stem cells and there is an increasing interest to perform these studies within the human population but preclinical studies are insufficient; therefore, much more and efficient studies should be conducted to evaluate the efficacy and safety of stem cells. PMID:28144608

  10. Orthostetrics: Management of Orthopedic Conditions in the Pregnant Patient.

    PubMed

    Matthews, Leslie J; McConda, David B; Lalli, Trapper A J; Daffner, Scott D

    2015-10-01

    Managing orthopedic conditions in pregnant patients leads to challenges that must be carefully considered so that the safety of both the mother and the fetus is maintained. Both perioperative and intraoperative considerations must be made based on physiologic changes during pregnancy, risks of radiation, and recommendations for monitoring. Operative timing, imaging, and medication selection are also factors that may vary based on trimester and clinical scenario. Pregnancy introduces unique parameters that can result in undesirable outcomes for both mother and fetus if not handled appropriately. Ultimately, pregnant patients offer a distinct challenge to the orthopedic surgeon in that the well-being of 2 patients must be considered in all aspects of care. In addition, not only does pregnancy affect the management of orthopedic conditions but the pregnant state also causes physiologic changes that may actually induce various pathologies. These pregnancy-related orthopedic conditions can interfere with an otherwise healthy pregnancy and should be recognized as possible complications. Although the management of orthopedic conditions in pregnancy is often conservative, pregnancy does not necessarily preclude safely treating pathologies operatively. When surgery is considered, regional anesthesia provides less overall drug exposure to the fetus and less variability in fetal heart rate. Intraoperative fluoroscopy can be used when appropriate, with 360° fetal shielding if possible. Lateral decubitus positioning is ideal to prevent hypotension associated with compression of the inferior vena cava.

  11. The Economic Burden of Orthopedic Surgery Residency Interviews on Applicants

    PubMed Central

    Fogel, Harold A.; Finkler, Elissa S.; Wu, Karen; Schiff, Adam P.; Nystrom, Lukas M.

    2016-01-01

    Background The intense competition for orthopedic surgery residency positions influences the interview process. The financial impact on residency applicants is less well understood. The purpose of the present study was to define the economic burden of the orthopedic surgery residency interview process while additionally describing how applicants finance the expense. Methods We distributed surveys to 48 nonrotating applicants at our institution’s residency interview days for the 2015 match year. The survey consisted of eleven questions specific to the costs of interviewing for orthopedic surgery residency positions. Results The survey response rate was 90% (43/48). Applicants applied to a median of 65 orthopedic surgery residency programs (range 21-88) and targeted a median of 15 interviews (range 12-25). The mean cost estimate for a single interview was $450 (range $200-800) and the cost estimate for all interviews was $7,119 (range $2,500-15,000). Applicants spent a mean of $344 (range $0-750) traveling to our interview. Seventy-two percent borrowed money to finance their interview costs and 28% canceled interviews for financial reasons. Conclusions The financial cost of interviewing for orthopedic surgery is substantial and a majority of applicants add to their educational debt by taking out loans to finance interviews. Future considerations should be made to minimize these costs for an already financially burdened population. PMID:27528831

  12. The effects of maitland orthopedic manual therapy on improving constipation.

    PubMed

    Koo, Ja-Pung; Choi, Jung-Hyun; Kim, Nyeon-Jun

    2016-10-01

    [Purpose] This study aimed to examine the effects of interventions on constipation and to provide basic data for physical therapy in internal medicine. [Subjects and Methods] The colon transit times of 30 subjects were measured and after the interventions. Fifteen subjects were assigned to a Maitland orthopedic manual therapy group, and 15 subjects were assigned to a dietary fiber group. [Results] The analysis of changes in colon transit time showed statistically significant differences in left colon transit time, rectosigmoid colon transit time, and total colon transit time for the Maitland orthopedic manual therapy group and statistically significant differences in rectosigmoid colon transit time and total colon transit time for the dietary fiber group. An analysis of group differences in the effects of Maitland orthopedic manual therapy and dietary fiber showed that the Maitland orthopedic manual therapy group achieved statistically significantly larger declines in rectosigmoid colon transit time and total colon transit time compared with the dietary fiber group. [Conclusion] This study confirmed that Maitland orthopedic manual therapy can be an effective treatment method for internal conditions such as functional constipation by almost normalizing the colon transit time, not only by improving the symptoms of constipation but also by facilitating intestinal movements.

  13. Desktop teleradiology in support of rural orthopedic trauma care.

    PubMed Central

    Reid, J. G.; McGowan, J. J.; Ricci, M. A.; McFarlane, G.

    1997-01-01

    Research has shown that diagnostic quality images for most teleradiology applications requires a sophisticated telemedicine system and access to a large amount of bandwidth. While the ideal standards have been set by those involved in evaluating teleradiology, these standards are impractical for many small rural health centers which deliver routine trauma care. While there is no disagreement about the ultimate need for this level of teleradiology support, the purpose of this research was to determine whether Orthopedists would be able to read plain radiographs of orthopedic trauma injuries using a desktop teleradiology system in support of rural trauma care. METHOD: Two radiology residents and two orthopedic residents viewed forty radiographs, twenty through a desktop teleradiology system and twenty in person. Diagnostic findings and certainty of diagnosis were recorded. FINDINGS: There was no statistically significant difference between modalities in orthopedic residents' ability to correctly diagnose orthopedic trauma injuries. Further, for those instances when the diagnosis was imprecise, the residents were aware of their inability to make an accurate diagnosis. CONCLUSION: Although the study was relatively limited and further research needs to be done, the use of desktop teleradiology in support of rural orthopedic trauma consultation is a promising alternative to the more expensive forms of telemedicine technology. PMID:9357657

  14. The effects of maitland orthopedic manual therapy on improving constipation

    PubMed Central

    Koo, Ja-Pung; Choi, Jung-Hyun; Kim, Nyeon-Jun

    2016-01-01

    [Purpose] This study aimed to examine the effects of interventions on constipation and to provide basic data for physical therapy in internal medicine. [Subjects and Methods] The colon transit times of 30 subjects were measured and after the interventions. Fifteen subjects were assigned to a Maitland orthopedic manual therapy group, and 15 subjects were assigned to a dietary fiber group. [Results] The analysis of changes in colon transit time showed statistically significant differences in left colon transit time, rectosigmoid colon transit time, and total colon transit time for the Maitland orthopedic manual therapy group and statistically significant differences in rectosigmoid colon transit time and total colon transit time for the dietary fiber group. An analysis of group differences in the effects of Maitland orthopedic manual therapy and dietary fiber showed that the Maitland orthopedic manual therapy group achieved statistically significantly larger declines in rectosigmoid colon transit time and total colon transit time compared with the dietary fiber group. [Conclusion] This study confirmed that Maitland orthopedic manual therapy can be an effective treatment method for internal conditions such as functional constipation by almost normalizing the colon transit time, not only by improving the symptoms of constipation but also by facilitating intestinal movements. PMID:27821950

  15. Local antimicrobial administration for prophylaxis of surgical site infections.

    PubMed

    Huiras, Paul; Logan, Jill K; Papadopoulos, Stella; Whitney, Dana

    2012-11-01

    Despite a lack of consensus guidelines, local antibiotic administration for prophylaxis of surgical site infections is used during many surgical procedures. The rationale behind this practice is to provide high antibiotic concentrations at the site of surgery while minimizing systemic exposure and adverse effects. Local antibiotic administration for surgical site prophylaxis has inherent limitations in that antibiotics are applied after the incision is made, rather than the current standard for surgical site prophylaxis that recommends providing adequate antibiotic concentrations at the site before the incision. The efficacy and safety of local application of antibiotics for surgical site prophylaxis have been assessed in different types of surgery with a variety of antibiotic agents and methods of application. We identified 22 prospective, randomized, controlled trials that evaluated local application of antibiotics for surgical site prophylaxis. These trials were subsequently divided and analyzed based on the type of surgical procedure: dermatologic, orthopedic, abdominal, colorectal, and cardiothoracic. Methods of local application analyzed included irrigations, powders, ointments, pastes, beads, sponges, and fleeces. Overall, there is a significant lack of level I evidence supporting this practice for any of the surgical genres evaluated. In addition, the literature spans several decades, and changes in surgical procedures, systemic antibiotic prophylaxis, and microbial flora make conclusions difficult to determine. Based on available data, the efficacy of local antibiotic administration for the prophylaxis of surgical site infections remains uncertain, and recommendations supporting this practice for surgical site prophylaxis cannot be made.

  16. Team Tune-Up: Examining Team Transcripts

    ERIC Educational Resources Information Center

    Journal of Staff Development, 2010

    2010-01-01

    This article presents a worksheet that can be used to examine documentation of team meetings in light of goals the team has established. Materials for this worksheet include copies of team transcripts, yellow and pink highlighters, and pencils. Directions for examining team transcripts are presented.

  17. Cammp Team

    NASA Technical Reports Server (NTRS)

    Evertt, Shonn F.; Collins, Michael; Hahn, William

    2008-01-01

    The International Space Station (ISS) Configuration Analysis Modeling and Mass Properties (CAMMP) Team is presenting a demo of certain CAMMP capabilities at a Booz Allen Hamilton conference in San Antonio. The team will be showing pictures of low fidelity, simplified ISS models, but no dimensions or technical data. The presentation will include a brief description of the contract and task, description and picture of the Topology, description of Generic Ground Rules and Constraints (GGR&C), description of Stage Analysis with constraints applied, and wrap up with description of other tasks such as Special Studies, Cable Routing, etc. The models include conceptual Crew Exploration Vehicle (CEV) and Lunar Lander images and animations created for promotional purposes, which are based entirely on public domain conceptual images from public NASA web sites and publicly available magazine articles and are not based on any actual designs, measurements, or 3D models. Conceptual Mars rover and lander are completely conceptual and are not based on any NASA designs or data. The demonstration includes High Fidelity Computer Aided Design (CAD) models of ISS provided by the ISS 3D CAD Team which will be used in a visual display to demonstrate the capabilities of the Teamcenter Visualization software. The demonstration will include 3D views of the CAD models including random measurements that will be taken to demonstrate the measurement tool. A 3D PDF file will be demonstrated of the Blue Book fidelity assembly complete model with no vehicles attached. The 3D zoom and rotation will be displayed as well as random measurements from the measurement tool. The External Configuration Analysis and Tracking Tool (ExCATT) Microsoft Access Database will be demonstrated to show its capabilities to organize and track hardware on ISS. The data included will be part numbers, serial numbers, historical, current, and future locations, of external hardware components on station. It includes dates of

  18. Intraoperative Hypothermia During Surgical Fixation of Hip Fractures.

    PubMed

    Frisch, Nicholas B; Pepper, Andrew M; Jildeh, Toufic R; Shaw, Jonathan; Guthrie, Trent; Silverton, Craig

    2016-11-01

    Hip fractures are common orthopedic injuries and are associated with significant morbidity/mortality. Intraoperative normothermia is recommended by national guidelines to minimize additional morbidity/mortality, but limited evidence exists regarding hypothermia's effect on orthopedic patients. The purpose of this study was to determine the incidence of intraoperative hypothermia in patients with operatively treated hip fractures and evaluate its effect on complications and outcomes. Retrospective chart review was performed on clinical records from 1541 consecutive patients who sustained a hip fracture and underwent operative fixation at the authors' institution between January 2005 and October 2013. A total of 1525 patients were included for analysis, excluding those with injuries requiring additional surgical intervention. Patient demographic data, surgery-specific data, postoperative complications, length of stay, and 30-day readmission were recorded. Patients with a mean intraoperative temperature less than 36°C were identified as hypothermic. Statistical analysis with univariate and multivariate logistic regression modeling evaluated associations with hypothermia and effect on complications/outcomes. The incidence of intraoperative hypothermia in operatively treated hip fractures was 17.0%. Hypothermia was associated with an increase in the rate of deep surgical-site infection (odds ratio, 3.30; 95% confidence interval, 1.19-9.14; P=.022). Lower body mass index and increasing age demonstrated increased association with hypothermia (P=.004 and P=.005, respectively). To the authors' knowledge, this is the first and largest study analyzing the effect of intraoperative hypothermia in orthopedic patients. In patients with hip fractures, the study's findings confirm evidence found in other surgical specialties that hypothermia may be associated with an increased risk of deep surgical-site infection and that lower body mass index and increasing age are risk factors

  19. Policy Analysis of Surgical Utilization at Blanchfield Army Community Hospital

    DTIC Science & Technology

    2009-04-09

    orthopedics/podiatry, eyes/ears/nose/throat (EENT), general surgery , and specialized clinics in optical refractory care and bariatric surgery . Patients that...numbers of surgeries , and the access to care. The first three courses of action show improvement with these projected outcomes, however, the... surgery , surgical, utilization, in room time, resource sharing, swing shift 16. SECURITY CLASSIFICATION OF: a. REPORT U b. ABSTRACT U c. THIS PAGE U

  20. Homo quintadus, computers and ROOMS (repetitive ocular orthopedic motion stress).

    PubMed

    Grant, A H

    1990-04-01

    Inherent conflict exists between computer systems and ocular physiology of Homo quintadus. Adverse ocular side effects of excessive saccades, excyclotorsion, supraduction, excessive field-of-fixation usage, capitas extension, astigmatic changes, otostatic reflex mismatching, and needless orthopedic malfunctions are imposed upon computer operators. Although the orthopedic dysfunctions are commonly grouped under the heading of Repetitive Strain Injuries (RSI), the inextricable linkage to poor ocular-neurological function argues for postulation of a broader schema entitled Repetitive Ocular Orthopedic Motion Stress (ROOMS). Concepts of good tool usage, total tactile familiarity, total proprioceptive familiarity, and visual cone-of-comfort clash with the installed-equipment base and indicate need for an integrated computer work station to facilitate near covisualization of screen/keyboard and to afford freedom-of-choice for optimal hand/eye synchronicity. The advocacy of computer operators' needs by user-welfare groups, universities, labor unions, and government agencies are portents for achieving genuine improvements.

  1. Computer assisted outcomes research in orthopedics: total joint replacement.

    PubMed

    Arslanian, C; Bond, M

    1999-06-01

    Long-term studies are needed to determine clinically relevant outcomes within the practice of orthopedic surgery. Historically, the patient's subjective feelings of quality of life have been largely ignored. However, there has been a strong movement toward measuring perceived quality of life through such instruments as the SF-36. In a large database from an orthopedic practice results are presented. First, computerized data entry using touch screen technology is not only cost effective but user friendly. Second, patients undergoing hip or knee arthroplasty surgeries make statistically significant improvements in seven of the eight domains of the SF-36 in the first 3 months after surgery. Additional statistically significant improvements over the next 6 to 12 months are also seen. The data are presented here in detail to demonstrate the benefits of a patient outcomes program, to enhance the understanding and use of outcomes data and to encourage further work in outcomes measurement in orthopedics.

  2. Necrotizing fasciitis in a pediatric orthopedic population.

    PubMed

    Tancevski, Aleksandar; Bono, Kenneth; Willis, Leisel; Klingele, Kevin

    2013-06-01

    Few studies have analyzed necrotizing fasciitis in children, and all have relied on cases of necrotizing fasciitis in the abdomen, head, and neck region. The authors sought to correlate the preoperative values of several laboratory tests previously validated in the adult literature, such as the Laboratory Risk Indicator for Necrotizing Fasciitis, with surgically confirmed necrotizing fasciitis in children to provide clinical guidance for the preoperative laboratory workup of necrotizing fasciitis. A retrospective chart review was performed on consecutive patients younger than 18 years with a diagnosis of necrotizing fasciitis. A total of 13 patients with an average age of 7.9 years (range, 9 months-16 years) were included. Ten (76.9%) infections were found in the lower extremity and 3 (23.1%) in the upper extremity. Seven (53.8%) patients had ecchymosis on examination. All patients presented with an elevated white blood cell count. No amputations were performed, and no mortality occurred. All patients underwent surgery within 24 hours of presentation. Elevated temperature, white blood count, erythrocyte sedimentation rate, and C-reactive protein values are typically seen in pediatric patients with necrotizing fasciitis; however, no correlation existed between other the preoperative laboratory values with the previously described scoring systems, such as the Laboratory Risk Indicator for Necrotizing Fasciitis. Aggressive monitoring of signs and symptoms is suggested, even if a patient does not meet all conventional diagnostic criteria. The authors recommend prompt surgical debridement and early administration of antibiotics, which should include clindamycin.

  3. Nanomedicine applications in orthopedic medicine: state of the art

    PubMed Central

    Mazaheri, Mozhdeh; Eslahi, Niloofar; Ordikhani, Farideh; Tamjid, Elnaz; Simchi, Abdolreza

    2015-01-01

    The technological and clinical need for orthopedic replacement materials has led to significant advances in the field of nanomedicine, which embraces the breadth of nanotechnology from pharmacological agents and surface modification through to regulation and toxicology. A variety of nanostructures with unique chemical, physical, and biological properties have been engineered to improve the functionality and reliability of implantable medical devices. However, mimicking living bone tissue is still a challenge. The scope of this review is to highlight the most recent accomplishments and trends in designing nanomaterials and their applications in orthopedics with an outline on future directions and challenges. PMID:26451110

  4. Nanomedicine applications in orthopedic medicine: state of the art.

    PubMed

    Mazaheri, Mozhdeh; Eslahi, Niloofar; Ordikhani, Farideh; Tamjid, Elnaz; Simchi, Abdolreza

    2015-01-01

    The technological and clinical need for orthopedic replacement materials has led to significant advances in the field of nanomedicine, which embraces the breadth of nanotechnology from pharmacological agents and surface modification through to regulation and toxicology. A variety of nanostructures with unique chemical, physical, and biological properties have been engineered to improve the functionality and reliability of implantable medical devices. However, mimicking living bone tissue is still a challenge. The scope of this review is to highlight the most recent accomplishments and trends in designing nanomaterials and their applications in orthopedics with an outline on future directions and challenges.

  5. Novel nanostructured hydroxyapatite coating for dental and orthopedic implants

    NASA Astrophysics Data System (ADS)

    Liu, Huinan; Jiang, Wenping; Malshe, Ajay

    2009-09-01

    A novel hybrid coating process, combining NanoSpray® (built on electrostatic spray coating) technology with microwave sintering process, was developed for synthesizing hydroxyapatite- (HA-) based nanostructured coating with favorable properties for dental and orthopedic implants. Specifically, HA nanoparticles were deposited on commercially pure titanium substrates using NanoSpray technique to produce the HA coating, which was then sintered in a microwave furnace under controlled conditions. The study showed that the use of NanoSpray followed by microwave sintering results in nanoscale HA coating for dental/orthopedic application.

  6. Orthopedic conditions of small ruminants. Llama, sheep, goat, and deer.

    PubMed

    Kaneps, A J

    1996-03-01

    Diagnosis and treatment of diseases of the foot, infectious arthritis, angular limb deformities, patellar luxation, tendon contracture and injuries, and fractures encountered in sheep, goats, llamas, and deer are reviewed. These species share similar orthopedic problems to cattle, but management conditions, particularly for pet animals, may place special demands on the veterinarian treating these disease conditions. The mild temperament and relatively small body size of these animals make them excellent candidates for treatment of orthopedic problems often not amenable to practical treatment in larger or more fractious animals.

  7. Decision making in surgical oncology.

    PubMed

    Lamb, B; Green, J S A; Vincent, C; Sevdalis, N

    2011-09-01

    Decisions in surgical oncology are increasingly being made by multi-disciplinary teams (MDTs). Although MDTs have been widely accepted as the preferred model for cancer service delivery, the process of decision making has not been well described and there is little evidence pointing to the ideal structure of an MDT. Performance in surgery has been shown to depend on non-technical skills, such as decision making, as well as patient factors and the technical skills of the healthcare team. Application of this systems approach to MDT working allows the identification of factors that affect the quality of decision making for cancer patients. In this article we review the literature on decision making in surgical oncology and by drawing from the systems approach to surgical performance we provide a framework for understanding the process of decision making in MDTs. Technical factors that affect decision making include the information about patients, robust ICT and video-conferencing equipment, a minimum dataset with expert review of radiological and pathological information, implementation and recording of the MDTs decision. Non-technical factors with an impact on decision making include attendance of team members at meetings, leadership, teamwork, open discussion, consensus on decisions and communication with patients and primary care. Optimising these factors will strengthen the decision making process and raise the quality of care for cancer patients.

  8. 21 CFR 888.5850 - Nonpowered orthopedic traction apparatus and accessories.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Nonpowered orthopedic traction apparatus and accessories. 888.5850 Section 888.5850 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND... orthopedic traction apparatus and accessories. (a) Identification. A nonpowered orthopedic traction...

  9. 21 CFR 888.5850 - Nonpowered orthopedic traction apparatus and accessories.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Nonpowered orthopedic traction apparatus and accessories. 888.5850 Section 888.5850 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND... orthopedic traction apparatus and accessories. (a) Identification. A nonpowered orthopedic traction...

  10. The Special Orthopedic Hospital—Past and Present

    PubMed Central

    Platt, Harry

    1964-01-01

    Pioneer orthopedic institutions established in Europe in the late 18th and early 19th centuries, and in the U.S.A. in the second half of the 19th and the first decade of the 20th century, can trace their ancestry in ideas back to the practice and teachings of Hippocrates. Experience in treatment of great numbers of injured soldiers in the First World War opened a new era in reconstructive surgery of the locomotor system. After the Second World War, in advanced nations the pattern of crippling diseases showed a spectacular change. Problems that justify the existence of large special orthopedic hospitals are, in children, the more complex congenital deformities, cerebral palsies, and the increasing number of injuries due to hazards of modern life; in the adult, the reconstructive surgery of trauma and of arthritis. In modern orthopedic hospitals physicians have joined orthopedic surgeons in the study of the natural history of the various forms of arthritis. These centres provide facilities for biomechanical research and postgraduate training which acute general hospitals cannot offer. PMID:14228224

  11. Looking at the Social Activity for Adolescents with Orthopedic Impairments

    ERIC Educational Resources Information Center

    Biastro, Leslie; Frank, Heather; Larwin, Karen H.

    2015-01-01

    Adolescents with identified orthopedic impairments are often less likely to participate in social activities outside of the school setting. However, the adolescents who are able to participate in activities have higher social skills, more academic successes, and show more satisfaction in their roles as family member or friend. The aim of this…

  12. 45 CFR 1308.12 - Eligibility criteria: Orthopedic impairment.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ....12 Section 1308.12 Public Welfare Regulations Relating to Public Welfare (Continued) OFFICE OF HUMAN DEVELOPMENT SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES THE ADMINISTRATION FOR CHILDREN, YOUTH AND... affect a child's learning. An orthopedic impairment involves muscles, bones, or joints and...

  13. 45 CFR 1308.12 - Eligibility criteria: Orthopedic impairment.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ....12 Section 1308.12 Public Welfare Regulations Relating to Public Welfare (Continued) OFFICE OF HUMAN DEVELOPMENT SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES THE ADMINISTRATION FOR CHILDREN, YOUTH AND... affect a child's learning. An orthopedic impairment involves muscles, bones, or joints and...

  14. Higher Education and Students with Orthopedic Disabilities: A Survey Instrument.

    ERIC Educational Resources Information Center

    Singh, Delar K.

    A survey instrument is presented that was used in a national survey of 160 colleges and universities to explore facilities and services to students with orthopedic disabilities. The survey contains 33 items that focus on the following areas: structural accessibility, academic accessibility, dorm-living, and recreational opportunities. The total…

  15. Employability Development Teams: Team Member Roles

    ERIC Educational Resources Information Center

    Otto, Mary L.; Lewis, Meharry H.

    1972-01-01

    The authors point out that team roles are designed to be complementary, but much of the frustration that develops among team members is due to lack of role definition and too much overlapping of responsibility. (Author)

  16. Adopting Team Contracts to Initiate Team Learning

    ERIC Educational Resources Information Center

    Marcellino, Patricia Ann

    2008-01-01

    Creighton, Harris and Coleman (2005) suggest that educational leadership instructors introduce aspiring administrators to a sound knowledge base. Currently, engaging in teams is recommended for high performance and problem-solving. Bolton (1999) recommends that instructors coach teams so teaming skills are improved. But, oftentimes, there are team…

  17. Failed medial patellofemoral ligament reconstruction: Causes and surgical strategies

    PubMed Central

    Sanchis-Alfonso, Vicente; Montesinos-Berry, Erik; Ramirez-Fuentes, Cristina; Leal-Blanquet, Joan; Gelber, Pablo E; Monllau, Joan Carles

    2017-01-01

    Patellar instability is a common clinical problem encountered by orthopedic surgeons specializing in the knee. For patients with chronic lateral patellar instability, the standard surgical approach is to stabilize the patella through a medial patellofemoral ligament (MPFL) reconstruction. Foreseeably, an increasing number of revision surgeries of the reconstructed MPFL will be seen in upcoming years. In this paper, the causes of failed MPFL reconstruction are analyzed: (1) incorrect surgical indication or inappropriate surgical technique/patient selection; (2) a technical error; and (3) an incorrect assessment of the concomitant risk factors for instability. An understanding of the anatomy and biomechanics of the MPFL and cautiousness with the imaging techniques while favoring clinical over radiological findings and the use of common sense to determine the adequate surgical technique for each particular case, are critical to minimizing MPFL surgery failure. Additionally, our approach to dealing with failure after primary MPFL reconstruction is also presented. PMID:28251062

  18. Immobilized antibiotics to prevent orthopedic implant infections

    PubMed Central

    Hickok, Noreen J.; Shapiro, Irving M.

    2012-01-01

    Many surgical procedures require the placement of an inert or tissue-derived implant deep within the body cavity. While the majority of these implants do not become colonized by bacteria, a small percentage develops a biofilm layer that harbors invasive microorganisms. In orthopaedic surgery, unresolved periprosthetic infections can lead to implant loosening, arthrodeses, amputations and sometimes death. The focus of this review is to describe development of an implant in which an antibiotic tethered to the metal surface is used to prevent bacterial colonization and biofilm formation. Building on well-established chemical syntheses, studies show that antibiotics can be linked to titanium through a self-assembled monolayer of siloxy amines. The stable metal-antibiotic construct resists bacterial colonization and biofilm formation while remaining amenable to osteoblastic cell adhesion and maturation. In an animal model, the antibiotic modified implant resists challenges by bacteria that are commonly present in periprosthetic infections. While the long-term efficacy and stability is still to be established, ongoing studies support the view that this novel type of bioactive surface has a real potential to mitigate or prevent the devastating consequences of orthopaedic infection. PMID:22512927

  19. Mainstreaming Preschoolers: Children with Orthopedic Handicaps. A Guide for Teachers, Parents, and Others Who Work with Orthopedically Handicapped Preschoolers.

    ERIC Educational Resources Information Center

    Kieran, Shari Stokes; And Others

    This guide to mainstreaming preschoolers with orthopedic handicaps is one of a series of eight manuals on mainstreaming preschoolers developed by Project Head Start. The guide is addressed to parents, teachers, and other professionals and paraprofessionals. Chapter I presents information on the meaning, benefits and implementation of…

  20. Team Learning in Teacher Teams: Team Entitativity as a Bridge between Teams-in-Theory and Teams-in-Practice

    ERIC Educational Resources Information Center

    Vangrieken, Katrien; Dochy, Filip; Raes, Elisabeth

    2016-01-01

    This study aimed to investigate team learning in the context of teacher teams in higher vocational education. As teacher teams often do not meet all criteria included in theoretical team definitions, the construct "team entitativity" was introduced. Defined as the degree to which a group of individuals possesses the quality of being a…

  1. Developing Expert Teams with a Strong Safety Culture

    NASA Technical Reports Server (NTRS)

    Rogers, David G.

    2010-01-01

    Would you like to lead a world renowned team that draws out all the talents and expertise of its members and consistently out performs all others in the industry? Ever wonder why so many organizations fail to truly learn from past mistakes only to repeat the same ones at a later date? Are you a program/project manager or team member in a high-risk organization where the decisions made often carry the highest of consequences? Leadership, communication, team building, critical decision-making and continuous team improvement skills and behaviors are mere talking points without the attitudes, commitment and strategies necessary to make them the very fabric of a team. Developing Expert Teams with a Strong Safety Culture, will provide you with proven knowledge and strategies to take your team soaring to heights you may have not thought possible. A myriad of teams have applied these strategies and techniques within their organization team environments: military and commercial aviation, astronaut flight crews, Shuttle flight controllers, members of the Space Shuttle Program Mission Management Team, air traffic controllers, nuclear power control teams, surgical teams, and the fire service report having spectacular success. Many industry leaders are beginning to realize that although the circumstances and environments of these teams may differ greatly to their own, the core elements, governing principles and dynamics involved in managing and building a stellar safety conscious team remain identical.

  2. Retained Surgical Foreign Bodies after Surgery

    PubMed Central

    Zejnullahu, Valon A.; Bicaj, Besnik X.; Zejnullahu, Vjosa A.; Hamza, Astrit R.

    2017-01-01

    The problem of retained surgical bodies (RSB) after surgery is an issue for surgeons, hospitals and the entire medical team. They have potentially harmful consequences for the patient as they can be life threatening and usually, a further operation is necessary. The incidence of RSB is between 0.3 to 1.0 per 1,000 abdominal operations, and they occur due to a lack of organisation and communication between surgical staff during the process. Typically, the RSB are surgical sponges and instruments located in the abdomen, retroperitoneum and pelvis. PMID:28293325

  3. Team coordination dynamics.

    PubMed

    Gorman, Jamie C; Amazeen, Polemnia G; Cooke, Nancy J

    2010-07-01

    Team coordination consists of both the dynamics of team member interaction and the environmental dynamics to which a team is subjected. Focusing on dynamics, an approach is developed that contrasts with traditional aggregate-static concepts of team coordination as characterized by the shared mental model approach. A team coordination order parameter was developed to capture momentary fluctuations in coordination. Team coordination was observed in three-person uninhabited air vehicle teams across two experimental sessions. The dynamics of the order parameter were observed under changes of a team familiarity control parameter. Team members returned for the second session to either the same (Intact) or different (Mixed) team. 'Roadblock' perturbations, or novel changes in the task environment, were introduced in order to probe the stability of team coordination. Nonlinear dynamic methods revealed differences that a traditional approach did not: Intact and Mixed team coordination dynamics looked very different; Mixed teams were more stable than Intact teams and explored the space of solutions without the need for correction. Stability was positively correlated with the number of roadblock perturbations that were overcome successfully. The novel and non-intuitive contribution of a dynamical analysis was that Mixed teams, who did not have a long history working together, were more adaptive. Team coordination dynamics carries new implications for traditional problems such as training adaptive teams.

  4. Characterization of aerosols produced by surgical procedures

    SciTech Connect

    Yeh, H.C.; Muggenburg, B.A.; Lundgren, D.L.; Guilmette, R.A.; Snipes, M.B.; Jones, R.K.; Turner, R.S.

    1994-07-01

    In many surgeries, especially orthopedic procedures, power tools such as saws and drills are used. These tools may produce aerosolized blood and other biological material from bone and soft tissues. Surgical lasers and electrocautery tools can also produce aerosols when tissues are vaporized and condensed. Studies have been reported in the literature concerning production of aerosols during surgery, and some of these aerosols may contain infectious material. Garden et al. (1988) reported the presence of papilloma virus DNA in the fumes produced from laser surgery, but the infectivity of the aerosol was not assessed. Moon and Nininger (1989) measured the size distribution and production rate of emissions from laser surgery and found that particles were generally less than 0.5 {mu}m diameter. More recently there has been concern expressed over the production of aerosolized blood during surgical procedures that require power tools. In an in vitro study, the production of an aerosol containing the human immunodeficiency virus (HIV) was reported when power tools were used to cut tissues with blood infected with HIV. Another study measured the size distribution of blood aerosols produced by surgical power tools and found blood-containing particles in a number of size ranges. Health care workers are anxious and concerned about whether surgically produced aerosols are inspirable and can contain viable pathogens such as HIV. Other pathogens such as hepatitis B virus (HBV) are also of concern. The Occupational Safety and Health funded a project at the National Institute for Inhalation Toxicology Research Institute to assess the extent of aerosolization of blood and other tissues during surgical procedures. This document reports details of the experimental and sampling approach, methods, analyses, and results on potential production of blood-associated aerosols from surgical procedures in the laboratory and in the hospital surgical suite.

  5. The Application of Telemedicine in Orthopedic Surgery in Singapore: A Pilot Study on a Secure, Mobile Telehealth Application and Messaging Platform

    PubMed Central

    Wong, Keng Lin; Thambiah, Joseph

    2014-01-01

    Background The application of telemedicine has been described for its use in medical training and education, management of stroke patients, urologic surgeries, pediatric laparoscopic surgeries, clinical outreach, and the field of orthopedics. However, the usefulness of a secure, mobile telehealth application, and messaging platform has not been well described. Objective A pilot study was conducted to implement a health insurance portability and accountability act (HIPAA) compliant form of communication between doctors in an orthopedic clinical setting and determine their reactions to MyDoc, a secure, mobile telehealth application, and messaging platform. Methods By replacing current methods of communication through various mobile applications and text messaging services with MyDoc over a six week period, we gained feedback and determined user satisfaction with this innovative system from questionnaires handed to the program director, program coordinator, one trauma consultant, all orthopedic residents, and six non-orthopedic residents at the National University Hospital in Singapore. Results Almost everyone who completed the questionnaire strongly agreed that MyDoc should replace current systems of peer to peer communication in the hospital. The majority also felt that the quality of images, videos, and sound were excellent. Almost everyone agreed that they could communicate easily with each other and would feel comfortable doing so routinely. The majority felt that virtual consults through MyDoc should be made available to inpatients as well as outpatients to potentially lessen clinic loads and provide a secure manner in which patients can communicate with their primary teams any time convenient to both. It was also agreed by most that the potential of telerounding had advantages, especially on weekends as a supplement to normal rounds. Conclusions Potential uses of MyDoc in an orthopedic clinical setting include HIPAA-compliant peer to peer communication

  6. Infection prevention: the surgical care continuum.

    PubMed

    Barnes, Sue

    2015-05-01

    Lack of careful attention to the increasing complexity of surgical procedures, instrument cleaning and processing, and the transition of surgical and other invasive procedures from the OR to areas outside the traditional hospital OR can contribute to surgical site infection (SSI) risk. Regardless of the location of an intervention, when basic infection prevention measures are applied reliably, even low infection rates can be reduced. To address infection prevention challenges, infection preventionists (IPs) must be well informed regarding infection risk and prevention during surgical and other invasive procedures and the effect a facility type may have on patients' infection risk. The IP must have a solid understanding of surgical asepsis, instrument disinfection, and sterilization to educate and support clinical teams in identifying opportunities for improvement relative to infection prevention.

  7. Instructional Design Team

    ERIC Educational Resources Information Center

    Bancroft, Judith A.; Collins, Keith

    1974-01-01

    An instructional design team, composed of experts in nursing, education, and media production, is used at the University of Wisconsin School of Nursing, Madison, to produce instructional units for a new curriculum. The authors summarize steps of team/faculty communications, team methodology, and factors influencing the team's effectiveness. (EA)

  8. TeamXchange: A Team Project Experience Involving Virtual Teams and Fluid Team Membership

    ERIC Educational Resources Information Center

    Dineen, Brian R.

    2005-01-01

    TeamXchange, an online team-based exercise, is described. TeamXchange is consistent with the collaborative model of learning and provides a means of fostering enhanced student learning and engagement through collaboration in virtual teams experiencing periodic membership changes. It was administered in an undergraduate Organizational Behavior…

  9. Speeding Up Team Learning.

    ERIC Educational Resources Information Center

    Edmondson, Amy; Bohmer, Richard; Pisano, Gary

    2001-01-01

    A study of 16 cardiac surgery teams looked at how the teams adapted to new ways of working. The challenge of team management is to implement new processes as quickly as possible. Steps for creating a learning team include selecting a mix of skills and expertise, framing the challenge, and creating an environment of psychological safety. (JOW)

  10. Sports Teams Extend Reach

    ERIC Educational Resources Information Center

    Shah, Nirvi

    2012-01-01

    Unlike traditional high school athletic teams, Unified Sports teams are designed to immerse students with intellectual disabilities in a facet of school culture that has largely eluded them. Nationwide, more than 2,000 schools in 42 states have the teams, where the ideal is for about half the athletes on each team to be students with intellectual…

  11. Student Team Learning.

    ERIC Educational Resources Information Center

    Slavin, Robert E.

    Three Student Team Learning techniques have been extensively researched and found to significantly increase student learning. In Student Teams Achievement Divisions (STAD), teams are made up of high, average, and low performing students of both genders and different racial and ethnic backgrounds. Team members study worksheets, work problems in…

  12. The Discipline of Teams.

    ERIC Educational Resources Information Center

    Katzenbach, Jon R.; Smith, Douglas K.

    1993-01-01

    Teams share commitment, translate purpose into performance goals, and have members be accountable with and to their teammates. Types of teams are those that recommend, make or do things, and run things. The distinction between teams and other working groups is performance: an effective team is worth more than the sum of its parts. (SK)

  13. Assessing Team Performance.

    ERIC Educational Resources Information Center

    Trimble, Susan; Rottier, Jerry

    Interdisciplinary middle school level teams capitalize on the idea that the whole is greater than the sum of its parts. Administrators and team members can maximize the advantages of teamwork using team assessments to increase the benefits for students, teachers, and the school environment. Assessing team performance can lead to high performing…

  14. Hepatitis C virus infection: knowledge in the orthopedic community.

    PubMed

    Flowerdew, J M; McGrory, B J

    2000-04-01

    A survey with 14 questions pertaining to the natural history, infectiveness, and diagnosis and treatment of hepatitis C viral infection was given to all practicing orthopedic surgeons in Portland, Maine. Possible responses were "true," "false," or "don't know" to the 14 statements. A question regarding any interest in learning more about the hepatitis C virus was also posed. Most (82%, 23/28) surgeons completed the questionnaire. A total of 72% of the responses were either wrong or marked "don't know"; most (83%) of the respondents wanted to know more about the infection about hepatitis C viral infection. Not only are orthopedic surgeons at risk for exposure to this virus, but also they are often the first to notify a patient of a positive result after routine hepatitis C testing of autologous predonated blood. Education programs and journal reviews should be directed toward this goal.

  15. [SURGICAL HAND WASHING: HANDSCRUBBING OR HANDRUBBING].

    PubMed

    Santacatalina Mas, Roser; Peix Sagues, Ma Teresa; Miranda Salmerón, Josep; Claramunt Jofre, Marta; López López, Alba; Salas Marco, Elena

    2016-02-01

    The importance of protocols for preoperative antisepsis of the hands is given by the risk of transferring bacteria from the hands of the surgical team to the patient during surgery and it is relationship with infection of surgical wound site (SSI). Careful surgical scrub reduces the number of bacteria on the skin, but does not eliminate them completely, remaining transient microorganisms on hands after the surgical scrub. There fore if micropuncture in surgical gloves occurs, the correct preoperative preparation of hands and double gloving will be essential to reduce the risk of bacterial transmission to patients. The protocols for surgical hand antisepsis are two: Surgical scrub with antiseptic soap (hand scrubbing). Surgical scrub by rubbing alcohol (handrubbing). The hand antisepsis by rubbing with an alcohol solution has proved to be significantly more effective compared to soap solutions. We must also see that in surgical hand antisepsis with soap, you must rinse them with water. And often hospitals' taps and keys are contaminated by Pseudomonas spp., including P. aeuinosa.

  16. Developing Your Dream Team

    ERIC Educational Resources Information Center

    Gatlin, Kenda

    2005-01-01

    Almost anyone has held various roles on a team, be it a family unit, sports team, or a project-oriented team. As an educator, one must make a conscious decision to build and invest in a team. Gathering the best team possible will help one achieve one's goals. This article explores some of the key reasons why it is important to focus on the team…

  17. The discipline of teams.

    PubMed

    Katzenbach, J R; Smith, D K

    1993-01-01

    Groups don't become teams because that is what someone calls them. Nor do teamwork values by themselves ensure team performance. So what is a team? How can managers know when the team option makes sense and what they can do to ensure team success? In this article, drawn from their recent book The Wisdom of Teams, McKinsey partners Jon Katzenbach and Douglas Smith answer these questions and outline the discipline that makes a real team. The essence of a team is shared commitment. Without it, groups perform as individuals; with it, they become a powerful unit of collective performance. The best teams invest a tremendous amount of time shaping a purpose that they can own. The best teams also translate their purpose into specific performance goals. And members of successful teams pitch in and become accountable with and to their teammates. The fundamental distinction between teams and other forms of working groups turns on performance. A working group relies on the individual contributions of its members for group performance. But a team strives for something greater than its members could achieve individually. In short, an effective team is always worth more than the sum of its parts. Katzenbach and Smith identify three basic types of teams: teams that recommend things--task forces or project groups; teams that make or do things--manufacturing, operations, or marketing groups; and teams that run things--groups that oversee some significant functional activity. For managers, the key is knowing where in the organization real teams should be encouraged. Team potential exists anywhere hierarchy or organizational boundaries inhibit good performance.(ABSTRACT TRUNCATED AT 250 WORDS)

  18. Mending injured athletes: a track record of orthopedic advances.

    PubMed

    Schnirring, Lisa

    2003-09-01

    Physicians have long been closely allied with competitive sports. In 157 AD, Galen served as a physician to Greek gladiators.(1) Severe musculoskeletal trauma certainly shortened the careers of ancient pugilists who survived their matches. However, modern gladiators-from pick-up basketball players to football professionals-often get to "play another day" because of advances in orthopedic surgery, particularly those of the last 30 years.

  19. [Developing team reflexivity as a learning and working tool for medical teams].

    PubMed

    Riskin, Arieh; Bamberger, Peter

    2014-01-01

    Team reflexivity is a collective activity in which team members review their previous work, and develop ideas on how to modify their work behavior in order to achieve better future results. It is an important learning tool and a key factor in explaining the varying effectiveness of teams. Team reflexivity encompasses both self-awareness and agency, and includes three main activities: reflection, planning, and adaptation. The model of briefing-debriefing cycles promotes team reflexivity. Its key elements include: Pre-action briefing--setting objectives, roles, and strategies the mission, as well as proposing adaptations based on what was previously learnt from similar procedures; Post-action debriefing--reflecting on the procedure performed and reviewing the extent to which objectives were met, and what can be learnt for future tasks. Given the widespread attention to team-based work systems and organizational learning, efforts should be made toward ntroducing team reflexivity in health administration systems. Implementation could be difficult because most teams in hospitals are short-lived action teams formed for a particular event, with limited time and opportunity to consciously reflect upon their actions. But it is precisely in these contexts that reflexive processes have the most to offer instead of the natural impulsive collective logics. Team reflexivity suggests a potential solution to the major problems of iatorgenesis--avoidable medical errors, as it forces all team members to participate in a reflexive process together. Briefing-debriefing technology was studied mainly in surgical teams and was shown to enhance team-based learning and to improve quality-related outcomes and safety.

  20. Business and Practice Management Knowledge Deficiencies in Graduating Orthopedic Residents.

    PubMed

    Miller, D Joshua; Throckmorton, Thomas W; Azar, Frederick M; Beaty, James H; Canale, S Terry; Richardson, David R

    2015-10-01

    We conducted a study to determine the general level of knowledge that orthopedic residents have on business and practice management topics at graduation and to evaluate the level of knowledge that practicing orthopedic surgeons need in order to function effectively in a medical practice. Residency graduates from a single training program were asked to complete a survey that gathered demographic information and had surgeons rate their understanding of 9 general business and practice management skills and the importance of these skills in their current practice situation. The amount of necessary business knowledge they lacked at graduation was defined as a functional knowledge deficiency (FKD) and was calculated as the difference between the reported importance of a topic in current practice and the level of understanding of that topic at graduation (larger FKD indicates greater deficiency). Those in physician-managed practices reported significantly higher levels of understanding of economic analytical tools than those in nonphysician-managed practices. There were no other statistically significant differences among groups. Hospital-employed physicians had the lowest overall FKD (4.0), followed by those in academic practices (5.1) and private practices (5.9). Graduating orthopedic surgeons appear to be inadequately prepared to effectively manage business issues in their practices, as evidenced by the low overall knowledge levels and high FKDs.

  1. Overview of ultrasound usage trends in orthopedic and sports physiotherapy

    PubMed Central

    2012-01-01

    Background The purpose of this study is to examine current beliefs about the use, the clinical importance, the theoretical fundamentals and the utilization criteria of therapeutic ultrasound (TUS) among physical therapists on the clinical practice in orthopedic and sports physiotherapy in Brazil. Methods A brief survey was developed based on previous studies and was sent to 55 physical therapists with advanced competency in orthopedics and sports physiotherapy. The questions addressed general topics about the professional profile and ultrasound usage and dosage. Results Our data show the wide availability and frequent use of TUS in this sample of physical therapists. TUS is used in distinct musculoskeletal injuries and/or disorders in both acute and chronic conditions. Muscles, tendons and ligaments represented the major structures where TUS is used. Questions on the basic theory of TUS demonstrated a lack of knowledge of the ultrasound physiological effects as well as its interaction with biological tissues and TUS absolute contraindication. Conclusion A Brazilian profile about the US usage and dosage in orthopedic and sports physiotherapy is presented and highlights the need for a continuous upgrading process and further research into its effects. PMID:22871050

  2. Orthopedic cellular therapy: An overview with focus on clinical trials

    PubMed Central

    Noh, Moon Jong; Lee, Kwan Hee

    2015-01-01

    In this editorial, the authors tried to evaluate the present state of cellular therapy in orthopedic field. The topics the authors try to cover include not only the clinical trials but the various research areas as well. Both the target diseases for cellular therapy and the target cells were reviewed. New methods to activate the cells were interesting to review. Most advanced clinical trials were also included because several of them have advanced to phase III clinical trials. In the orthopedic field, there are many diseases with a definite treatment gap at this time. Because cellular therapies can regenerate damaged tissues, there is a possibility for cellular therapies to become disease modifying drugs. It is not clear whether cellular therapies will become the standard of care in any of the orthopedic disorders, however the amount of research being performed and the number of clinical trials that are on-going make the authors believe that cellular therapies will become important treatment modalities within several years. PMID:26601056

  3. Hemodynamic and oxidative mechanisms of tourniquet-induced muscle injury: near-infrared spectroscopy for the orthopedics setting

    NASA Astrophysics Data System (ADS)

    Shadgan, Babak; Reid, W. Darlene; Harris, R. Luke; Jafari, Siavash; Powers, Scott K.; O'Brien, Peter J.

    2012-08-01

    During orthopedic procedures, the tourniquets used to maintain bloodless surgical fields cause ischemia and then reperfusion (I/R), leading to oxidative muscle injury. Established methods exist neither for monitoring orthopedic I/R nor for predicting the extent of tourniquet-associated oxidative injury. To develop a predictive model for tourniquet-associated oxidative muscle injury, this study combined real-time near-infrared spectroscopy (NIRS) monitoring of I/R with Western blotting (WB) for oxidized proteins. We hypothesized strong correlations between NIRS-derived I/R indices and muscle protein oxidation. In 17 patients undergoing ankle fracture repair, a thigh tourniquet was inflated on the injured limb (300 mmHg). Using a continuous-wave (CW) NIRS setup, oxygenated (O2Hb), deoxygenated (HHb), and total (tHb) hemoglobin were monitored bilaterally (tourniquet versus control) in leg muscles. Leg muscle biopsies were collected unilaterally (tourniquet side) immediately after tourniquet inflation (pre) and before deflation (post). Average ischemia duration was 43.2±14.6 min. In post-compared to pre-biopsies, muscle protein oxidation (quantified using WB) increased 172.3%±145.7% (P<0.0005). Changes in O2Hb and tHb were negatively correlated with protein oxidation (respectively: P=0.040, R2=0.25 and P=0.003, R2=0.58). Reoxygenation rate was positively correlated with protein oxidation (P=0.041, R2=0.25). These data indicate that using CW NIRS, it is possible to predict orthopedic tourniquet-associated muscle oxidative injury noninvasively.

  4. [Surgical site infection: clinical and microbiological aspects].

    PubMed

    Sikora, Agnieszka; Kozioł-Montewska, Maria

    2010-01-01

    Surgical site infection (SSI) is one of the most common and serious postoperative complication of modern surgery. It contributes to an increase of morbidity, mortality, prolonged hospitalization and costs of treatment. The optimal strategy in order to reduce wound infections in surgery is SSI knowledge of risk factors associated with a patient, surgery and postoperative care as well as the caution of fundamental recommendations concerning prevention, which include: preparation of patient for surgery, preparation of antiseptic principles for hand skin of the operation team, the proceedings in the case of allegation of infection or colonization within the operation team members, preoperative antibiotic prophylaxis, procedures and aspects of aseptic surgical technique, postoperative care and the rules for monitoring infections in the surgical ward.

  5. [What do orthopedic surgeons need to know from radiologists?].

    PubMed

    Portabella, F; Pablos, O; Agulló, J L

    2012-09-01

    The diagnosis of tumors and pseudotumors depends on three pillars: the clinician, the radiologist, and the pathologist. The first two can establish a presumptive diagnosis on the basis of the clinical presentation and findings on complementary tests, whereas the pathologist will have to reach the definitive diagnosis after analyzing the biopsy specimens. Obviously, the clinician and radiologist should reach a consensus regarding the diagnostic orientation; however, for this to happen there must be a relationship between the two professionals and they must work together for the benefit of the patient. Orthopedic surgeons, like any other group of specialists, would like to have radiologists working in their own center who are dedicated to the organ/system they treat, in this case the locomotor apparatus, and who can provide them with their opinion about the different images obtained. This point is very important and especially so for tumors, because this type of disease is uncommon and few specialists are dedicated to it. For this reason, when faced with a lesion that has the characteristics of a tumor, orthopedic surgeons would like radiologists to give the most accurate description of the images as possible, defining the characteristics of benignity or malignancy of the process as well as indicating the risk of fracture in a metastatic lesion. On the other hand, orthopedic surgeons would ask for a clear and comprehensible description of the images obtained in complementary tests, because orthopedic surgeons have less experience in this type of images and they are often difficult to interpret. Another aspect that is often mentioned in discussions among orthopedic surgeons is the importance of having a radiology department that performs interventional procedures. Radiologists that perform interventional procedures can facilitate our work very much, both in the diagnosis and in the treatment of certain bone tumors. Finally, we would like to stress the importance of

  6. Moving forward in patient safety: multidisciplinary team training.

    PubMed

    Daniels, Kay; Auguste, Tamika

    2013-06-01

    Communication and teamwork deficiencies have been identified as major contributors to poor clinical outcomes in the labor and delivery unit. In response to these findings, multidisciplinary simulation-based team training techniques have developed to focus specifically on skills training for teams. The evidence demonstrates that multidisciplinary simulation-based team training minimizes poor outcomes by perfecting the elusive teamwork skills that cannot be taught in a didactic setting. Multidisciplinary simulation-based team training is also being used to detect latent system errors in existing or new units, to rehearse complicated procedures (surgical dress rehearsal), and to identify knowledge gaps of labor and delivery teams. Multidisciplinary simulation-based team training should be an integral component of ongoing quality-improvement efforts to ultimately produce teams of experts that perform proficiently.

  7. Team Effectiveness and Team Development in CSCL

    ERIC Educational Resources Information Center

    Fransen, Jos; Weinberger, Armin; Kirschner, Paul A.

    2013-01-01

    There is a wealth of research on computer-supported cooperative work (CSCW) that is neglected in computer-supported collaborative learning (CSCL) research. CSCW research is concerned with contextual factors, however, that may strongly influence collaborative learning processes as well, such as task characteristics, team formation, team members'…

  8. Team training/simulation.

    PubMed

    Clark, Erin A S; Fisher, Janet; Arafeh, Julia; Druzin, Maurice

    2010-03-01

    Obstetrical emergencies require the rapid formation of a team with clear communication, strong leadership, and appropriate decision-making to ensure a positive patient outcome. Obstetric teams can improve their emergency response capability and efficiency through team and simulation training. Postpartum hemorrhage is an ideal model for team and simulation training, as postpartum hemorrhage requires a multidisciplinary team with the capability to produce a protocol-driven, rapid response. This article provides an overview of team and simulation training and focuses on applications within obstetrics, particularly preparation for postpartum hemorrhage.

  9. Impact of diabetes mellitus on surgical outcomes in sports medicine.

    PubMed

    Wolfson, Theodore S; Hamula, Mathew J; Jazrawi, Laith M

    2013-11-01

    Diabetes mellitus (DM) affects a significant proportion of the patients evaluated and treated by orthopedic surgeons who specialize in sports medicine. Sports-medicine-related conditions associated with DM include tendinopathy, adhesive capsulitis of the shoulder, and articular cartilage disease. This article reviews the current literature adressing the effect of DM on surgical outcomes in sports medicine. In general, patients with DM undergo operations more frequently and experience inferior surgical outcomes compared with patients without DM. Diabetes mellitus is associated with increased rates of complications from sports medicine procedures, such as infection, delayed healing, and failure of the operation. However, additional research is needed to determine the full impact of DM on patient outcomes in sports medicine. Surgeons should be cognizant of special considerations in the population of patients with DM and aim to tailor the surgical management of this growing patient population.

  10. Geriatric assessment teams.

    PubMed

    Campbell, L J; Cole, K D

    1987-02-01

    In geriatric care, a form of teamwork is the recommended modality because of the complex biopsychosocial needs of the patient. The goal of geriatric assessment programs is to establish an intensive assessment of older adults which requires the competencies of several coordinated disciplines. Not only do teams have the capacity to assess patients in much greater depth but also patients share different information with different providers. The composition of the team is dictated by the needs of the patient population in accordance with resources available. Next, one must identify a method of team practice in order for interactions to take place. The method of functioning determines what kind of team it is, ranging from independent functioning with minimal formal interfacing to interdependent activity interspersed with formal and informal interactions. In initiating a geriatric assessment program, one needs to determine which tasks demand interdisciplinary collaboration, which require interdisciplinary consultation, and which can be performed using a matrix or extended team model. In this model, the core team is supplemented by other disciplines as determined by the team, predicated on patient problems. Teams can profit from training, which can help with choosing an appropriate model, establishing a manual of procedure, and managing interactive issues and problems. This can occur early in the team's formation, or when a team takes on new members. The minimal level of team development would include establishing program goals, delineating professional responsibilities and roles, and implementing a system for exchanging and documenting information about patient plans. Saving input to share only in team meeting is inefficient, so health care teams need to recognize the importance of informal interchanges. It is still a matter of conjecture about what team works best with which patients under what circumstances or conditions. Multiple randomized clinical trials with teams

  11. Radiation Oncology Treatment Team

    MedlinePlus

    ... patients to be advocates. View more information Treatment Team Quick Links Meet the Treatment Team Radiation Oncologist ... as medical oncologists and surgeons to maximize radiation’s effectiveness. Radiation oncologists are the only physicians with the ...

  12. Tiger Team audits

    SciTech Connect

    Cheney, G.T.

    1992-03-01

    This paper will address the purpose, scope, and approach of the Department of Energy Tiger Team Assessments. It will use the Tiger Team Assessment experience of Sandia National Laboratories at Albuquerque, New Mexico, as illustration.

  13. Tiger Team audits

    SciTech Connect

    Cheney, G.T.

    1992-01-01

    This paper will address the purpose, scope, and approach of the Department of Energy Tiger Team Assessments. It will use the Tiger Team Assessment experience of Sandia National Laboratories at Albuquerque, New Mexico, as illustration.

  14. Trends in the orthopedic job market and the importance of fellowship subspecialty training.

    PubMed

    Morrell, Nathan T; Mercer, Deana M; Moneim, Moheb S

    2012-04-01

    Previous studies have examined possible incentives for pursuing orthopedic fellowship training, but we are unaware of previously published studies reporting the trends in the orthopedic job market since the acceptance of certain criteria for fellowship programs by the Accreditation Council for Graduate Medical Education (ACGME) in 1985. We hypothesized that, since the initiation of accredited postresidency fellowship programs, job opportunities for fellowship-trained orthopedic surgeons have increased and job opportunities for nonfellowship-trained orthopedic surgeons have decreased. We reviewed the job advertisements printed in the Journal of Bone and Joint Surgery, American Volume, for the years 1984, 1994, 2004, and 2009. We categorized the job opportunities as available for either a general (nonfellowship-trained) orthopedic surgeon or a fellowship-trained orthopedic surgeon. Based on the advertisements posted in the Journal of Bone and Joint Surgery, American Volume, a trend exists in the orthopedic job market toward seeking fellowship-trained orthopedic surgeons. In the years 1984, 1994, 2004, and 2009, the percentage of job opportunities seeking fellowship-trained orthopedic surgeons was 16.7% (95% confidence interval [CI], 13.1%-20.3%), 40.6% (95% CI, 38.1%-43.1%), 52.2% (95% CI, 48.5%-55.9%), and 68.2% (95% CI, 65.0%-71.4%), respectively. These differences were statistically significant (analysis of variance, P<.05). Fellowship training is thus a worthwhile endeavor.

  15. Systematic reviews and meta-analyses in spine surgery, neurosurgery and orthopedics: guidelines for the surgeon scientist.

    PubMed

    Phan, Kevin; Mobbs, Ralph J

    2015-12-01

    The research evidence in the realm of surgery is expanding at a rapid pace, and thus corresponds with an increasing need to critically appraise and synthesize the available literature. Particularly in fields such as spine surgery, neurosurgery and orthopedics which traditionally have little Class I randomized clinical data, reviews are important to pool the available evidence on clinical questions which are otherwise difficult to answer. Whilst systematic reviews and meta-analyses have the potential to provide critical and updated surgical evidence to guide clinical decisions, poorly performed analyses and misinterpretation of such reviews may have a detrimental effect on patient care and outcomes. We present a summary of the critical steps in performing a systematic review and meta-analysis, allowing the surgeon scientist to better interpret and perform their own systematic reviews and meta-analyses.

  16. Team Evolution and Maturation

    DTIC Science & Technology

    1989-04-01

    Ifor NGFS and ASW teams. These efforts have provided an unparalleled set of observations concerning the nature of training-induced changes in team...Variations in TRAEX/SELEX performance scores across teams or over time provide indications of gross changes in the nature of training or of the...of effective communication behaviors increased significantly more for the "posted" teams curing the Last phase of training. There were insufficient

  17. Orthopedics nursing patients' profile of a public hospital in Salvador-Bahia

    PubMed Central

    de Castro, Renata Reis Matutino; Ribeiro, Natália Fonseca; de Andrade, Aline Mendonça; Jaques, Bruno Dórea

    2013-01-01

    OBJECTIVES: To describe the profile of patients treated in the trauma and orthopedics nursing of a trauma care referral public hospital of in the state of Bahia. METHODS: Cross-sectional study in which data were collected from medical records of patients in the period from July to December 2008. RESULTS: The profile of the patients involved was formed by subjects mostly male young subjects, victims of trauma from accidents, especially those with motorcycles or car runover. On the other hand,the most frequent traumas associated with urban violence were perforations by gunshot and stab wounds. The primary injury presented by these individuals was exposed fracture of the femur and the most common treatment was external fixation. The most frequent in-hospital complication was wound infection, which required another surgical approach. Most inpatients were discharged and only one death was reported during this period. CONCLUSION: The results of this study corroborate those from other institutions in the country, which may contribute to elaborate public policies for accidents and violence prevention. Level of Evidence IV, Case Series. PMID:24453666

  18. Team Building [in HRD].

    ERIC Educational Resources Information Center

    1995

    These five papers are from a symposium that was facilitated by Susan Dougherty at the 1995 conference of the Academy of Human Resource Development (HRD). "The Relationship between Productivity and Work Team Autonomy and Team Process Effectiveness" (Candice L. Phelan) reports that correlation analysis of results of a study of 21 work teams revealed…

  19. A Genuine TEAM Player

    NASA Technical Reports Server (NTRS)

    2001-01-01

    Qualtech Systems, Inc. developed a complete software system with capabilities of multisignal modeling, diagnostic analysis, run-time diagnostic operations, and intelligent interactive reasoners. Commercially available as the TEAMS (Testability Engineering and Maintenance System) tool set, the software can be used to reveal unanticipated system failures. The TEAMS software package is broken down into four companion tools: TEAMS-RT, TEAMATE, TEAMS-KB, and TEAMS-RDS. TEAMS-RT identifies good, bad, and suspect components in the system in real-time. It reports system health results from onboard tests, and detects and isolates failures within the system, allowing for rapid fault isolation. TEAMATE takes over from where TEAMS-RT left off by intelligently guiding the maintenance technician through the troubleshooting procedure, repair actions, and operational checkout. TEAMS-KB serves as a model management and collection tool. TEAMS-RDS (TEAMS-Remote Diagnostic Server) has the ability to continuously assess a system and isolate any failure in that system or its components, in real time. RDS incorporates TEAMS-RT, TEAMATE, and TEAMS-KB in a large-scale server architecture capable of providing advanced diagnostic and maintenance functions over a network, such as the Internet, with a web browser user interface.

  20. Who Owns Your Team?

    ERIC Educational Resources Information Center

    Weisen, Kathy; Love, Phyllis

    1988-01-01

    Feelings of team ownership promote team cohesiveness which yields better performance. Coaches should implement strategies that encourage team members to share with the coach responsibility for morale, skill-building, play improvement, and decision making. Maturity level of athletes influences the degree of ownership allowed. Strategies for…

  1. The "A" Team.

    ERIC Educational Resources Information Center

    Guinn, Larry D.; And Others

    1984-01-01

    The Academic Team (A Team) program at Plano (Texas) Senior High School provides academic enrichment for talented students in grades 9-12. Outstanding A Team students are recognized with trophies and scholarships. The school district and the high school have found the program an excellent means of encouraging academic achievement. (MCG)

  2. Leadership of Creative Teams.

    ERIC Educational Resources Information Center

    Kolb, Judith A.

    1992-01-01

    This study examined leadership in 16 research and 16 nonresearch teams in various manufacturing, aerospace, and health services companies. It concluded that research team leaders need to be able to fulfill a public relations or boundary management role. Engineering research teams, however, showed leadership patterns suggesting different needs for…

  3. Tracking dynamic team activity

    SciTech Connect

    Tambe, M.

    1996-12-31

    AI researchers are striving to build complex multi-agent worlds with intended applications ranging from the RoboCup robotic soccer tournaments, to interactive virtual theatre, to large-scale real-world battlefield simulations. Agent tracking - monitoring other agent`s actions and inferring their higher-level goals and intentions - is a central requirement in such worlds. While previous work has mostly focused on tracking individual agents, this paper goes beyond by focusing on agent teams. Team tracking poses the challenge of tracking a team`s joint goals and plans. Dynamic, real-time environments add to the challenge, as ambiguities have to be resolved in real-time. The central hypothesis underlying the present work is that an explicit team-oriented perspective enables effective team tracking. This hypothesis is instantiated using the model tracing technology employed in tracking individual agents. Thus, to track team activities, team models are put to service. Team models are a concrete application of the joint intentions framework and enable an agent to track team activities, regardless of the agent`s being a collaborative participant or a non-participant in the team. To facilitate real-time ambiguity resolution with team models: (i) aspects of tracking are cast as constraint satisfaction problems to exploit constraint propagation techniques; and (ii) a cost minimality criterion is applied to constrain tracking search. Empirical results from two separate tasks in real-world, dynamic environments one collaborative and one competitive - are provided.

  4. Quality Work Teams.

    ERIC Educational Resources Information Center

    Oswald, Lori Jo

    1995-01-01

    A growing number of schools and districts are considering using teams to handle all types of decision making and advisory activities. The term "teams" can be applied to a wide spectrum of groups with various purposes or powers. This bulletin was designed to assist those who want to create efficient, successful teams. It provides…

  5. The 50 Most Cited Articles in Orthopedic Cartilage Surgery

    PubMed Central

    Arshi, Armin; Siesener, Nathan J.; McAllister, David R.; Williams, Riley J.; Sherman, Seth L.; Jones, Kristofer J.

    2015-01-01

    Objective To determine the 50 most cited articles in orthopedic cartilage surgery and their characteristics. Design A systematic review of the Science Citation Index Expanded was performed for articles related to cartilage surgery published in the 66 journals under the category “Orthopedics.” The 50 most cited articles were determined, and the following characteristics were analyzed for each article: authors, journal and year of publication, number of citations, geographic origin, article type (basic science or clinical), article subtype by study design, and level of evidence. Citation density (total number of citations/years since publication) was also computed. Results The 50 most cited articles ranged from 989 to 172 citations, with citation density ranging from 71.5 to 4.1. The publication years spanned from 1968 to 2008, with the 2000s accounting for half (25) of the articles and the highest mean citation density (14.6). The 50 most cited articles were published in 11 journals. The majority of the articles (29) were clinical, with level IV representing the most common level of evidence (10). The remaining basic science articles were most commonly animal in vivo studies (14). Stronger level of evidence was correlated with overall number of citations (P = 0.044), citation density (P < 0.001), and year of publication (P = 0.003). Conclusions Articles with stronger levels of evidence are more highly cited, with an increasing trend as evidence-based practice has been emphasized. This article list provides clinicians, researchers, and trainees with a group of “citation classics” in orthopedic cartilage surgery. PMID:27375839

  6. Minocycline-Induced Cutaneous Hyperpigmentation in an Orthopedic Patient Population

    PubMed Central

    Hanada, Yuri; Berbari, Elie F.; Steckelberg, James M.

    2016-01-01

    Background. The objectives of this study were to estimate the incidence and evaluate risk factors for development of minocycline-induced cutaneous hyperpigmentation in patients with orthopedic infections. Methods. Patients with orthopedic infections evaluated at Mayo Clinic (Rochester, MN) and treated with minocycline from 1 January 2002 to 31 December 2011 were retrospectively identified. Long-term minocycline suppression was defined as daily minocycline use for at least 3 months. A proportional hazards model was used to evaluate potential risk factors. Results. Of 291 patients receiving long-term minocycline suppression, 54% (156 of 291) developed hyperpigmentation after a mean follow-up of 4.8 years (range, 0.3–13.2 years); 88% involved blue-gray pigmentation of normal skin that appeared most commonly in the lower (75%) and upper extremities (44%). The mean duration of minocycline therapy before hyperpigmentation was 1.5 years (range, 0.1–9 years) with a mean cumulative dosage of 107.3 g (range, 8.6–657 g). Notable risk factors include a history of vitamin D deficiency (relative risk [RR], 6.29; 95% confidence interval [CI], 1.91–15.27; P = .0052), presence of a shoulder prosthesis (RR, 3.2; 95% CI, 1.23–6.56; P = .0062), noncirrhotic liver pathology (RR, 3.63; 95% CI, 1.11–8.75; P = .0359), and use of a concurrent medication also known to cause hyperpigmentation (RR, 4.75; 95% CI, 1.83–10.1; P = .0029). Conclusions. Hyperpigmentation associated with the use of long-term minocycline suppression in patients with orthopedic infections is common. PMID:26835479

  7. Patient-specific geometrical modeling of orthopedic structures with high efficiency and accuracy for finite element modeling and 3D printing.

    PubMed

    Huang, Huajun; Xiang, Chunling; Zeng, Canjun; Ouyang, Hanbin; Wong, Kelvin Kian Loong; Huang, Wenhua

    2015-12-01

    We improved the geometrical modeling procedure for fast and accurate reconstruction of orthopedic structures. This procedure consists of medical image segmentation, three-dimensional geometrical reconstruction, and assignment of material properties. The patient-specific orthopedic structures reconstructed by this improved procedure can be used in the virtual surgical planning, 3D printing of real orthopedic structures and finite element analysis. A conventional modeling consists of: image segmentation, geometrical reconstruction, mesh generation, and assignment of material properties. The present study modified the conventional method to enhance software operating procedures. Patient's CT images of different bones were acquired and subsequently reconstructed to give models. The reconstruction procedures were three-dimensional image segmentation, modification of the edge length and quantity of meshes, and the assignment of material properties according to the intensity of gravy value. We compared the performance of our procedures to the conventional procedures modeling in terms of software operating time, success rate and mesh quality. Our proposed framework has the following improvements in the geometrical modeling: (1) processing time: (femur: 87.16 ± 5.90 %; pelvis: 80.16 ± 7.67 %; thoracic vertebra: 17.81 ± 4.36 %; P < 0.05); (2) least volume reduction (femur: 0.26 ± 0.06 %; pelvis: 0.70 ± 0.47, thoracic vertebra: 3.70 ± 1.75 %; P < 0.01) and (3) mesh quality in terms of aspect ratio (femur: 8.00 ± 7.38 %; pelvis: 17.70 ± 9.82 %; thoracic vertebra: 13.93 ± 9.79 %; P < 0.05) and maximum angle (femur: 4.90 ± 5.28 %; pelvis: 17.20 ± 19.29 %; thoracic vertebra: 3.86 ± 3.82 %; P < 0.05). Our proposed patient-specific geometrical modeling requires less operating time and workload, but the orthopedic structures were generated at a higher rate of success as compared with the conventional method. It is expected to benefit the surgical planning of orthopedic

  8. A History of Orthopedics in San Francisco and the West

    PubMed Central

    Mandell, Peter; Raih, Thomas; Taylor, Lloyd W.

    1976-01-01

    The unique development of early medical specialization in the West can be traced to California's geography and economic development. Such early specialization produced men with orthopedic inclinations. Early orthopedists founded the first medical school and the first modern teaching hospital, helped to found Stanford's Lane Medical Library and made the first use of x-rays in the West. In addition many of these orthopedists were prominent in the political and social activities of the time. ImagesFigure 1.Figure 2.Figure 3.Figure 4. PMID:795165

  9. Klebsiella pneumoniae carrying bla NDM-1 gene in orthopedic practice.

    PubMed

    Gupta, Varsha; Bansal, Neha; Gupta, Ravi; Chander, Jagdish

    2014-09-01

    Emergence and spread of carbapenemases in Enterobacteriaceae is a cause of concern worldwide, the latest threat being New Delhi metallo-β-lactamase (NDM-1). This report is of an orthopedic case with fracture femur managed with internal fixation and bone grafting, who subsequently developed secondary infection with Klebsiella pneumoniae harboring bla NDM-1 gene. Minimum inhibitory concentration (MIC) of imipenem was ≥8 μg/ml by E-test, suggestive of carbapenemase production. Phenotypic and further genotypic detection confirmed the presence of bla NDM-1 gene. The isolate remained susceptible only to tigecycline, colistin, and polymyxin B.

  10. Effect of social media in health care and orthopedic surgery.

    PubMed

    Saleh, Jenine; Robinson, Brooke S; Kugler, Nathan W; Illingworth, Kenneth D; Patel, Pranay; Saleh, Khaled J

    2012-04-01

    With the growth of social media platforms, their potential to affect health care, and orthopedics specifically, continues to expand. We reviewed the literature to obtain all pertinent information on social media in health care and examined its strengths and weaknesses from patient and physician perspectives. Health care professionals have slowly begun to use social media to stay connected with patients. The recent use of networking sites aims to improve education, provide a forum to discuss relevant medical topics, and allow for improved patient care. The use of social media, with the understanding of its limitations, may help promote patient happiness and safety and serve as an educational platform.

  11. Surface evaluation of orthopedic hip implants marketed in Brazil

    NASA Astrophysics Data System (ADS)

    Souza, M. M.; Trommer, R. M.; Maru, M. M.; Roesler, C. R. M.; Barros, W. S.; Dutra, M. S.

    2016-07-01

    One of the factors that contribute to the quality of total hip prostheses is the degree of accuracy in the manufacturing of the joint surfaces. The dimensional control of joint components is important because of its direct influence on the durability and, consequently, in the patients’ life quality. This work presents studies on the form and roughness of orthopedic hip prostheses marketed in Brazil. The results provide data for quality control of the surfaces of the femoral heads and acetabular components of hip prostheses and indicate the need of improvement in the procedures used to this control.

  12. Comparison of Complications and Length of Hospital Stay Between Orthopedic and Orthogeriatric Treatment in Elderly Patients With a Hip Fracture

    PubMed Central

    Wagner, Pablo; Fuentes, Paola; Diaz, Andres; Martinez, Felipe; Amenabar, Pedro; Schweitzer, Daniel; Botello, Eduardo; Gac, Homero

    2012-01-01

    Hip fractures in the elderly individuals are a complex problem. Our objective was to determine whether orthogeriatric treatment is effective in terms of reducing length of hospital stay, morbidity, and mortality of elderly patients with a hip fracture compared with orthopedic (traditional) treatment. From July 2009 to May 2011, patients older than 65 years with a hip fracture were followed prospectively. They were co-treated by geriatric and orthopedic teams. This cohort was compared with a retrospective cohort followed from January 2007 to June 2009 that was managed by the orthopedic surgery team only. Epidemiology, pre- and postoperative hematocrit, and renal function were registered. Also, in-hospital and distant mortality data (determined by consulting the national registry), mortality-associated factors, postoperative complications, hospital stay length, and transfers to other services were registered. One hundred and eighty-three patients in the retrospective group and 92 in the prospective group were included in this study with a median follow-up of 26 months (interquartile range: 13-41). The average age was 84 years and 74% of patients were female. Intertrochanteric fracture accounted for 51% of the cases. There was no difference between groups with regard to hospital stay length, hematocrit at discharge, in-hospital mortality, long-term survival, or transfers to internal medicine or the intensive care unit. It did show differences in the transfer to the intermediate care unit, prolonged hospitalizations (>20 days), and diagnosis of delirium and anemia requiring transfusion. In the present study, orthogeriatric treatment is slightly more effective than traditional treatment in terms of morbidity, but there is no difference in hospital stay length or mortality. Further studies and longer follow-up are needed to draw more conclusions. PMID:23569697

  13. Improving Surgical Access in Rural Africa through a Surgical Camp Model

    PubMed Central

    Kituuka, O.; Elobu, E.; Jombwe, J.; Sekabira, J.; Butler, Elissa; Faulal, J.

    2016-01-01

    Introduction. Surgical camps are preplanned activities where volunteer surgical teams congregate at specified place(s) and perform a wide range of mostly elective procedures for a limited period of time. This is usually at no cost to the patients, who belong to vulnerable (poor and hard to reach) communities. We describe a surgical camp model and its challenges as a means of improving access to surgical services. Methods. A cross-sectional descriptive study. Data from a recent Association of Surgeons of Uganda surgical camp were collected and analyzed for demographics, costs, procedure types, and rates and, in addition, challenges encountered and solutions. Personnel that participated in this exercise included specialist surgeons, surgical residents, medical officers, clinical officers, anesthetists, and theater nurses (a total of 121 staff). Results. In total, 551 procedures were performed during a four-day-long camp. Mean age was 35 years (SD 23), M : F ratio was 2 : 1. Herniorrhaphy, skin lump excision, hydrocelectomy, and thyroidectomy formed 81% of all the procedures. Average cost per procedure was $73 USD. Conclusion. Surgical camps offer increased access to surgical services to vulnerable populations. Hernias and goiters were most common. Surgical camps should become an integral part of the Health Service delivery in low-resourced environments. PMID:27413775

  14. The Early Years of Organized Chiropractic Orthopedics, 1954–1973: A Social History

    PubMed Central

    Green, Bart N.; Johnson, Claire D.

    2009-01-01

    Objective: This paper presents the origins and development of the organized chiropractic orthopedics movement in the United States from 1954–1973. Methods: Hand searches of early periodicals were performed and information was organized chronologically to create a timeline. Context for the timeline was provided by extracting pertinent information from audio recordings of interviews. Relevant background information was located using the cumulative index of the journal Chiropractic History and searching the MANTIS database. Historical Features: After World War I, The advent of third party reimbursement for health care created a new environment for health care practitioners. For doctors of chiropractic, this event provided the impetus to begin the postgraduate chiropractic orthopedics program over 50 years ago. In 1954, Alvin A. Hancock, DC and F. Maynard Lipe, DC successfully launched an active orthopedics movement after several earlier attempts failed during the 1940s and early 1950s. The movement generated from the desire to train and certify chiropractors to manage personal injury and workers’ compensation low back injuries. In addition to developing interdisciplinary educational programs, the chiropractic orthopedics group was responsible for producing a research agenda, some of the profession’s early orthopedic-focused research, and for starting the National Council on Chiropractic Orthopedics of the National Chiropractic Association, which later became the American Chiropractic Association Council on Orthopedics. These organizations produced thousands of specialists in chiropractic orthopedics, later known as Diplomates of the American Board of Chiropractic Orthopedists. Conclusion: Several orthopedics interest groups were formed and credentialing processes were created to qualify doctors as recognized chiropractic orthopedics specialists. The popularity of this movement resulted in the inclusion of orthopedics into core chiropractic college curricula and

  15. Micro-surgical endodontics.

    PubMed

    Eliyas, S; Vere, J; Ali, Z; Harris, I

    2014-02-01

    Non-surgical endodontic retreatment is the treatment of choice for endodontically treated teeth with recurrent or residual disease in the majority of cases. In some cases, surgical endodontic treatment is indicated. Successful micro-surgical endodontic treatment depends on the accuracy of diagnosis, appropriate case selection, the quality of the surgical skills, and the application of the most appropriate haemostatic agents and biomaterials. This article describes the armamentarium and technical procedures involved in performing micro-surgical endodontics to a high standard.

  16. Team Cognition in Experienced Command-and-Control Teams

    ERIC Educational Resources Information Center

    Cooke, Nancy J.; Gorman, Jamie C.; Duran, Jasmine L.; Taylor, Amanda R.

    2007-01-01

    Team cognition in experienced command-and-control teams is examined in an UAV (Uninhabited Aerial Vehicle) simulation. Five 3-person teams with experience working together in a command-and-control setting were compared to 10 inexperienced teams. Each team participated in five 40-min missions of a simulation in which interdependent team members…

  17. Surgical innovation as sui generis surgical research.

    PubMed

    Lotz, Mianna

    2013-12-01

    Successful innovative 'leaps' in surgical technique have the potential to contribute exponentially to surgical advancement, and thereby to improved health outcomes for patients. Such innovative leaps often occur relatively spontaneously, without substantial forethought, planning, or preparation. This feature of surgical innovation raises special challenges for ensuring sufficient evaluation and regulatory oversight of new interventions that have not been the subject of controlled investigatory exploration and review. It is this feature in particular that makes early-stage surgical innovation especially resistant to classification as 'research', with all of the attendant methodological and ethical obligations--of planning, regulation, monitoring, reporting, and publication--associated with such a classification. This paper proposes conceptual and ethical grounds for a restricted definition according to which innovation in surgical technique is classified as a form of sui generis surgical 'research', where the explicit goal of adopting such a definition is to bring about needed improvements in knowledge transfer and thereby benefit current and future patients.

  18. The craniofacial team and the Navajo patient.

    PubMed

    Smoot, E C; Kucan, J O; Cope, J S; Aase, J M

    1988-10-01

    The craniofacial team at the University of New Mexico Medical Center in Albuquerque, New Mexico has treated a large population of Navajo Indians. Team awareness of the Navajo concept of health as man in balance with his environment has resulted in more expedient treatment of the Navajo children. An understanding of Navajo concerns with ghosts, skinwalkers, and rules for orderly living has allowed team members to integrate the family and the Navajo medicine man in caring for the children with craniofacial disease. Special concerns for informed surgical consent and genetic counseling of the Navajo are reviewed. Respect for the traditional Navajo healing ceremonies and special handling of disposed body parts in surgery are required of the health professionals caring for these people.

  19. Evidence for extended prophylaxis in the setting of orthopedic surgery.

    PubMed

    Dobesh, Paul P

    2004-07-01

    Patients undergoing orthopedic surgery represent one of the highest risk groups for the development of venous thromboembolism (VTE). Evidence shows that this risk extends beyond the period in which the patient is hospitalized, especially for patients undergoing hip surgery. Clinical trials have shown that extended prophylaxis with the low-molecular-weight heparins is effective in reducing the rate of total VTE, and a meta-analysis demonstrated a reduction in symptomatic VTE with extended prophylaxis after total hip replacement surgery. Based on these results, the American College of Chest Physicians gives a grade 2A recommendation for the use of extended prophylaxis after orthopedic surgery. Until recently, data evaluating the role of prophylaxis in patients undergoing hip fracture surgery were limited. Subsequently, a novel anticoagulant, fondaparinux, demonstrated significant benefit in these patients and has become the first and only agent approved by the United States Food and Drug Administration (FDA) for use in patients undergoing hip fracture surgery Despite the limitations of the older trials, their findings supported the need to evaluate extended prophylaxis in patients undergoing hip fracture surgery. In the first well-conducted trial of extended prophylaxis for hip fracture surgery, fondaparinux provided impressive results in reducing total and symptomatic VTE. The results of this trial have once again led to fondaparinux being the first and only agent to be granted FDA approval for the indication of extended prophylaxis in patients undergoing hip fracture surgery.

  20. Angiogenesis and osteogenesis in an orthopedically expanded suture

    NASA Technical Reports Server (NTRS)

    Chang, H. N.; Garetto, L. P.; Potter, R. H.; Katona, T. R.; Lee, C. H.; Roberts, W. E.

    1997-01-01

    The purpose of this study was to examine the angiogenic and the subsequent osteogenic responses during a 96-hour time-course after sutural expansion. Fifty rats were divided into: (1) a control group that received only angiogenic induction through injection of 5 ng/gm recombinant human endothelial cell growth factor (rhECGF); (2) an experimental group that received orthopedic expansion and rhECGF; (3) a sham group that received expansion and sodium chloride (NaCl) injection; and (4) a baseline group that received no expansion or injection. All rats were injected with 3H-thymidine (1.0 microCi/gm) 1 hour before death to label the DNA of S-phase cells. Demineralized sections (4 microm thick) were stained with hematoxylin and eosin. Angiogenesis and cell migration were analyzed with a previously established cell kinetics model. Analysis of variance was used to test the hypothesis that enhancement of angiogenesis stimulates reestablishment of osteogenic capability. Blood vessel number, area, and endothelial cell-labeled index significantly increased in experimental groups, but no difference was found between control and baseline groups. Labeled-pericyte index and activated pericyte numbers in the experimental group were also higher than in the sham groups. These results show that supplemental rhECGF enhances angiogenesis in expanded sutures but not in nonexpanded sutures. Data also suggest that pericytes are the source of osteoblasts in an orthopedically expanded suture.

  1. Breed susceptibility for developmental orthopedic diseases in dogs.

    PubMed

    LaFond, Elizabeth; Breur, Gert J; Austin, Connie C

    2002-01-01

    A large-scale epidemiological study was conducted to determine breeds at risk for 12 developmental orthopedic diseases (DODs). Developmental orthopedic diseases investigated included canine hip dysplasia (CHD); craniomandibular osteopathy (CMO); fragmented coronoid process; hypertrophic osteodystrophy; Legg-Calvé-Perthes disease; osteochondrosis of the medial humeral condyle, caudal humeral head, femoral condyles, and talar trochlear ridges; panosteitis; patella luxation; and ununited anconeal process. Dogs that were diagnosed with any one of the diseases of interest at any of 10 veterinary teaching hospitals participating in the Veterinary Medical Database from 1986 to 1995 were included as cases. Odds ratios and corresponding 95% confidence intervals were calculated to determine risk. Frequency of diagnosis during the 10-year period ranged from 35 cases (CMO) to 10,637 cases (CHD). The number of breeds at increased risk for a disease ranged from one (CMO) to 35 (CHD). Breed susceptibility for a DOD may suggest a genetic component in the disease etiology. The results of this study serve to increase veterinarians' awareness of breeds susceptible to DODs and may facilitate the control of such diseases by identifying breeds that might benefit from breeding programs or environmental intervention such as dietary modification.

  2. Maximizing Patient Thermoregulation in US Army Forward Surgical Teams

    DTIC Science & Technology

    2008-01-01

    Zelenock GB. Hypothermia is an independent predictor of mortality in ruptured abdominal aortic aneurysms . Vasc Endovasc Surg. 2004;38(1):37-42. 8...Factors affecting mortality rates in patients with abdominal vascular injuries. J Trauma. 2001;50 (6):1020-1026. 5. Cushman JG, Feliciano DV, Renz BM...Ann Surg. 1997;226(4):439-447. 12. Johnson JW, Gracias VH, Schwab CW, et al. Evolution in damage control for exsanguinating penetrating abdominal

  3. The Orthopedically Disabled Child: Psychological Implications with an Individual Basis. July 1984 Revision.

    ERIC Educational Resources Information Center

    Sigmon, Scott B.

    This study describes the implications of the Individual Psychology of Alfred Adler and field theory associated with Kurt Lewin in understanding orthopedically disabled children and points out that orthopedically disabled youngsters have a remarkable range of individual differences both in type of disability as well as level of adjustment.…

  4. Age, Physical Activity, Physical Fitness, Body Composition, and Incidence of Orthopedic Problems.

    ERIC Educational Resources Information Center

    Research Quarterly for Exercise and Sport, 1989

    1989-01-01

    Effects of age, physical activity, physical fitness, and body mass index (BMI) on the occurrence of orthopedic problems were examined. For men, physical fitness, BMI, and physical activity were associated with orthopedic problems; for women, physical activity was the main predictor. Age was not a factor for either gender. (JD)

  5. Guidelines for the Implementation of Programs for Pupils Who Are Orthopedically Handicapped.

    ERIC Educational Resources Information Center

    Black, Robert S.; Fusco, Carol B.

    Guidelines are provided for the development of programs in South Carolina for orthopedically handicapped (OH) pupils. Basic information is given concerning the definition of orthopedic handicap, the legal mandates on the education of OH pupils, funding sources, authorized programs (whether self-contained programs, resource rooms, or itinerant…

  6. Interpretation by radiologists of orthopedic total joint radiographs: Is it necessary or cost-effective?

    PubMed Central

    Nayak, K. Naresh K.; Rorabeck, Cecil H.; Bourne, Robert B.; Mulliken, Brian; Robinson, Eric

    1996-01-01

    Objective To examine the necessity and cost-effectiveness of interpretation by radiologists of orthopedic radiographs obtained for patients who undergo total hip or knee replacement. Design A prospective study. Serial preoperative and postoperative x-ray films of the joint in patients scheduled to undergo total hip or knee joint replacement during one calendar year were interpreted by both radiology and orthopedic department staff and compared. Intraoperative findings were used to confirm the radiologic interpretation. The follow-up was 1 year. Setting A university teaching hospital. Interventions Primary or revision total hip or knee replacement. Main Outcome Measures Differences in interpretation of radiographs by radiologists and orthopedic surgeons for any of the four procedures. A change in orthopedic management. Results For preoperative radiographs, there were no discrepancies between the radiologists and orthopedic surgeons with respect to primary joint replacement. For 100 revision procedures there were 15 discrepancies, but in all cases the orthopedic surgeon’s interpretation proved to be correct. For the postoperative radiographs, there were no discrepancies in the group of revision hip replacements. For the other three groups there were a total of six discrepancies and in all cases the orthopedic surgeon’s interpretation was correct. In two cases conditions were present that were not recognized by staff from either the radiology department or orthopedic department. Conclusion Interpretation by radiologists of total joint radiographs in patients who undergo primary or revision total hip or knee replacement arthroplasty is not necessary or cost-effective. PMID:8857988

  7. Military Curricula for Vocational & Technical Education. Orthopedic Specialist, Classroom Course 10-13.

    ERIC Educational Resources Information Center

    Brooke Army Medical Center, Fort Sam Houston, TX. Health Care Research Div.

    These military-developed curriculum materials for a course for orthopedic specialists are targeted for students from grades 11 through the adult level. The course is designed to provide a working knowledge of the application of casts, traction, and splints to orthopedic patients and the removal of these devices; a working knowledge of assisting in…

  8. A qualitative and quantitative needs assessment of pain management for hospitalized orthopedic patients.

    PubMed

    Cordts, Grace A; Grant, Marian S; Brandt, Lynsey E; Mears, Simon C

    2011-08-08

    Despite advances in pain management, little formal teaching is given to practitioners and nurses in its use for postoperative orthopedic patients. The goal of our study was to determine the educational needs for orthopedic pain management of our residents, nurses, and physical therapists using a quantitative and qualitative assessment. The needs analysis was conducted in a 10-bed orthopedic unit at a teaching hospital and included a survey given to 20 orthopedic residents, 9 nurses, and 6 physical therapists, followed by focus groups addressing barriers to pain control and knowledge of pain management. Key challenges for nurses included not always having breakthrough pain medication orders and the gap in pain management between cessation of patient-controlled analgesia and ordering and administering oral medications. Key challenges for orthopedic residents included treating pain in patients with a history of substance abuse, assessing pain, and determining when to use long-acting vs short-acting opioids. Focus group assessments revealed a lack of training in pain management and the need for better coordination of care between nurses and practitioners and improved education about special needs groups (the elderly and those with substance abuse issues). This needs assessment showed that orthopedic residents and nurses receive little formal education on pain management, despite having to address pain on a daily basis. This information will be used to develop an educational program to improve pain management for postoperative orthopedic patients. An integrated educational program with orthopedic residents, nurses, and physical therapists would promote understanding of issues for each discipline.

  9. Endovascular repair of femoral artery pseudoaneurysm after orthopedic surgery with balloon-expandable covered stents.

    PubMed

    Eslami, Mohammad H; Silvia, Brian A

    2008-01-01

    Arterial injury after orthopedic procedures is an uncommon complication that can present clinically in a variety of forms and has conventionally been repaired by open vascular surgery. The case and discussion in this article highlights the usefulness of endovascular repair following a delayed presentation of vascular injury from an orthopedic procedure.

  10. Factors affecting interest in orthopedics among female medical students: a prospective analysis.

    PubMed

    Baldwin, Keith; Namdari, Surena; Bowers, Andrea; Keenan, Mary Ann; Levin, L Scott; Ahn, Jaimo

    2011-12-06

    The field of orthopedics has a limited ability to recruit high-quality female applicants. The purpose of this study was to determine whether early exposure to the field affects a woman's decision to pursue orthopedics. We performed a prospective, nonrandomized cohort study between academic years 2005 and 2009 and compared interest in orthopedic surgery among female (n=271) and male (n=71) medical students at 2 urban teaching institutions. Elective lectures and orthopedic literature were distributed via e-mail to the study participants. These materials included articles published in the medical literature, materials produced and distributed by the American Academy of Orthopaedic Surgeons, and Web sites providing educational materials. The primary outcome was the likelihood of application for orthopedic residency. We studied the influence of demographics, exposure, and attitudes on interest in pursuing an orthopedic career. Men had a significantly higher baseline level of interest in orthopedic surgery than women (P=.005). Younger age (P<.001) and personal (P<.001), independent (P<.001), and school (P=.023) exposures to orthopedics were significantly related to interest among women. At final follow-up, total personal exposures (P=.003) and total independent exposures (P<.001) in the form of our literature and lectures were correlated with final interest in women. Female interest was decreased by the long hours, physical demands, and predominantly male nature of the field. Early exposure to orthopedic educational resources may be useful in generating female interest. Perceptions and attitudes regarding orthopedic surgery must to be changed to attract the best and brightest minds, regardless of sex.

  11. Managing multicultural teams.

    PubMed

    Brett, Jeanne; Behfar, Kristin; Kern, Mary C

    2006-11-01

    Multicultural teams offer a number of advantages to international firms, including deep knowledge of different product markets, culturally sensitive customer service, and 24-hour work rotations. But those advantages may be outweighed by problems stemming from cultural differences, which can seriously impair the effectiveness of a team or even bring itto a stalemate. How can managers best cope with culture-based challenges? The authors conducted in-depth interviews with managers and members of multicultural teams from all over the world. Drawing on their extensive research on dispute resolution and teamwork and those interviews, they identify four problem categories that can create barriers to a team's success: direct versus indirect communication, trouble with accents and fluency, differing attitudes toward hierarchy and authority, and conflicting norms for decision making. If a manager--or a team member--can pinpoint the root cause of the problem, he or she is likelier to select an appropriate strategy for solving it. The most successful teams and managers, the authors found, dealt with multicultural challenges in one of four ways: adaptation (acknowledging cultural gaps openly and working around them), structural intervention (changing the shape or makeup of the team), managerial intervention (setting norms early or bringing in a higher-level manager), and exit (removing a team member when other options have failed). Which strategy is best depends on the particular circumstances--and each has potential complications. In general, though, managers who intervene early and set norms; teams and managers who try to engage everyone on the team; and teams that can see challenges as stemming from culture, not personality, succeed in solving culture-based problems with good humor and creativity. They are the likeliest to harvest the benefits inherent in multicultural teams.

  12. The surgical ensemble: choreography as a simulation and training tool.

    PubMed

    Satava, Richard M; Hunter, Anne Marie

    2011-09-01

    Team training and interprofessional training have recently emerged as critical new simulations that enhance performance by coordinating communication, leadership, professional, and, to a certain extent, technical skills. In describing these new training tools, the term choreography has been loosely used, but no critical appraisal of the role of the science of choreography has been applied to a surgical procedure. By analogy, the surgical team, including anesthetists, surgeons, nurses, and technicians, constitutes a complete ensemble, whose physical actions and interactions constitute the "performance of surgery." There are very specific "elements" (tools) that are basic to choreography, such as space, timing, rhythm, energy, cues, transitions, and especially rehearsal. This review explores whether such a metaphor is appropriate and the possibility of applying the science of choreography to the surgical team in the operating theater.

  13. Congenital and acquired orthopedic abnormalities in patients with myelomeningocele.

    PubMed

    Westcott, M A; Dynes, M C; Remer, E M; Donaldson, J S; Dias, L S

    1992-11-01

    This article presents a radiologic review of the spectrum of acquired and congenital orthopedic abnormalities found in patients with myelomeningocele. These abnormalities are caused predominantly by muscle imbalance, paralysis, and decreased sensation in the lower extremity. Iatrogenic injury, such as a postoperative tethered cord, may also cause bone abnormalities. Selected images were obtained from more than 800 children. Important entities presented include spinal curvatures such as kyphosis, scoliosis, and lordosis; subluxation and dislocation of the hip, coxa valga, contractures of the hip, and femoral torsion; knee deformities; rotational abnormalities of the lower extremity and external and internal torsion; ankle and foot abnormalities such as ankle valgus, calcaneus foot, congenital vertical talus (rocker-bottom deformity), and talipes equinovarus; and metaphyseal, diaphyseal, and physeal fractures. Familiarity with congenital abnormalities and an understanding of the pathogenesis of acquired disorders in patients with myelomeningocele are essential for proper radiologic interpretation and timely therapy.

  14. Mechanical Properties of Nanotextured Titanium Orthopedic Screws for Clinical Applications.

    PubMed

    Descamps, Stephane; Awitor, Komla O; Raspal, Vincent; Johnson, Matthew B; Bokalawela, Roshan S P; Larson, Preston R; Doiron, Curtis F

    2013-06-01

    In this work, we modified the topography of commercial titanium orthopedic screws using electrochemical anodization in a 0.4 wt% hydrofluoric acid solution to produce titanium dioxide nanotube layers. The morphology of the nanotube layers were characterized using scanning electron microscopy. The mechanical properties of the nanotube layers were investigated by screwing and unscrewing an anodized screw into several different types of human bone while the torsional force applied to the screwdriver was measured using a torque screwdriver. The range of torsional force applied to the screwdriver was between 5 and [Formula: see text]. Independent assessment of the mechanical properties of the same surfaces was performed on simple anodized titanium foils using a triboindenter. Results showed that the fabricated nanotube layers can resist mechanical stresses close to those found in clinical situations.

  15. Barriers to the clinical translation of orthopedic tissue engineering.

    PubMed

    Evans, Christopher H

    2011-12-01

    Tissue engineering and regenerative medicine have been the subject of increasingly intensive research for over 20 years, and there is concern in some quarters over the lack of clinically useful products despite the large sums of money invested. This review provides one perspective on orthopedic applications from a biologist working in academia. It is suggested that the delay in clinical application is not atypical of new, biologically based technologies. Some barriers to progress are acknowledged and discussed, but it is also noted that preclinical studies have identified several promising types of cells, scaffolds, and morphogenetic signals, which, although not optimal, are worth advancing toward human trials to establish a bridgehead in the clinic. Although this transitional technology will be replaced by more sophisticated, subsequent systems, it will perform valuable pioneering functions and facilitate the clinical development of the field. Some strategies for achieving this are suggested.

  16. Abortion - surgical - aftercare

    MedlinePlus

    ... this page: //medlineplus.gov/ency/patientinstructions/000658.htm Abortion - surgical - aftercare To use the sharing features on ... please enable JavaScript. You have had a surgical abortion. This is a procedure that ends pregnancy by ...

  17. Orthopedic Correction of Growing Hyperdivergent, Retrognathic, Patients with Miniscrew Implants

    PubMed Central

    Buschang, Peter H.; Carrillo, Roberto; Rossouw, P. Emile

    2010-01-01

    Traditional orthodontic treatments do not adequately address the skeletal problems of retrognathic, hyperdivergent, Class II adolescents; the few approaches that do require long-term patient compliance. This paper introduces a novel approach using miniscrew implants (MSIa) and growth to treat retrognathic hyperdivergent adolescents. Nine consecutive patients were evaluated at the start of treatment (13.2 ±1.1 years of age) and again at the end of the orthopedic phase (after 1.9 ±0.3 years). Each patient had two MSIs placed in either side of the palate. Coil springs (150 g) extended from the MSIs to a RPE, which served as a rigid segment for intruding the maxillary premolar and molars. Two additional MSIs were placed between the first mandibular molars and second premolars; coil spring (150 g) extended from the MSIs to hold or intrude the mandibular molars. Prior to treatment, the patients exhibited substantial and significant mandibular retrusion (Z-score=−1.0), facial convexity (Z-score=0.7), and hyperdivergence (Z-score=1.6). Treatment produced consistent and substantial orthopedic effects. The chin was advanced an average of 2.4 mm, the SNB angle increased by 2.1°, the mandibular plane angle decreased 3.9°, and facial convexity decreased by approximately 3.2°. Questionnaires showed that this treatment approach was not painful or uncomfortable; the majority of the patients indicated that they were very likely to recommend the treatment to others. Treatment was accomplished by titrating the amount of orthodontic intrusion performed based on the individuals’ growth potential. PMID:21236539

  18. Applications of finite element simulation in orthopedic and trauma surgery

    PubMed Central

    Herrera, Antonio; Ibarz, Elena; Cegoñino, José; Lobo-Escolar, Antonio; Puértolas, Sergio; López, Enrique; Mateo, Jesús; Gracia, Luis

    2012-01-01

    Research in different areas of orthopedic and trauma surgery requires a methodology that allows both a more economic approach and the ability to reproduce different situations in an easy way. Simulation models have been introduced recently in bioengineering and could become an essential tool in the study of any physiological unity, regardless of its complexity. The main problem in modeling with finite elements simulation is to achieve an accurate reproduction of the anatomy and a perfect correlation of the different structures, in any region of the human body. Authors have developed a mixed technique, joining the use of a three-dimensional laser scanner Roland Picza captured together with computed tomography (CT) and 3D CT images, to achieve a perfect reproduction of the anatomy. Finite element (FE) simulation lets us know the biomechanical changes that take place after hip prostheses or osteosynthesis implantation and biological responses of bone to biomechanical changes. The simulation models are able to predict changes in bone stress distribution around the implant, so allowing preventing future pathologies. The development of a FE model of lumbar spine is another interesting application of the simulation. The model allows research on the lumbar spine, not only in physiological conditions but also simulating different load conditions, to assess the impact on biomechanics. Different degrees of disc degeneration can also be simulated to determine the impact on adjacent anatomical elements. Finally, FE models may be useful to test different fixation systems, i.e., pedicular screws, interbody devices or rigid fixations compared with the dynamic ones. We have also developed models of lumbar spine and hip joint to predict the occurrence of osteoporotic fractures, based on densitometric determinations and specific biomechanical models, including approaches from damage and fracture mechanics. FE simulations also allow us to predict the behavior of orthopedic splints

  19. Surface Functionalization of Orthopedic Titanium Implants with Bone Sialoprotein.

    PubMed

    Baranowski, Andreas; Klein, Anja; Ritz, Ulrike; Ackermann, Angelika; Anthonissen, Joris; Kaufmann, Kerstin B; Brendel, Christian; Götz, Hermann; Rommens, Pol M; Hofmann, Alexander

    2016-01-01

    Orthopedic implant failure due to aseptic loosening and mechanical instability remains a major problem in total joint replacement. Improving osseointegration at the bone-implant interface may reduce micromotion and loosening. Bone sialoprotein (BSP) has been shown to enhance bone formation when coated onto titanium femoral implants and in rat calvarial defect models. However, the most appropriate method of BSP coating, the necessary level of BSP coating, and the effect of BSP coating on cell behavior remain largely unknown. In this study, BSP was covalently coupled to titanium surfaces via an aminosilane linker (APTES), and its properties were compared to BSP applied to titanium via physisorption and untreated titanium. Cell functions were examined using primary human osteoblasts (hOBs) and L929 mouse fibroblasts. Gene expression of specific bone turnover markers at the RNA level was detected at different intervals. Cell adhesion to titanium surfaces treated with BSP via physisorption was not significantly different from that of untreated titanium at any time point, whereas BSP application via covalent coupling caused reduced cell adhesion during the first few hours in culture. Cell migration was increased on titanium disks that were treated with higher concentrations of BSP solution, independent of the coating method. During the early phases of hOB proliferation, a suppressive effect of BSP was observed independent of its concentration, particularly when BSP was applied to the titanium surface via physisorption. Although alkaline phosphatase activity was reduced in the BSP-coated titanium groups after 4 days in culture, increased calcium deposition was observed after 21 days. In particular, the gene expression level of RUNX2 was upregulated by BSP. The increase in calcium deposition and the stimulation of cell differentiation induced by BSP highlight its potential as a surface modifier that could enhance the osseointegration of orthopedic implants. Both

  20. Applications of finite element simulation in orthopedic and trauma surgery.

    PubMed

    Herrera, Antonio; Ibarz, Elena; Cegoñino, José; Lobo-Escolar, Antonio; Puértolas, Sergio; López, Enrique; Mateo, Jesús; Gracia, Luis

    2012-04-18

    Research in different areas of orthopedic and trauma surgery requires a methodology that allows both a more economic approach and the ability to reproduce different situations in an easy way. Simulation models have been introduced recently in bioengineering and could become an essential tool in the study of any physiological unity, regardless of its complexity. The main problem in modeling with finite elements simulation is to achieve an accurate reproduction of the anatomy and a perfect correlation of the different structures, in any region of the human body. Authors have developed a mixed technique, joining the use of a three-dimensional laser scanner Roland Picza captured together with computed tomography (CT) and 3D CT images, to achieve a perfect reproduction of the anatomy. Finite element (FE) simulation lets us know the biomechanical changes that take place after hip prostheses or osteosynthesis implantation and biological responses of bone to biomechanical changes. The simulation models are able to predict changes in bone stress distribution around the implant, so allowing preventing future pathologies. The development of a FE model of lumbar spine is another interesting application of the simulation. The model allows research on the lumbar spine, not only in physiological conditions but also simulating different load conditions, to assess the impact on biomechanics. Different degrees of disc degeneration can also be simulated to determine the impact on adjacent anatomical elements. Finally, FE models may be useful to test different fixation systems, i.e., pedicular screws, interbody devices or rigid fixations compared with the dynamic ones. We have also developed models of lumbar spine and hip joint to predict the occurrence of osteoporotic fractures, based on densitometric determinations and specific biomechanical models, including approaches from damage and fracture mechanics. FE simulations also allow us to predict the behavior of orthopedic splints

  1. Hydroxyapatite-nanotube composites and coatings for orthopedic applications

    NASA Astrophysics Data System (ADS)

    Lahiri, Debrupa

    Hydroxyapatite (HA) has received wide attention in orthopedics, due to its biocompatibility and osseointegration ability. Despite these advantages, the brittle nature and low fracture toughness of HA often results in rapid wear and premature fracture of implant. Hence, there is a need to improve the fracture toughness and wear resistance of HA without compromising its biocompatibility. The aim of the current research is to explore the potential of nanotubes as reinforcement to HA for orthopedic implants. HA- 4 wt.% carbon nanotube (CNT) composites and coatings are synthesized by spark plasma sintering and plasma spraying respectively, and investigated for their mechanical, tribological and biological behavior. CNT reinforcement improves the fracture toughness (>90%) and wear resistance (>66%) of HA for coating and free standing composites. CNTs have demonstrated a positive influence on the proliferation, differentiation and matrix mineralization activities of osteoblasts, during in-vitro biocompatibility studies. In-vivo exposure of HA-CNT coated titanium implant in animal model (rat) shows excellent histocompatibility and neobone integration on the implant surface. The improved osseointegration due to presence of CNTs in HA is quantified by the adhesion strength measurement of single osteoblast using nano-scratch technique. Considering the ongoing debate about cytotoxicity of CNTs in the literature, the present study also suggests boron nitride nanotube (BNNT) as an alternative reinforcement. BNNT with the similar elastic modulus and strength as CNT, were added to HA. The resulting composite having 4 wt.% BNNTs improved the fracture toughness (˜85%) and wear resistance (˜75%) of HA in the similar range as HA-CNT composites. BNNTs were found to be non-cytotoxic for osteoblasts and macrophages. In-vitro evaluation shows positive role of BNNT in osteoblast proliferation and viability. Apatite formability of BNNT surface in ˜4 days establishes its osseointegration

  2. Surface Functionalization of Orthopedic Titanium Implants with Bone Sialoprotein

    PubMed Central

    Ritz, Ulrike; Ackermann, Angelika; Anthonissen, Joris; Kaufmann, Kerstin B.; Brendel, Christian; Götz, Hermann; Rommens, Pol M.; Hofmann, Alexander

    2016-01-01

    Orthopedic implant failure due to aseptic loosening and mechanical instability remains a major problem in total joint replacement. Improving osseointegration at the bone-implant interface may reduce micromotion and loosening. Bone sialoprotein (BSP) has been shown to enhance bone formation when coated onto titanium femoral implants and in rat calvarial defect models. However, the most appropriate method of BSP coating, the necessary level of BSP coating, and the effect of BSP coating on cell behavior remain largely unknown. In this study, BSP was covalently coupled to titanium surfaces via an aminosilane linker (APTES), and its properties were compared to BSP applied to titanium via physisorption and untreated titanium. Cell functions were examined using primary human osteoblasts (hOBs) and L929 mouse fibroblasts. Gene expression of specific bone turnover markers at the RNA level was detected at different intervals. Cell adhesion to titanium surfaces treated with BSP via physisorption was not significantly different from that of untreated titanium at any time point, whereas BSP application via covalent coupling caused reduced cell adhesion during the first few hours in culture. Cell migration was increased on titanium disks that were treated with higher concentrations of BSP solution, independent of the coating method. During the early phases of hOB proliferation, a suppressive effect of BSP was observed independent of its concentration, particularly when BSP was applied to the titanium surface via physisorption. Although alkaline phosphatase activity was reduced in the BSP-coated titanium groups after 4 days in culture, increased calcium deposition was observed after 21 days. In particular, the gene expression level of RUNX2 was upregulated by BSP. The increase in calcium deposition and the stimulation of cell differentiation induced by BSP highlight its potential as a surface modifier that could enhance the osseointegration of orthopedic implants. Both

  3. Surgical treatment of dental and skeletal Class III malocclusion.

    PubMed

    Brunharo, Ione Helena Vieira Portella

    2013-01-01

    Orthodontic preparation for surgical treatment of skeletal Class III malocclusion involves joint planning with an oral and maxillofacial surgeon to address the functional and esthetic needs of the patient. In order to allow surgical manipulation of the jaws in the preoperative phase, the need to achieve a negative overjet through incisor decompensation often leads the orthodontist to extract the upper first premolars. This report illustrates an orthodontic preparation case where due to specific factors inherent in the patient's psychological makeup retroclination of the upper incisors and proclination of the mandibular incisors was achieved without removing any teeth. This case was presented to the Brazilian Board of Orthodontics and Facial Orthopedics (BBO) in partial fulfillment of the requirements for obtaining the BBO Diploma.

  4. Vertical orbital dystopia--surgical correction.

    PubMed

    Edgerton, M T; Jane, J A

    1981-02-01

    The surgical correction of vertical malpositions of the human eye has been made relatively safe and reliable by recent surgical techniques. The authors define this condition as vertical orbital dystopia and review the etiology of this deformity in 38 recent consecutive cases that were surgically treated at the Craniofacial Anomalies Center of The University of Virginia. Some new and useful tests are described that are of value to the plastic surgeon in analysis of the facial deformity and in planning the appropriate surgical procedure to correct the vertical dystopia of one or both eyes. Several cases are illustrated that describe the principal surgical methods of moving the eye up or down without loss of vision. The vertical eye shifts in this series have been in the range of 2 to 3 mm to over 22 mm. No loss of vision was produced by these corrections. The most common difficulties and complications of orbital dystopia corrections are described. The implications of this type of surgery in terms of visual physiology are suggested. The authors conclude that surgical correction of vertical orbital dystopias is possible, safe, and rewarding to the patients. However, they advise that the correction is best performed in young children and by a specially trained team of plastic surgeons, neurosurgeons, and ophthalmologists.

  5. The value analysis team: a shared mental model.

    PubMed

    Lang, Kathryn; Eaton, Bradley

    2009-01-01

    Value analysis teams, which standardize procurement and use of products across hospitals and health systems, have experienced great success in saving money for health care organizations. One example is the work of the Medical/Surgical Value Analysis Team at a larger New York metropolitan multihospital system, which has saved the system $1.2 million. This article examines what managers need to consider before forming such teams and how to guide the work. It will also look at the qualities and qualifications of the people who must be involved to make the process effective.

  6. TEAM Electron Microscope Animation

    SciTech Connect

    2012-01-01

    The TEAM Electron Microscope, a device that enables atomic-scale imaging in 3-D, has a rotating stage that can hold and position samples inside electron microscopes with unprecedented stability, position-control accuracy, and range of motion.The TEAM Stage makes one of the world's most powerful electron microscopes even better, and enables previously impossible experiments.

  7. Team Based Work. Symposium.

    ERIC Educational Resources Information Center

    2002

    This document contains three papers from a symposium on team-based work in human resource development (HRD). "Toward Transformational Learning in Organizations: Effects of Model-II Governing Variables on Perceived Learning in Teams" (Blair K. Carruth) summarizes a study that indicated that, regardless of which Model-II variable (valid…

  8. Making Science Teams Work

    ERIC Educational Resources Information Center

    Miller, Roxanne Greitz

    2004-01-01

    Science teachers, likely have more experience with students working together than teachers in any other subject area due to teaming students for hands-on activities. While the importance of teamwork is emphasized in the National Science Education Standards, getting teams to actually work-meaning getting students to share equally in the academic…

  9. Interactive Team Cognition

    ERIC Educational Resources Information Center

    Cooke, Nancy J.; Gorman, Jamie C.; Myers, Christopher W.; Duran, Jasmine L.

    2013-01-01

    Cognition in work teams has been predominantly understood and explained in terms of shared cognition with a focus on the similarity of static knowledge structures across individual team members. Inspired by the current zeitgeist in cognitive science, as well as by empirical data and pragmatic concerns, we offer an alternative theory of team…

  10. Team-Based Learning

    ERIC Educational Resources Information Center

    Michaelsen, Larry K.; Sweet, Michael

    2011-01-01

    Team-based learning (TBL), when properly implemented, includes many, if not all, of the common elements of evidence-based best practices. To explain this, a brief overview of TBL is presented. The authors examine the relationship between the best practices of evidence-based teaching and the principles that constitute team-based learning. (Contains…

  11. Reaching Out: Team AETHER

    NASA Technical Reports Server (NTRS)

    Murphy, Gloria A.

    2010-01-01

    Embry Riddle Aeronautical University's Daytona Beach Campus Lunabotics Team took the opportunity to share the love of space, engineering and technology through the educational outreach portion of the competition. Through visits to elementary schools and high schools, and through support of science fairs and robotics competitions, younger generations were introduced to space, engineering and robotics. This report documents the outreach activities of team Aether.

  12. Team Learning Beliefs and Behaviours in Response Teams

    ERIC Educational Resources Information Center

    Boon, Anne; Raes, Elisabeth; Kyndt, Eva; Dochy, Filip

    2013-01-01

    Purpose: Teams, teamwork and team learning have been the subject of many research studies over the last decades. This article aims at investigating and confirming the Team Learning Beliefs and Behaviours (TLB&B) model within a very specific population, i.e. police and firemen teams. Within this context, the paper asks whether the team's…

  13. Measuring Team Learning Behaviours through Observing Verbal Team Interaction

    ERIC Educational Resources Information Center

    Raes, Elisabeth; Boon, Anne; Kyndt, Eva; Dochy, Filip

    2015-01-01

    Purpose: This study aims to explore, as an answer to the observed lack of knowledge about actual team learning behaviours, the characteristics of the actual observed basic team learning behaviours and facilitating team learning behaviours more in-depth of three project teams. Over time, team learning in an organisational context has been…

  14. Leading Teams of Leaders: What Helps Team Member Learning?

    ERIC Educational Resources Information Center

    Higgins, Monica; Young, Lissa; Weiner, Jennie; Wlodarczyk, Steven

    2010-01-01

    School districts are moving toward a new form of management in which superintendents need to form and nurture leadership teams. A study of 25 such teams in Connecticut suggests that a team's effectiveness is maximized when the team members are coached by other team members, not the superintendent, and when they are coached on task-related…

  15. Groups Meet . . . Teams Improve: Building Teams That Learn

    ERIC Educational Resources Information Center

    Hillier, Janet; Dunn-Jensen, Linda M.

    2013-01-01

    Although most business students participate in team-based projects during undergraduate or graduate course work, the team experience does not always teach team skills or capture the team members' potential: Students complete the task at hand but the explicit process of becoming a team is often not learned. Drawing from organizational learning…

  16. The Problems Facing Multidisciplinary Teams: As Perceived by Team Members.

    ERIC Educational Resources Information Center

    Pfeiffer, Steven I.

    1981-01-01

    Investigated the problems team members perceive to exist on multidisciplinary teams. Results indicated the two major areas of concern for urban, multidisciplinary team members were: too constrictive a set of team roles and goals, and teams functioning under extensive pressure with minimal support. (Author)

  17. Team Psychological Safety and Team Learning: A Cultural Perspective

    ERIC Educational Resources Information Center

    Cauwelier, Peter; Ribière, Vincent M.; Bennet, Alex

    2016-01-01

    Purpose: The purpose of this paper was to evaluate if the concept of team psychological safety, a key driver of team learning and originally studied in the West, can be applied in teams from different national cultures. The model originally validated for teams in the West is applied to teams in Thailand to evaluate its validity, and the views team…

  18. [Skeletal discrepancies: could we avoid surgical procedures?].

    PubMed

    Bouletreau, Pierre; Raberin, Monique; Mayeux, Jean-François

    2014-12-01

    Orthodontic-surgical protocols are nowadays considered as the state-of-the-art in cases of skeletal dentomaxillary dysmorphosis. However, for some reasons, it may happen that unquestionable indications for orthodontic-surgical procedures are not respected, patients being treated by orthodontics alone. This kind of mistake in the treatment planning lay the patient open to various potential complications such as: abnormal duration of the orthodontic treatment, dental root resorptions, questionable tooth extraction, unfavorable facial aesthetics, treatment instability... The authors discuss these points illustrated by clinical cases. Although orthognathic surgery protocols became considerably simplified these last two decades, orthodontic-surgical protocols are still relevantly considered as heavy both by patients and practitioners. As a consequence, their indication must be carefully weighed by a multidisciplinary team, keeping in mind that these protocols represent the ultimate functional and aesthetic treatment for dento-skeletal dysmorphoses.

  19. Citations and Team Sizes

    NASA Astrophysics Data System (ADS)

    Abt, Helmut A.

    2017-02-01

    I explore whether small or large teams produce the most important astronomical results, on average, using citation counts as our metric. I present evidence that citation counts indicate the importance of papers. For the 1343 papers published in A&A, ApJ, and MNRAS in 2012 January-February, I considered 4.5 years worth of citations. In each journal, there are larger citation counts for papers from large teams than from small teams by a factor of about 2. To check whether the results from 2012 were unusual, I collected data from 2013 for A&A and found it to be the same as that for 2012. Could the preponderance of papers by large teams be due to self-citations (i.e., citing and cited papers sharing one or more authors)? To answer this, I looked at 136 papers with one to 266 authors and discovered a linear relation that ranges from a 12.7% self-citation rate for single-author papers to a 45.9% self-citation rate for papers with 100 authors. Correcting for these factors is not enough to explain the predominance of the papers with large teams. Then I computed citations per author. While large teams average more citations than small ones by a factor of 2, individuals on small teams average more citations than individuals on large teams by a factor of 6. The papers by large teams often have far more data, but those by small teams tend to discuss basic physical processes.

  20. Quality and Patient Safety Teams in the Perioperative Setting.

    PubMed

    Serino, Michele Fusco

    2015-12-01

    Quality and patient safety teams in the perioperative setting can provide perioperative personnel with a safety net to prevent avoidable errors, which is a necessity in today's complex surgical world. The primary goal of the quality and patient safety team should be to develop and implement a perioperative quality and patient safety strategic plan. The mission of the plan can be developed by surveying facility employees, choosing a quality methodology, and using an evidence-based approach to develop and implement quality programs and processes. To create and sustain a quality and patient safety team, it is important to select a heterogeneous group; define team roles; identify day-to-day, weekly, and monthly team responsibilities; actively participate in facility committees, meetings, and new employee orientation; conduct audits; and schedule project time.

  1. Elastomeric high-mineral content hydrogel-hydroxyapatite composites for orthopedic applications.

    PubMed

    Song, Jie; Xu, Jianwen; Filion, Tera; Saiz, Eduardo; Tomsia, Antoni P; Lian, Jane B; Stein, Gary S; Ayers, David C; Bertozzi, Carolyn R

    2009-06-15

    The design of synthetic bone grafts that mimic the structure and composition of bone and possess good surgical handling characteristics remains a major challenge. We report the development of poly(2-hydroxyethyl methacrylate) (pHEMA)-hydroxyapatite (HA) composites termed "FlexBone" that possess osteoconductive mineral content approximating that of human bone yet exhibit elastomeric properties enabling the press-fitting into a defect site. The approach involves crosslinking pHEMA hydrogel in the presence of HA using viscous ethylene glycol as a solvent. The composites exhibit excellent structural integration between the apatite mineral component and the hydroxylated hydrogel matrix. The stiffness of the composite and the ability to withstand compressive stress correlate with the microstructure and content of the mineral component. The incorporation of porous aggregates of HA nanocrystals rather than compact micrometer-sized calcined HA effectively improved the resistance of the composite to crack propagation under compression. Freeze-dried FlexBone containing 50 wt % porous HA nanocrystals could withstand hundreds-of-megapascals compressive stress and >80% compressive strain without exhibiting brittle fractures. Upon equilibration with water, FlexBone retained good structural integration and withstood repetitive moderate (megapascals) compressive stress at body temperature. When subcutaneously implanted in rats, FlexBone supported osteoblastic differentiation of the bone marrow stromal cells pre-seeded on FlexBone. Taken together, the combination of high osteoconductive mineral content, excellent organic-inorganic structural integration, elasticity, and the ability to support osteoblastic differentiation in vivo makes FlexBone a promising candidate for orthopedic applications.

  2. Elastomeric high-mineral content hydrogel-hydroxyapatite composites for orthopedic applications

    PubMed Central

    Song, Jie; Xu, Jianwen; Filion, Tera; Saiz, Eduardo; Tomsia, Antoni P.; Lian, Jane B.; Stein, Gary S.; Ayers, David C.; Bertozzi, Carolyn R.

    2009-01-01

    The design of synthetic bone grafts that mimic the structure and composition of bone and possess good surgical handling characteristics remains a major challenge. We report the development of poly(2-hydroxyethyl methacrylate) (pHEMA)-hydroxyapatite (HA) composites termed “FlexBone” that possess osteoconductive mineral content approximating that of human bone yet exhibit elastomeric properties enabling the press-fitting into a defect site. The approach involves crosslinking pHEMA hydrogel in the presence of HA using viscous ethylene glycol as a solvent. The composites exhibit excellent structural integration between the apatite mineral component and the hydroxylated hydrogel matrix. The stiffness of the composite and the ability to withstand compressive stress correlate with the microstructure and content of the mineral component. The incorporation of porous aggregates of HA nanocrystals rather than compact micrometer-sized calcined HA effectively improved the resistance of the composite to crack propagation under compression. Freeze-dried FlexBone containing 50 wt % porous HA nanocrystals could withstand hundreds-of-megapascals compressive stress and >80% compressive strain without exhibiting brittle fractures. Upon equilibration with water, FlexBone retained good structural integration and withstood repetitive moderate (megapascals) compressive stress at body temperature. When subcutaneously implanted in rats, FlexBone supported osteoblastic differentiation of the bone marrow stromal cells pre-seeded on FlexBone. Taken together, the combination of high osteoconductive mineral content, excellent organic-inorganic structural integration, elasticity, and the ability to support osteoblastic differentiation in vivo makes FlexBone a promising candidate for orthopedic applications. PMID:18546185

  3. Postoperative Surgical Infection After Spinal Surgery in Rheumatoid Arthritis.

    PubMed

    Koyama, Kensuke; Ohba, Tetsuro; Ebata, Shigeto; Haro, Hirotaka

    2016-05-01

    Individuals with rheumatoid arthritis are at higher risk for infection than the general population, and surgical site infection after spinal surgery in this population can result in clinically significant complications. The goal of this study was to identify risk factors for acute surgical site infection after spinal surgery in patients with rheumatoid arthritis who were treated with nonbiologic (conventional) disease-modifying antirheumatic drugs (DMARDs) alone or with biologic DMARDs. All patients treated with biologic agents were treated with nonbiologic agents as well. The authors performed a retrospective, single-center review of 47 consecutive patients with rheumatoid arthritis who underwent spinal surgery and had follow-up of 3 months or longer. The incidence of surgical site infection was examined, and multivariate logistic regression analysis was performed to test the association of surgical site infection with putative risk factors, including the use of biologic agents, methotrexate, and prednisolone, as well as the duration of rheumatoid arthritis, the presence of diabetes, patient age, length of surgery, and number of operative levels. After spinal surgery, 14.89% (7 of 47) of patients had surgical site infection. Use of methotrexate and/or prednisolone, patient age, diabetes, duration of rheumatoid arthritis, length of surgery, number of operative levels, and use of biologic DMARDs did not significantly increase the risk of infection associated with spinal surgery. All patients who had surgical site infection had undergone spinal surgery with instrumentation. The findings show that greater attention to preventing surgical site infection may be needed in patients with rheumatoid arthritis who undergo spinal surgery with instrumentation. To the authors' knowledge, this is the first study to show that the use of biologic agents did not increase the incidence of surgical site infection after spinal surgery in patients with rheumatoid arthritis

  4. Teams without Roles: Empowering Teams for Greater Creativity.

    ERIC Educational Resources Information Center

    McCrimmon, Mitch

    1995-01-01

    Criticizes Belbin's team role theory on the basis that roles are appropriate only in static organizations. Argues that most teams have no set roles and members interchange them. Suggests that all team members be trained to manage teamwork effectively. (SK)

  5. [Orthopedic surgical implants and allergies: joint statement by the implant allergy working group (AK 20) of the DGOOC (German association of orthopedics and orthopedic surgery), DKG (German contact dermatitis research group) and dgaki (German society for allergology and clinical immunology)].

    PubMed

    Thomas, P; Schuh, A; Ring, J; Thomsen, M

    2008-01-01

    Materials used in osteosynthesis or artificial joint replacement are usually well tolerated. Complaints after such operations are mostly related to infection or mechanical problems but may also be caused by allergic reactions. The latter encompass skin changes, e.g., eczema, delayed wound/bone healing, recurrent effusion, pain, or implant loosening. In contrast to the high incidence of cutaneous metal contact allergy, allergies associated with implants are a rare condition. However, epidemiological data on the incidence of implant-related allergic reactions are still missing. Typical elicitors are nickel, chromium, cobalt, and constituents of bone cement (acrylates und additives such as gentamicin or benzoyl peroxide). After exclusion of the most common differential diagnoses, allergy diagnostic procedures are primarily based on patch tests including a metal and bone cement component series. Additional analysis of periimplant tissue is recommended. However, further studies are necessary to show the significance of the histologic findings and the role of the lymphocyte transformation test (LTT). Which combinations of factors will induce allergic sensitization to implants or trigger periimplant allergic reactions in the case of preexisting cutaneous metal allergy is still unknown. Titanium-based osteosynthesis materials are recommended for metal allergic patients. In elective hip replacements, a ceramic/polyethylene (PE) articulation should be used, and in knee replacements "alternative materials". If a regular, potentially applicable CoCr/PE articulation is preferred, the patient must be well informed and must give his/her written consent.

  6. [Orthopedic surgical implants and allergies. Joint statement by the Implant Allergy Working Group (AK 20) of the DGOOC (German Association of Orthopedics and Orthopedic Surgery), DKG (German Contact Dermatitis Research Group) and DGAKI (German Society for Allergology and Clinical Immunology)].

    PubMed

    Thomas, P; Schuh, A; Ring, J; Thomsen, M

    2008-03-01

    Materials used in osteosynthesis or artificial joint replacement are usually well tolerated. Complaints after such operations are mostly related to infection or mechanical problems but may also be caused by allergic reactions. The latter encompass skin changes, e.g., eczema, delayed wound/bone healing, recurrent effusion, pain, or implant loosening. In contrast to the high incidence of cutaneous metal contact allergy, allergies associated with implants are a rare condition. However, epidemiological data on the incidence of implant-related allergic reactions are still missing. Typical elicitors are nickel, chromium, cobalt, and constituents of bone cement (acrylates und additives such as gentamicin or benzoyl peroxide). After exclusion of the most common differential diagnoses, allergy diagnostic procedures are primarily based on patch tests including a metal and bone cement component series. Additional analysis of periimplant tissue is recommended. However, further studies are necessary to show the significance of the histologic findings and the role of the lymphocyte transformation test (LTT). Which combinations of factors will induce allergic sensitization to implants or trigger periimplant allergic reactions in the case of preexisting cutaneous metal allergy is still unknown. Titanium-based osteosynthesis materials are recommended for metal allergic patients. In elective hip replacements, a ceramic/polyethylene (PE) articulation should be used, and in knee replacements "alternative materials". If a regular, potentially applicable CoCr/PE articulation is preferred, the patient must be well informed and must give his/her written consent.

  7. Surgical Lasers In Gynecology

    NASA Astrophysics Data System (ADS)

    Schellhas, Helmut F.; Barnes, Alfonso E.

    1982-12-01

    Multipurpose surgical CO2 lasers marketed in the USA have been developed to be applicable to a variety of surgical procedures in many surgical fields. They are all suited for endoscopic surgical procedures and can be fitted to all standard surgical microscopes. They all can adjust the focal length of the laser beam to the different standard focal lengths of the surgical microscope which for instance in laryngoscopy is 400 mm and in colposcopy 300 mm. One laser instrument can even change the spot size in a given focal distance which is very advantageous for some microsurgical procedures (Merrimack Laboratories 820). All multipurpose surgical CO2 laser systems provide a multi-articulated surgical arm for free-hand surgery. The surgical arms are cumbersome to use but they are adapted to the surgeons needs with ingenuity. The practicality of the multi-articulated surgical arms depends mostly on the distance of the handpiece from the surgical console which now is also overbridged by the laser tube in most surgical laser system. The spot size of the beam is variable in most handpieces by interchangeable lenses which modify the focal distance of the beam and the power density. Another common feature in all systems is a coaxial He-Ne pilot light which provides a red spot which unfortunately becomes invisible in a bleeding surgical field. Most surgical laser systems have a spacial mode of TEM 00 which is essential for incisional surgery. The continuous mode of beam delivery is used for incisional surgery and also for most endoscopic procedures.

  8. Usefulness of a metal artifact reduction algorithm for orthopedic implants in abdominal CT: phantom and clinical study results.

    PubMed

    Jeong, Seonji; Kim, Se Hyung; Hwang, Eui Jin; Shin, Cheong-Il; Han, Joon Koo; Choi, Byung Ihn

    2015-02-01

    OBJECTIVE. The purpose of this study was to evaluate the usefulness of a metal artifact reduction (MAR) algorithm for orthopedic prostheses in phantom and clinical CT. MATERIALS AND METHODS. An agar phantom with two sets of spinal screws was scanned at various tube voltage (80-140 kVp) and tube current-time (34-1032 mAs) settings. The orthopedic MAR algorithm was combined with filtered back projection (FBP) or iterative reconstruction. The mean SDs in three ROIs were compared among four datasets (FBP, iterative reconstruction, FBP with orthopedic MAR, and iterative reconstruction with orthopedic MAR). For the clinical study, the mean SDs of three ROIs and 4-point scaled image quality in 52 patients with metallic orthopedic prostheses were compared between CT images acquired with and without orthopedic MAR. The presence and type of image quality improvement with orthopedic MAR and the presence of orthopedic MAR-related new artifacts were also analyzed. RESULTS. In the phantom study, the mean SD with orthopedic MAR was significantly lower than that without orthopedic MAR regardless of dose settings and reconstruction algorithms (FBP versus iterative reconstruction). The mean SD near the metallic prosthesis in 52 patients was significantly lower on CT images with orthopedic MAR (28.04 HU) than those without it (49.21 HU). Image quality regarding metallic artifact was significantly improved with orthopedic MAR (rating of 2.60 versus 1.04). Notable reduction of metallic artifacts and better depiction of abdominal organs were observed in 45 patients. Diagnostic benefit was achieved in six patients, but orthopedic MAR-related new artifacts were seen in 30 patients. CONCLUSION. Use of the orthopedic MAR algorithm significantly reduces metal artifacts in CT of both phantoms and patients and has potential for improving diagnostic performance in patients with severe metallic artifacts.

  9. Teams make it work: how team work engagement mediates between social resources and performance in teams.

    PubMed

    Torrente, Pedro; Salanova, Marisa; Llorens, Susana; Schaufeli, Wilmar B

    2012-02-01

    In this study we analyze the mediating role of team work engagement between team social resources (i.e., supportive team climate, coordination, teamwork), and team performance (i.e., in-role and extra-role performance) as predicted by the Job Demands-Resources Model. Aggregated data of 533 employees nested within 62 teams and 13 organizations were used, whereas team performance was assessed by supervisor ratings. Structural equation modeling revealed that, as expected, team work engagement plays a mediating role between social resources perceived at the team level and team performance as assessed by the supervisor.

  10. Making Teamwork Work: Team Knowledge for Team Effectiveness.

    PubMed

    Guchait, Priyanko; Lei, Puiwa; Tews, Michael J

    2016-01-01

    This study examined the impact of two types of team knowledge on team effectiveness. The study assessed the impact of taskwork knowledge and teamwork knowledge on team satisfaction and performance. A longitudinal study was conducted with 27 service-management teams involving 178 students in a real-life restaurant setting. Teamwork knowledge was found to impact both team outcomes. Furthermore, team learning behavior was found to mediate the relationships between teamwork knowledge and team outcomes. Educators and managers should therefore ensure these types of knowledge are developed in teams along with learning behavior for maximum effectiveness.

  11. Building the team for team science

    USGS Publications Warehouse

    Read, Emily K.; O'Rourke, M.; Hong, G. S.; Hanson, P. C.; Winslow, Luke A.; Crowley, S.; Brewer, C. A.; Weathers, K. C.

    2016-01-01

    The ability to effectively exchange information and develop trusting, collaborative relationships across disciplinary boundaries is essential for 21st century scientists charged with solving complex and large-scale societal and environmental challenges, yet these communication skills are rarely taught. Here, we describe an adaptable training program designed to increase the capacity of scientists to engage in information exchange and relationship development in team science settings. A pilot of the program, developed by a leader in ecological network science, the Global Lake Ecological Observatory Network (GLEON), indicates that the training program resulted in improvement in early career scientists’ confidence in team-based network science collaborations within and outside of the program. Fellows in the program navigated human-network challenges, expanded communication skills, and improved their ability to build professional relationships, all in the context of producing collaborative scientific outcomes. Here, we describe the rationale for key communication training elements and provide evidence that such training is effective in building essential team science skills.

  12. Spines of Steel: A Case of Surgical Enthusiasm in Cold War America.

    PubMed

    Linker, Beth

    2016-01-01

    Just as the prevalence of scoliosis began to decline precipitously after World War II, American orthopedic surgeon Dr. Paul R. Harrington devised a new, invasive surgical system whereby implantable prosthetic metal rods and hooks were used to straighten curved backs. By the 1970s, "Harrington rods" had become the gold standard of surgical scoliosis care in the United States, replacing more conventional methods of exercise, bracing, and casting. This article situates the success of Harrington rods within a much larger and historically longer debate about why, when compared to those in other nations, American surgeons appear to be "more aggressive" and "knife-happy." Using Harrington's papers and correspondence, I argue that patients played a vital role in the rise of spinal surgery. As such, this article examines not only how surgical enthusiasm has been historically measured, defined, and morally evaluated, but also how scoliosis became classified as a debility in need of surgical management.

  13. Surgical instrument similarity metrics and tray analysis for multi-sensor instrument identification

    NASA Astrophysics Data System (ADS)

    Glaser, Bernhard; Schellenberg, Tobias; Franke, Stefan; Dänzer, Stefan; Neumuth, Thomas

    2015-03-01

    A robust identification of the instrument currently used by the surgeon is crucial for the automatic modeling and analysis of surgical procedures. Various approaches for intra-operative surgical instrument identification have been presented, mostly based on radio-frequency identification (RFID) or endoscopic video analysis. A novel approach is to identify the instruments on the instrument table of the scrub nurse with a combination of video and weight information. In a previous article, we successfully followed this approach and applied it to multiple instances of an ear, nose and throat (ENT) procedure and the surgical tray used therein. In this article, we present a metric for the suitability of the instruments of a surgical tray for identification by video and weight analysis and apply it to twelve trays of four different surgical domains (abdominal surgery, neurosurgery, orthopedics and urology). The used trays were digitized at the central sterile services department of the hospital. The results illustrate that surgical trays differ in their suitability for the approach. In general, additional weight information can significantly contribute to the successful identification of surgical instruments. Additionally, for ten different surgical instruments, ten exemplars of each instrument were tested for their weight differences. The samples indicate high weight variability in instruments with identical brand and model number. The results present a new metric for approaches aiming towards intra-operative surgical instrument detection and imply consequences for algorithms exploiting video and weight information for identification purposes.

  14. How to Collaborate through Teams

    ERIC Educational Resources Information Center

    Conderman, Greg

    2016-01-01

    Teachers are spending more of their time and making more decisions within teams. Effective teacher-based teams provide academic and behavioral support for students as well as professional development for teachers. Learn how the best teams function.

  15. Rational design of nanofiber scaffolds for orthopedic tissue repair and regeneration

    PubMed Central

    Ma, Bing; Xie, Jingwei; Jiang, Jiang; Shuler, Franklin D; Bartlett, David E

    2013-01-01

    This article reviews recent significant advances in the design of nanofiber scaffolds for orthopedic tissue repair and regeneration. It begins with a brief introduction on the limitations of current approaches for orthopedic tissue repair and regeneration. It then illustrates that rationally designed scaffolds made up of electrospun nanofibers could be a promising solution to overcome the problems that current approaches encounter. The article also discusses the intriguing properties of electrospun nanofibers, including control of composition, structures, orders, alignments and mechanical properties, use as carriers for topical drug and/or gene sustained delivery, and serving as substrates for the regulation of cell behaviors, which could benefit musculoskeletal tissue repair and regeneration. It further highlights a few of the many recent applications of electrospun nanofiber scaffolds in repairing and regenerating various orthopedic tissues. Finally, the article concludes with perspectives on the challenges and future directions for better design, fabrication and utilization of nanofiber scaffolds for orthopedic tissue engineering. PMID:23987110

  16. Rational design of nanofiber scaffolds for orthopedic tissue repair and regeneration.

    PubMed

    Ma, Bing; Xie, Jingwei; Jiang, Jiang; Shuler, Franklin D; Bartlett, David E

    2013-09-01

    This article reviews recent significant advances in the design of nanofiber scaffolds for orthopedic tissue repair and regeneration. It begins with a brief introduction on the limitations of current approaches for orthopedic tissue repair and regeneration. It then illustrates that rationally designed scaffolds made up of electrospun nanofibers could be a promising solution to overcome the problems that current approaches encounter. The article also discusses the intriguing properties of electrospun nanofibers, including control of composition, structures, orders, alignments and mechanical properties, use as carriers for topical drug and/or gene sustained delivery, and serving as substrates for the regulation of cell behaviors, which could benefit musculoskeletal tissue repair and regeneration. It further highlights a few of the many recent applications of electrospun nanofiber scaffolds in repairing and regenerating various orthopedic tissues. Finally, the article concludes with perspectives on the challenges and future directions for better design, fabrication and utilization of nanofiber scaffolds for orthopedic tissue engineering.

  17. JPL web team

    NASA Technical Reports Server (NTRS)

    Bickler, D. B.

    1986-01-01

    The Jet Propulsion Laboratory (JPL) WEB Team activities were reported for activities which were directed toward identifying and attacking areas in the growth of dendritic web ribbon, to complement the program at Westinghouse Electric Corp.

  18. PPB | Study Team

    Cancer.gov

    The Pleuropulmonary Blastoma (PPB) DICER1 Syndrome Study team is made up of researchers from the National Cancer Institute, Children¹s National Medical Center, the International Pleuropulmonary Blastoma Registry, and Washington University in St. Louis.

  19. Environmental Response Team

    EPA Pesticide Factsheets

    This website will serve as a resource directory of the Environmental Response Team's roles and capabilities as well as list contacts for each discipline to provide information to EPA personnel and the public.

  20. What is Team X?

    NASA Technical Reports Server (NTRS)

    Warfield, Keith

    2012-01-01

    Team X is a concurrent engineering team for rapid design and analysis of space mission concepts. It was developed in 1995 by JPL to reduce study time and cost. More than 1100 studies have been completed It is institutionally endorsed and it has been emulated by many institutions. In Concurrent Engineering (i.e., Parallel) diverse specialists work in real time, in the same place, with shared data, to yield an integrated design

  1. Do Astronauts Havbe a Higher Rate of Orthopedic Shoulder Conditions Than a Cohort of Working Professionals

    NASA Technical Reports Server (NTRS)

    Laughlin, M. S.; Murray, J. D.; Young, M.; Wear, M. L.; Van Baalen, M.; Tarver, W. J.

    2016-01-01

    Occupational surveillance of astronaut shoulder injuries began with operational concerns at the Neutral Buoyancy Laboratory (NBL) during Extra Vehicular Activity (EVA) training. Orthopedic shoulder injury and surgery rates were calculated [1], but classifying the rates as normal, high or low was highly dependent on the comparison group. Thus, the purpose of this study was to identify a population of working professionals and compare orthopedic shoulder consultation and surgery rates.

  2. TEAMS Model Analyzer

    NASA Technical Reports Server (NTRS)

    Tijidjian, Raffi P.

    2010-01-01

    The TEAMS model analyzer is a supporting tool developed to work with models created with TEAMS (Testability, Engineering, and Maintenance System), which was developed by QSI. In an effort to reduce the time spent in the manual process that each TEAMS modeler must perform in the preparation of reporting for model reviews, a new tool has been developed as an aid to models developed in TEAMS. The software allows for the viewing, reporting, and checking of TEAMS models that are checked into the TEAMS model database. The software allows the user to selectively model in a hierarchical tree outline view that displays the components, failure modes, and ports. The reporting features allow the user to quickly gather statistics about the model, and generate an input/output report pertaining to all of the components. Rules can be automatically validated against the model, with a report generated containing resulting inconsistencies. In addition to reducing manual effort, this software also provides an automated process framework for the Verification and Validation (V&V) effort that will follow development of these models. The aid of such an automated tool would have a significant impact on the V&V process.

  3. Surgical Ablation of Atrial Fibrillation.

    PubMed

    Ramlawi, Basel; Abu Saleh, Walid K

    2015-01-01

    The Cox-maze procedure for the restoration of normal sinus rhythm, initially developed by Dr. James Cox, underwent several iterations over the years. The main concept consists of creating a series of transmural lesions in the right and left atria that disrupt re-entrant circuits responsible for propagating the abnormal atrial fibrillation rhythm. The left atrial appendage is excluded as a component of the Maze procedure. For the first three iterations of the Cox- maze procedure, these lesions were performed using a surgical cut-and-sew approach that ensured transmurality. The Cox-Maze IV is the most currently accepted iteration. It achieves the same lesion set of the Cox- maze III but uses alternative energy sources to create the transmural lesions, potentially in a minimally invasive approach on the beating heart. High-frequency ultrasound, microwave, and laser energy have all been used with varying success in the past. Today, bipolar radiofrequency heat or cryotherapy cooling are the most accepted sources for creating linear lesions with consistent safety and transmurality. The robust and reliable nature of these energy delivery methods has yielded a success rate reaching 90% freedom from atrial fibrillation at 12 months. Such approaches offer a significant long-term advantage over catheter-based ablation, especially in patients having longstanding, persistent atrial fibrillation with characteristics such as dilated left atrial dimensions, poor ejection fraction, and failed catheter ablation. Based on these improved results, there currently is significant interest in developing a hybrid ablation strategy that incorporates the superior transmural robust lesions of surgical ablation, the reliable stroke prevention potential of epicardial left atrial appendage exclusion, and sophisticated mapping and confirmatory catheter-based ablation technology. Such a minimally invasive hybrid strategy for ablation may lead to the development of multidisciplinary "Afib teams" to

  4. Communication as a core skill of palliative surgical care.

    PubMed

    Miner, Thomas J

    2012-03-01

    Excellence as a surgeon requires not only the technical and intellectual ability to effectively take care of surgical disease but also an ability to respond to the needs and questions of patients. This article provides an overview of the importance of communication skills in optimal surgical palliation and offers suggestions for a multidisciplinary team approach, using the palliative triangle as the ideal model of communication and interpersonal skills. This article also discusses guidelines for advanced surgical decision making and outlines methods to improve communication skills.

  5. Systems Approaches to Surgical Quality and Safety

    PubMed Central

    Vincent, Charles; Moorthy, Krishna; Sarker, Sudip K.; Chang, Avril; Darzi, Ara W.

    2004-01-01

    Objective: This approach provides the basis of our research program, which aims to expand operative assessment beyond patient factors and the technical skills of the surgeon; to extend assessment of surgical skills beyond bench models to the operating theater; to provide a basis for assessing interventions; and to provide a deeper understanding of surgical outcomes. Summary Background Data: Research into surgical outcomes has primarily focused on the role of patient pathophysiological risk factors and on the skills of the individual surgeon. However, this approach neglects a wide range of factors that have been found to be of important in achieving safe, high-quality performance in other high-risk environments. The outcome of surgery is also dependent on the quality of care received throughout the patient's stay in hospital and the performance of a considerable number of health professionals, all of whom are influenced by the environment in which they work. Methods: Drawing on the wider literature on safety and quality in healthcare, and recent papers on surgery, this article argues for a much wider assessment of factors that may be relevant to surgical outcome. In particular, we suggest the development of an “operation profile” to capture all the salient features of a surgical operation, including such factors as equipment design and use, communication, team coordination, factors affecting individual performance, and the working environment. Methods of assessing such factors are outlined, and ethical issues and other potential concerns are discussed. PMID:15024308

  6. The Making of a Skull Base Team and the Value of Multidisciplinary Approach in the Management of Sinonasal and Ventral Skull Base Malignancies.

    PubMed

    Snyderman, Carl H; Wang, Eric W; Fernandez-Miranda, Juan C; Gardner, Paul A

    2017-02-01

    The management of sinonasal and ventral skull base malignancies is best performed by a team. Although the composition of the team may vary, it is important to have multidisciplinary representation. There are multiple obstacles, both individual and institutional, that must be overcome to develop a highly functioning team. Adequate training is an important part of team-building and can be fostered with surgical telementoring. A quality improvement program should be incorporated into the activities of a skull base team.

  7. Biofilm Disrupting Technology for Orthopedic Implants: What’s on the Horizon?

    PubMed Central

    Connaughton, Alexander; Childs, Abby; Dylewski, Stefan; Sabesan, Vani J.

    2014-01-01

    The use of orthopedic implants in joints has revolutionized the treatment of patients with many debilitating chronic musculoskeletal diseases such as osteoarthritis. However, the introduction of foreign material into the human body predisposes the body to infection. The treatment of these infections has become very complicated since the orthopedic implants serve as a surface for multiple species of bacteria to grow at a time into a resistant biofilm layer. This biofilm layer serves as a protectant for the bacterial colonies on the implant making them more resistant and difficult to eradicate when using standard antibiotic treatment. In some cases, the use of antibiotics alone has even made the bacteria more resistant to treatment. Thus, there has been surge in the creation of non-antibiotic anti-biofilm agents to help disrupt the biofilms on the orthopedic implants to help eliminate the infections. In this study, we discuss infections of orthopedic implants in the shoulder then we review the main categories of anti-biofilm agents that have been used for the treatment of infections on orthopedic implants. Then, we introduce some of the newer biofilm disrupting technology that has been studied in the past few years that may advance the treatment options for orthopedic implants in the future. PMID:25705632

  8. Snow Catastrophe Conditions: What is its Impact on Orthopedic Injuries?

    PubMed Central

    Mardani-Kivi, Mohsen; Karimi-Mobarakeh, Mahmoud; Kazemnejad, Ehsan; Saheb-Ekhtiari, Khashayar; Hashemi-Motlagh, Keyvan

    2014-01-01

    Background: Iran places sixth amongst high risk natural disaster countries and Guilan province of Iran shoulders a large amount of socio-economic burden due to snow catastrophes. The more knowledge of circumstances we have, the more efficient our future encounters will be. Methods: In this retrospective study, of all of the patients admitted to Poursina Hospital due to snow and ice related trauma in the first two weeks of February 2014, 306 cases were found eligible for entry into the present study. Results: Of the 306 eligible patients (383 injuries), there were 175 men (57.2%) and 131 women (42.8%). Most patients suffered from orthopedic injuries (81%) and the most common fractures were distal radius fractures in the upper extremities and hip fractures in the lower extremities. Slipping was the most common and motor vehicle accidents had the rarest injury mechanisms. It was shown that the frequency of injuries were higher on icy days (67.6%) than snowy days (32.4%). Conclusions: Snow crises may lead to increased risk of slipping and falling situations, especially on icy days. The peak of injury rates is a few days after snowfall with the most common injury being distal radius fracture. Providing essential instructions and supporting resource allocation to better handle such catastrophes may improve outcomes. PMID:25207329

  9. PEEK Biomaterials in Trauma, Orthopedic, and Spinal Implants

    PubMed Central

    Kurtz, S. M.; Devine, J. N.

    2007-01-01

    Since the 1980s, polyaryletherketones (PAEKs) have been increasingly employed as biomaterials for trauma, orthopedic, and spinal implants. We have synthesized the extensive polymer science literature as it relates to structure, mechanical properties, and chemical resistance of PAEK biomaterials. With this foundation, one can more readily appreciate why this family of polymers will be inherently strong, inert, and biocompatible. Due to its relative inertness, PEEK biomaterials are an attractive platform upon which to develop novel bioactive materials, and some steps have already been taken in that direction, with the blending of HA and TCP into sintered PEEK. However, to date, blended HA-PEEK composites have involved a trade-off in mechanical properties in exchange for their increased bioactivity. PEEK has had the greatest clinical impact in the field of spine implant design, and PEEK is now broadly accepted as a radiolucent alternative to metallic biomaterials in the spine community. For mature fields, such as total joint replacements and fracture fixation implants, radiolucency is an attractive but not necessarily critical material feature. PMID:17686513

  10. Amino acid containing glass-ionomer cement for orthopedic applications

    NASA Astrophysics Data System (ADS)

    Wu, Wei

    Amino acid containing glass-ionomer cements were synthesized, formulated, and evaluated for orthopedic application. The formulation of different amino acid containing glass-ionomer bone cements was optimized, and conventional and resin-modified glass-ionomer bone cements were compared. Properties of interest included handling characteristics, physical and chemical properties, and mechanical strength of the bone cement. The study was based on the synthesis of different vinyl containing amino acids, different polyelectrolytes containing these amino acid residues, and different resin-modified polyelectrolytes, as well as formulation and evaluation of conventional and resin-modified glass-ionomer bone cements using these polyelectrolytes. Systematic preparation of polyelectrolytes and formulation of glass-ionomer bone cements were essential features of this work, since we anticipated that the mechanical properties of the glass-ionomer bone cements could be strongly affected by the nature of the polyelectrolytes and formulation. Mechanical properties were evaluated in a screw driven mechanical testing machine, and structure-property relationships were determined by scanning electron microscopic (SEM) observation of the fracture surface of the specimens. How the structure of polyelectrolytes, such as different amino acid residues, molecular weight, different modifying resin, and formulation of glass-ionomer bone cement, affected the mechanical properties was also studied.

  11. The Top 100 Cited Articles in Clinical Orthopedic Sports Medicine.

    PubMed

    Nayar, Suresh K; Dein, Eric J; Spiker, Andrea M; Bernard, Johnathan A; Zikria, Bashir A

    2015-08-01

    Orthopedic sports medicine continues to evolve, owing much of its clinical management and practice to rigorous academic research. In this review, we identify and describe the top 100 cited articles in clinical sports medicine and recognize the authors and institutions driving the research. We collected articles (excluding basic science, animal, and cadaveric studies) from the 25 highest-impact sports medicine journals and analyzed them by number of citations, journal, publication date, institution, country, topic, and author. Mean number of citations was 408 (range, 229-1629). The articles were published in 7 journals, most in the 1980s to 2000s, and represented 15 countries. Thirty topics were addressed, with a heavy emphasis on anterior cruciate ligament injury and reconstruction, knee rating systems, rotator cuff reconstruction, and chondrocyte transplantation. The 3 most cited articles, by Insall and colleagues, Constant and Murley, and Tegner and Lysholm, addressed a knee, a shoulder, and another knee rating system, respectively. Several authors contributed multiple articles. The Hospital for Special Surgery and the University of Bern contributed the most articles (5 each). This study provides a comprehensive list of the past century's major academic contributions to sports medicine. Residents and fellows may use this list to guide their scholarly investigations.

  12. Bioactive, mechanically favorable, and biodegradable copolymer nanocomposites for orthopedic applications.

    PubMed

    Victor, Sunita Prem; Muthu, Jayabalan

    2014-06-01

    We report the synthesis of mechanically favorable, bioactive, and biodegradable copolymer nanocomposites for potential bone applications. The nanocomposites consist of in situ polymerized biodegradable copolyester with hydroxyapatite (HA). Biodegradable copolyesters comprise carboxy terminated poly(propylene fumarate) (CT-PPF) and poly(trimethylol propane fumarate co mannitol sebacate) (TF-Co-MS). Raman spectral imaging clearly reveals a uniform homogenous distribution of HA in the copolymer matrix. The mechanical studies reveal that improved mechanical properties formed when crosslinked with methyl methacrylate (MMA) when compared to N-vinyl pyrrolidone (NVP). The SEM micrographs of the copolymer nanocomposites reveal a serrated structure reflecting higher mechanical strength, good dispersion, and good interfacial bonding of HA in the polymer matrix. In vitro degradation of the copolymer crosslinked with MMA is relatively more than that of NVP and the degradation decreases with an increase in the amount of the HA filler. The mechanically favorable and degradable MMA based nanocomposites also have favorable bioactivity, blood compatibility, cytocompatibility and cell adhesion. The present nanocomposite is a more promising material for orthopedic applications.

  13. Tissue engineering strategies for the regeneration of orthopedic interfaces.

    PubMed

    Lu, Helen H; Subramony, Siddarth D; Boushell, Margaret K; Zhang, Xinzhi

    2010-06-01

    A major focus in the field of orthopedic tissue engineering is the development of tissue engineered bone and soft tissue grafts with biomimetic functionality to allow for their translation to the clinical setting. One of the most significant challenges of this endeavor is promoting the biological fixation of these grafts with each other as well as the implant site. Such fixation requires strategic biomimicry to be incorporated into the scaffold design in order to re-establish the critical structure-function relationship of the native soft tissue-to-bone interface. The integration of distinct tissue types (e.g. bone and soft tissues such as cartilage, ligaments, or tendons), necessitates a multi-phased or stratified scaffold with distinct yet continuous tissue regions accompanied by a gradient of mechanical properties. This review discusses tissue engineering strategies for regenerating common tissue-to-tissue interfaces (ligament-to-bone, tendon-to-bone, or cartilage-to-bone), and the strategic biomimicry implemented in stratified scaffold design for multi-tissue regeneration. Potential challenges and future directions in this emerging field will also be presented. It is anticipated that interface tissue engineering will enable integrative soft tissue repair, and will be instrumental for the development of complex musculoskeletal tissue systems with biomimetic complexity and functionality.

  14. Functional orthopedic magnetic appliance (FOMA) III--modus operandi.

    PubMed

    Vardimon, A D; Graber, T M; Voss, L R; Muller, T P

    1990-02-01

    An intraoral intermaxillary appliance has been developed for the treatment of Class III malocclusions that exhibit midface sagittal deficiency with or without mandibular excess. The functional orthopedic magnetic appliance (FOMA) III consists of upper and lower acrylic plates with a permanent magnet incorporated into each plate. The upper magnet is linked to a retraction screw. The upper magnet is retracted periodically (e.g., monthly) to stimulate maxillary advancement and mandibular retardation. The attractive mode neodymium magnets used in this study produced a horizontal force of 98 gm and a vertical force of 371 gm. Six female Macaca fascicularis monkeys were treated with FOMA IIIs. An additional three animals were treated with sham appliances. After 4 months of treatment, the following results were found: the growth pattern of the cranial base (saddle angle) was not altered; midfacial protraction did occur along a recumbent hyperbolic curve with a horizontal maxillary displacement and an anterosuperior premaxillary rotation; the cumulative protraction of the maxillary complex was initiated at the pterygomaxillary fissure with an additional contribution provided by other circummaxillary sutures (zygomaticomaxillary s., transverse s., premaxillary s.); and inhibition of mandibular length was minimal, but a tendency toward a vertical condylar growth pattern was observed. The interaction between sutural and condylar growth sites appeared biphasic, characterized by an immediate and rapid excitation of the circummaxillary sutures followed by a delayed and slow suppression of the condylar cartilage. Long-term animal and clinical FOMA III studies are recommended.

  15. Informed consent practices for surgical care at university teaching hospitals: a case in a low resource setting

    PubMed Central

    2014-01-01

    Background Informed consent in medical practice is essential and a global standard that should be sought at all the times doctors interact with patients. Its intensity would vary depending on the invasiveness and risks associated with the anticipated treatment. To our knowledge there has not been any systematic review of consent practices to document best practices and identify areas that need improvement in our setting. The objective of the study was to evaluate the informed consent practices of surgeons at University teaching Hospitals in a low resource setting. Methods A cross-sectional study conducted at three university teaching hospitals in Uganda. Self-guided questionnaires were left at a central location in each of the surgical departments after verbally communicating to the surgeons of the intention of the study. Filled questionnaires were returned at the same location by the respondents for collection by the research team. In addition, 20 in-depth interviews were held with surgeons and a review of 384 patients’ record files for informed consent documentation was done. Results A total of 132 (62.1%) out of 214 questionnaires were completed and returned. Respondents were intern doctors, residents and specialists from General surgery, Orthopedic surgery, Ear, Nose and Throat, Ophthalmology, Dentistry, Obstetrics and Gynaecology departments. The average working experience of respondents was 4.8 years (SD 4.454, range 0–39 years). 48.8% of the respondents said they obtained consent all the time surgery is done while 51.2% did not obtain consent all the time. Many of the respondents indicated that informed consent was not obtained by the surgeon who operated the patient but was obtained either at admission or by nurses in the surgical units. The consent forms used in the hospitals were found to be inadequate and many times signed at admission before diagnosing the patient’s disease. Conclusions Informed consent administration and documentation for

  16. Comparison in clinical outcome of two surgical treatments in degenerative scoliosis.

    PubMed

    Sun, Yapeng; Shen, Yong; Ding, Wenyuan; Qie, Suhui; Zhang, Wei; Yang, Dalong; Wang, Linfeng

    2014-09-01

    To evaluate the clinical outcome of two different surgical treatments in treating degenerative scoliosis. Forty patients with degenerative scoliosis hospitalized in our department from June 2010 to June 2012 were selected. They were randomly divided into two groups. The first group was performed on the points with nerve or spinal compression for decompression, bone grafting, and short-segmental fixation in situ; The second group was treated with sufficient decompression, long-segmental fixation, and short-segmental fusion to operate orthopedic on scoliosis in three dimensions. All patients completed the follow-up period for more than 1 year, with the average of 18 months. Bone grafting fusion was achieved in all of the patients. The second group showed significantly better result in remission rate of postoperative pain and ODI improvement rate than the first group. Long-segmental internal fixation orthopedic is a better surgical option for patients with degenerative scoliosis to achieve sufficient decompression and three-dimensional orthopedic; therefore, it is a better solution for biomechanical reconstruction of spine.

  17. American Pediatric Surgical Association

    MedlinePlus

    ... Curricula Membership + Members Join APSA Careers Surgical Practice Management In Memoriam About APSA + APSA Mission Awards APSA Leadership Committees Alliances APSA Foundation Third-Party Advertising Disclaimer ...

  18. Incontinence Treatment: Surgical Treatments

    MedlinePlus

    ... Bowel Incontinence Signs & Symptoms Symptoms of Incontinence Diarrhea Treatment Lifestyle Changes Dietary Tips Medication Bowel Management Biofeedback Surgical Treatments Newer Treatment Options Tips on Finding a Doctor ...

  19. Expertise of Team Leaders in Analysing Team Conflicts

    ERIC Educational Resources Information Center

    Rupprecht, Maria; Strasser, Josef; Gruber, Hans; Harteis, Christian

    2010-01-01

    Team leaders are expected to adequately analyse team conflicts. Both content and analytical depth of cognitive processes determine team leaders' performance and are assumed to differ with level of expertise. A study is reported in which team leaders at four different levels of expertise (novices, semi-experts, experts, mediators) were compared in…

  20. The Effects of a Team Charter on Student Team Behaviors

    ERIC Educational Resources Information Center

    Aaron, Joshua R.; McDowell, William C.; Herdman, Andrew O.

    2014-01-01

    The authors contribute to growing evidence that team charters contribute positively to performance by empirically testing their effects on key team process outcomes. Using a sample of business students in a team-based task requiring significant cooperative and coordinative behavior, the authors compare emergent team norms under a variety of team…

  1. Increasing Student-Learning Team Effectiveness with Team Charters

    ERIC Educational Resources Information Center

    Hunsaker, Phillip; Pavett, Cynthia; Hunsaker, Johanna

    2011-01-01

    Because teams are a ubiquitous part of most organizations today, it is common for business educators to use team assignments to help students experientially learn about course concepts and team process. Unfortunately, students frequently experience a number of problems during team assignments. The authors describe the results of their research and…

  2. Skills Inventory for Teams (SIFT): A Resource for Teams.

    ERIC Educational Resources Information Center

    Garland, Corinne; And Others

    The Skills Inventory for Teams (SIFT) was developed for early intervention practitioners from a variety of disciplines to help them evaluate their ability to work as part of an early intervention team in identifying and serving young children with disabilities. The Team Member section is designed to help individual team members identify the skills…

  3. Team Talk: Communication Skills for Early Intervention Teams.

    ERIC Educational Resources Information Center

    Briggs, Margaret H.

    1993-01-01

    This article discusses ways that early intervention team members can improve their communication, qualities of effective teams, roles that members assume on teams, a step-by-step process for creating a transdisciplinary team, verbal and nonverbal skills necessary for successful communicative interaction, and behaviors that serve as barriers to…

  4. Team Teaching from the Perspective of Team Members.

    ERIC Educational Resources Information Center

    Shields, Julia L.

    This study examined advantages and disadvantages of team teaching and elements of successful teams from the perspective of eight teachers and a principal at one elementary school. The teachers were all participants in several types of school teams. During individual interviews, they discussed their thoughts and feelings about team teaching. Their…

  5. Team members' emotional displays as indicators of team functioning.

    PubMed

    Homan, Astrid C; Van Kleef, Gerben A; Sanchez-Burks, Jeffrey

    2016-01-01

    Emotions are inherent to team life, yet it is unclear how observers use team members' emotional expressions to make sense of team processes. Drawing on Emotions as Social Information theory, we propose that observers use team members' emotional displays as a source of information to predict the team's trajectory. We argue and show that displays of sadness elicit more pessimistic inferences regarding team dynamics (e.g., trust, satisfaction, team effectiveness, conflict) compared to displays of happiness. Moreover, we find that this effect is strengthened when the future interaction between the team members is more ambiguous (i.e., under ethnic dissimilarity; Study 1) and when emotional displays can be clearly linked to the team members' collective experience (Study 2). These studies shed light on when and how people use others' emotional expressions to form impressions of teams.

  6. Relation between social cohesion and team performance in soccer teams.

    PubMed

    Tziner, Aharon; Nicola, Nicola; Rizac, Anis

    2003-02-01

    Investigations of the influence on team performance of team composition, in terms of task-related attributes, e.g., personality traits, cognitive abilities, often assumes this relation to be mediated by the strength (intensity) of the interpersonal relations (social cohesion) among team members. However, there has been little empirical examination of how much social cohesion actually affects team outcomes. This preliminary study sought to examine this issue using soccer teams, which have been held to resemble workplace teams. Perceptions of team cohesion were collected from 198 Israeli soccer players (comprising 36 national league teams) during the week preceding their weekly games. A significant correlation was found between the perceptions of social cohesion and the results of the soccer matches, indicating a link between team social cohesion and team performance. Implications of the results, as well as the study's limitations, are discussed, and avenues for research are suggested.

  7. Surgical ethics and the challenge of surgical innovation.

    PubMed

    Angelos, Peter

    2014-12-01

    Surgical ethics as a specific discipline is relatively new to many. Surgical ethics focuses on the ethical issues that are particularly important to the care of surgical patients. Informed consent for surgical procedures, the level of responsibility that surgeons feel for their patients' outcomes, and the management of surgical innovation are specific issues that are important in surgical ethics and are different from other areas of medicine. The future of surgical progress is dependent on surgical innovation, yet the nature of surgical innovation raises specific concerns that challenge the professionalism of surgeons. These concerns will be considered in the following pages.

  8. Surgical mission planning in the developing world.

    PubMed

    McClenaghan, F; Fell, M; Martin, D; Smith, G; McGurk, M

    2013-12-01

    Surgical missions to the developing world have been criticized for their lack of outcome analysis. Reported studies indicate a high rate of postoperative complications. An integrated pathway developed for surgical missions and a report of its performance in action is presented herein. Patients were optimized for surgery by a medical team from the UK for a minimum of 14 days preoperatively. They were then transferred to hospital for surgery and returned when stable. At the completion of the mission a junior doctor remained behind for 3 weeks to chart the patients' progress. Thirty case patients were treated over a 2-week period. The complication rate at 3 weeks postoperatively was 7/30. Twenty-two operations were classified as complex (over 1h with more than one flap) and eight as simple (under 1h with minimal flaps). Of those undergoing the simple operations, 2/8 encountered complications at an average of 5 days postoperatively (range 3-7 days). Many medical teams depart in an elevated atmosphere of accomplishment, which without an outcome analysis gives a false impression of their positive impact. Outcome analysis is essential to honestly appraise the effect of surgical missions.

  9. The role of team goal monitoring in the curvilinear relationship between team efficacy and team performance.

    PubMed

    Rapp, Tammy L; Bachrach, Daniel G; Rapp, Adam A; Mullins, Ryan

    2014-09-01

    In this research, we apply a team self-regulatory perspective to build and test theory focusing on the relationships between team efficacy and 2 key team performance criteria: a performance behavior (i.e., team effort) and a performance outcome (i.e., objective team sales). We theorize that rather than having a linear association, the performance benefits of team efficacy reach a point of inflection, reflective of too much of a good thing. Further, in an effort to establish a boundary condition of the inverted-U shaped relationship we predict, we also test the moderating role played by team goal monitoring in the nonmonotonic relationship between team efficacy and team performance. The results from a lagged field test, in which we collect multisource data from 153 technology sales teams, reveal a significant curvilinear association that is moderated by team goal monitoring behavior. Implications for theory and practice are discussed.

  10. Evaluation of platelet function using PFA-100® in patients treated with Acetylsalicylic acid and qualified for Trauma and Orthopedic surgery procedures.

    PubMed

    Kurak, J; Zając, P; Czyżewski, D; Kucharski, R; Grzanka, R; Kasperska-Zajac, A; Koczy, B

    2016-11-01

    The phenomenon of high on-acetylsalicylic acid (ASA) treatment platelet (PLT) reactivity - HATPR - and its clinical implications have not been fully understood. Little data is available on assessing PLT activity based on the severity of intra- and postoperative bleeding in a population of orthopedic patients with normal closure time (CT) measured by a PLT function analyzer PFA-100®, despite being given long-term ASA therapy. The aim is to assess PLT function using PFA-100® in patients with ASA therapy and qualified for trauma and orthopedic surgery procedures. The retrospective analysis covered 384 patients whose PLT reactivity was assessed using PFA-100®. Out of those, 198 had been taking ASA with a 75 mg dose until hospital admission. In addition, a group of 70 patients with a proximal femoral fracture surgically treated using the dynamic hip screw (DHS) was selected, in whom severity of bleeding was assessed by HIP ASA (+). The reference group comprised 52 patients (without ASA therapy) who were operated on due to the same indications. Normal CT was found in 37% of ASA-receiving patients. Patients with normal CT, despite ASA therapy, exhibited significantly more intense bleeding after DHS surgery. A similar number of patients required red blood cells (RBCs) transfusion in HIP ASA (+) and HIP ASA (-). Increased risk of complications in HIP ASA (+) group was not found.

  11. Internet promotion of minimally invasive surgery and computer-assisted orthopedic surgery in total knee arthroplasty by members of American Association Of Hip And Knee Surgeons.

    PubMed

    Warth, Lucian C; Callaghan, John J; Liu, Steve S; Klein, Gregg R; Hozack, William J

    2007-09-01

    Minimally invasive surgery (MIS) and computer-assisted orthopedic surgery (CAOS) surgical options in total knee arthroplasty (TKA) have recently prompted increased discussion. This study addresses the question, "What is the level of promotion of MIS and CAOS TKAs through the Internet by American Association of Hip and Knee Surgeons (AAHKS) members?" Google, Yahoo, and Excite were used to search for Web sites related to active members of the AAHKS. Web sites were evaluated for MIS and CAOS TKAs information. Direct (surgeon/private practice) and indirect (institution/hospital) information from each site was evaluated. Seven hundred eighteen active AAHKS members were found to have 727 total Web sites. These sites (8.4% and 12.7%) made indirect and direct reference to MIS TKA, respectively (P < .01). In contrast, MIS-specific TKA risks were presented by only 55.7% and 25% of the sites, respectively (P < .001). Computer-assisted orthopedic surgery TKA was discussed in 4.3% and 5.6% of these sites, respectively (P < 1.0). Although our findings confirm that MIS and CAOS TKAs are not commonly promoted via the Internet by members of the AAHKS, MIS and CAOS TKAs can potentially be associated with these surgeons via institutional Web sites or hospital affiliations (12.7% direct claims with an additional 8.4% indirect claims).

  12. Predictors of Team Work Satisfaction

    ERIC Educational Resources Information Center

    Hamlyn-Harris, James H.; Hurst, Barbara J.; von Baggo, Karola; Bayley, Anthony J.

    2006-01-01

    The ability to work in teams is an attribute highly valued by employers of information technology (IT) graduates. For IT students to effectively engage in team work tasks, the process of working in teams should be satisfying for the students. This work explored whether university students who were involved in compulsory team work were satisfied…

  13. Holmium:YAG surgical lasers.

    PubMed

    1995-03-01

    "Holmium:YAG (Ho:YAG)" is the shorthand name for a family of solid-state lasers that use the doping element holmium in a laser crystal (e.g., YAG [yttrium-aluminum-garnet]) and that emit energy at approximately 2.1 microns. This wavelength is relatively new to medicine and has been used in laser surgery for only about the last six years. Like the carbon dioxide (CO2) laser when it was first used clinically, the Ho:YAG laser is poised for rapid and wide-spread use. Ho:YAG lasers, like CO2 lasers, offer precise cutting with minimal damage to adjacent tissue; however, unlike CO2 lasers, they also offer fiberoptic delivery (which is ideal for endoscopic use) and the ability to treat tissue in a liquid-filled environment (e.g., saline, blood). The initial specialty for which the Ho:YAG laser was used was arthroscopic surgery, especially diskectomy. Today, it is effectively used in many surgical specialties, including general surgery, urology, laparoscopy, neurosurgery, lithotripsy, angioplasty, orthopedic surgery (which includes procedures such as meniscectomy, bone sculpting [may also be performed in plastic surgery], and some experimental surgery, such as cartilage shrinking to tighten loose joints), and dentistry. Because of its broad range of potential applications, it has been called the "Swiss Army Knife" of lasers. High-powered Ho:YAG lasers, which enable surgeons to work more quickly and cut more smoothly, have been made available only within the last three years (units offering > 20 W) to 18 months (units offering > 60 W). Because of this rapid increase, high-powered units are still relatively expensive, and it is not yet clear whether maximum power outputs will continue to increase or whether the cost of higher-power units will begin to come down. Although low-power and high-power Ho:YAG lasers can be used for the same procedures, their different ranges of possible clinical techniques make them better suited to different applications: low-power units are

  14. Temporomandibular joint multidisciplinary team clinic.

    PubMed

    Ahmed, Nabeela; Poate, Tim; Nacher-Garcia, Cristina; Pugh, Nicola; Cowgill, Helen; Page, Lisa; Matthews, N Shaun

    2014-11-01

    Patients with dysfunction of the temporomandibular joint (TMJ) commonly present to oral and maxillofacial departments and are increasingly being managed by a subspecialist group of surgeons. We review the outcomes of patients attending a specialist TMJ multidisciplinary team (MDT) clinic. All patients are simultaneously reviewed by a consultant oral and maxillofacial surgeon, consultant in oral medicine, specialist physiotherapist, and maxillofacial prosthetist, and they can also see a consultant liaison psychiatrist. They are referred from primary, secondary, and tertiary care when medical and surgical treatment in the routine TMJ clinic has failed, and are triaged by the attending maxillofacial surgeon. On discharge they are returned to the care of the referring practitioner. We review the outcomes of patients attending this clinic over a 2-year period and show improvements in pain scores and maximal incisal opening, as well as quality of life outcome measures. All units in the UK with an interest in the management of diseases of the TMJ should consider establishing this type of clinic and should use available resources and expertise to maximise outcomes.

  15. Surgical Technology Program Guide.

    ERIC Educational Resources Information Center

    Georgia Univ., Athens. Dept. of Vocational Education.

    This surgical technology program guide presents the standard curriculum for technical institutes in Georgia. The curriculum addresses the minimum competencies for a surgical technology program. The program guide is designed to relate primarily to the development of those skills needed by individuals in the field to provide services in the…

  16. Creativity and Creative Teams

    NASA Technical Reports Server (NTRS)

    Wood, Richard M.; Bauer, Steven X. S.; Hunter, Craig A.

    2001-01-01

    A review of the linkage between knowledge, creativity, and design is presented and related to the best practices of multidisciplinary design teams. The discussion related to design and design teams is presented in the context of both the complete aerodynamic design community and specifically the work environment at the NASA Langley Research Center. To explore ways to introduce knowledge and creativity into the research and design environment at NASA Langley Research Center a creative design activity was executed within the context of a national product development activity. The success of the creative design team activity gave rise to a need to communicate the experience in a straightforward and managed approach. As a result the concept of creative potential its formulated and assessed with a survey of a small portion of the aeronautics research staff at NASA Langley Research Center. The final section of the paper provides recommendations for future creative organizations and work environments.

  17. [Surgical site infections].

    PubMed

    Sganga, Gabriele

    2014-01-01

    Surgical site infections (SSIs) are recognized as a common surgical complication, occurring in about 2-5% of all surgical procedures. SSIs represent the third most frequent nosocomial infection, accounting for 14-16% of all infections observed in hospitalized patients and up to 38% of those observed among surgical patients. Knowledge of incidence, epidemiology, classification, process of wound healing, and pathogenesis of surgical site infection is of great importance. Given the high economic burden that infections provoke, beyond the increased morbidity and mortality, it appears mandatory to improve our tools in order to reduce their incidence, as a reduction of only 0.1% can result in a considerable saving of economic resources to be allocated to other activities, such as screening and prevention programs.

  18. Chemokines Associated with Pathologic Responses to Orthopedic Implant Debris

    PubMed Central

    Hallab, Nadim J.; Jacobs, Joshua J.

    2017-01-01

    Despite the success in returning people to health saving mobility and high quality of life, the over 1 million total joint replacements implanted in the US each year are expected to eventually fail after approximately 15–25 years of use, due to slow progressive subtle inflammation to implant debris compromising the bone implant interface. This local inflammatory pseudo disease state is primarily caused by implant debris interaction with innate immune cells, i.e., macrophages. This implant debris can also activate an adaptive immune reaction giving rise to the concept of implant-related metal sensitivity. However, a consensus of studies agree the dominant form of this response is due to innate reactivity by macrophages to implant debris danger signaling (danger-associated molecular pattern) eliciting cytokine-based and chemokine inflammatory responses. This review covers implant debris-induced release of the cytokines and chemokines due to activation of the innate (and the adaptive) immune system and how this leads to subsequent implant failure through loosening and osteolysis, i.e., what is known of central chemokines (e.g., IL-8, monocyte chemotactic protein-1, MIP-1, CCL9, CCL10, CCL17, and CCL22) associated with implant debris reactivity as related to the innate immune system activation/cytokine expression, e.g., danger signaling (e.g., IL-1β, IL-18, IL-33, etc.), toll-like receptor activation (e.g., IL-6, tumor necrosis factor α, etc.), bone catabolism (e.g., TRAP5b), and hypoxia responses (HIF-1α). More study is needed, however, to fully understand these interactions to effectively counter cytokine- and chemokine-based orthopedic implant-related inflammation. PMID:28154552

  19. Chitosan for gene delivery and orthopedic tissue engineering applications.

    PubMed

    Raftery, Rosanne; O'Brien, Fergal J; Cryan, Sally-Ann

    2013-05-15

    Gene therapy involves the introduction of foreign genetic material into cells in order exert a therapeutic effect. The application of gene therapy to the field of orthopaedic tissue engineering is extremely promising as the controlled release of therapeutic proteins such as bone morphogenetic proteins have been shown to stimulate bone repair. However, there are a number of drawbacks associated with viral and synthetic non-viral gene delivery approaches. One natural polymer which has generated interest as a gene delivery vector is chitosan. Chitosan is biodegradable, biocompatible and non-toxic. Much of the appeal of chitosan is due to the presence of primary amine groups in its repeating units which become protonated in acidic conditions. This property makes it a promising candidate for non-viral gene delivery. Chitosan-based vectors have been shown to transfect a number of cell types including human embryonic kidney cells (HEK293) and human cervical cancer cells (HeLa). Aside from its use in gene delivery, chitosan possesses a range of properties that show promise in tissue engineering applications; it is biodegradable, biocompatible, has anti-bacterial activity, and, its cationic nature allows for electrostatic interaction with glycosaminoglycans and other proteoglycans. It can be used to make nano- and microparticles, sponges, gels, membranes and porous scaffolds. Chitosan has also been shown to enhance mineral deposition during osteogenic differentiation of MSCs in vitro. The purpose of this review is to critically discuss the use of chitosan as a gene delivery vector with emphasis on its application in orthopedic tissue engineering.

  20. Biocompatibility evaluation of porous ceria foams for orthopedic tissue engineering.

    PubMed

    Ball, Jordan P; Mound, Brittnee A; Monsalve, Adam G; Nino, Juan C; Allen, Josephine B

    2015-01-01

    Ceria ceramics have the unique ability to protect cells from free radical-induced damage, making them materials of interest for biomedical applications. To expand upon the understanding of the potential of ceria as a biomaterial, porous ceria, fabricated via direct foaming, was investigated to assess its biocompatibility and its ability to scavenge free radicals. A mouse osteoblast (7F2) cell line was cultured with the ceria foams to determine the extent of the foams' toxicity. Toxicity assessments indicate that mouse osteoblasts cultured directly on the ceria scaffold for 72 h did not show a significant (p > 0.05) increase in toxicity, but rather show comparable toxicity to cells cultured on porous 45S5 Bioglass. The in vitro inflammatory response elicited from porous ceria foams was measured as a function of tumor necrosis factor alpha (TNF-α) secreted from a human monocytic leukemia cell line. Results indicate that the ceria foams do not cause a significant inflammatory response, eliciting a response of 27.1 ± 7.1 pg mL(-1) of TNF-α compared to 36.3 ± 5.8 pg mL(-1) from cells on Bioglass, and 20.1 ± 2.9 pg mL(-1) from untreated cells. Finally, we report cellular toxicity in response to free radicals from tert-butyl hydroperoxide with and without foamed ceria. Our preliminary results show that the foamed ceria is able to decrease the toxic effect of induced oxidative stress. Collectively, this study demonstrates that foamed ceria scaffolds do not activate an inflammatory response, and show potential free radical scavenging ability, thus they have promise as an orthopedic biomaterial.

  1. Learning to work in teams.

    PubMed

    Schoonbeek, Sue; Henderson, Amanda

    2014-06-01

    Optimum individual and team functioning can be progressed through organizational learning. Organizational learning is facilitated through positive team interactions. However, the process of shifting and shaping team behavior is not simple. This article offers strategies to help teams modify their interactions to better engage with and learn from each other. The effectiveness of these strategies in continuing staff development is evidenced in the development of highly functioning teams.

  2. Autonomous mobile robot teams

    NASA Technical Reports Server (NTRS)

    Agah, Arvin; Bekey, George A.

    1994-01-01

    This paper describes autonomous mobile robot teams performing tasks in unstructured environments. The behavior and the intelligence of the group is distributed, and the system does not include a central command base or leader. The novel concept of the Tropism-Based Cognitive Architecture is introduced, which is used by the robots in order to produce behavior transforming their sensory information to proper action. The results of a number of simulation experiments are presented. These experiments include worlds where the robot teams must locate, decompose, and gather objects, and defend themselves against hostile predators, while navigating around stationary and mobile obstacles.

  3. Science Application Teams

    NASA Technical Reports Server (NTRS)

    2000-01-01

    This paper discusses the science application team activities. Science Application team are: (1) Represent the diversity of NASA onboard computing of the future. (2) Drive architecture and system software requirements. (3) Demonstrate the benefit of highly capable computing onboard. (4) Study the birth of the first galaxies. (5) Study formation of stars. (6) Discusses the next generation space telescope hardware/software requirement: image processing and on-board optical calibration. Also discusses gamma ray large area space telescope; orbital thermal imaging spectrometer; solar terrestrial probe program; autonomous Mars rover;fault tolerance and errors.

  4. The Use of Trazodone to Facilitate Post-Surgical Confinement in Dogs

    PubMed Central

    Gruen, Margaret E.; Roe, Simon C.; Griffith, Emily; Hamilton, Alexandra; Sherman, Barbara L.

    2015-01-01

    Objective To investigate the safety and efficacy of the oral serotonin antagonist/reuptake inhibitor trazodone hydrochloride to facilitate confinement and calming after orthopedic surgery in dogs. Design Prospective open-label trial. Animals 36 client-owned dogs. Procedures Healthy dogs were recruited when presented for pre-surgical evaluation for orthopedic procedures. Starting the day after surgery, dogs were administered trazodone (~3.5 mg/kg, per os (PO), q12h) with tramadol (4–6 mg/kg, PO, q8–12h) for pain management. After 3 days, tramadol was discontinued and trazodone was increased (~7 mg/kg, PO, q12h) and maintained for at least 4 weeks. If needed, trazodone dosage was increased to 7–10 mg/kg, PO, q8h. Clients completed electronic surveys rating their dogs’ confinement tolerance, calmness/hyperactivity level, and responses to specific provocative situations, prior to surgery and at 1, 2, 3, and 4 weeks and at the post-surgical evaluation (8–12 weeks). Results The majority of clients (~90%) reported that, when given trazodone during the 8–12 weeks following orthopedic surgery, their dogs improved moderately or extremely with regard to confinement tolerance and calmness. Trazodone was well tolerated, even in combination with non-steroidal drugs, antibiotics, and other medications; no dogs were withdrawn from the study due to adverse reactions. Client-reported median onset of action of trazodone was 31–45 minutes and median duration of action was four or more hours. Conclusions and Clinical Relevance The results suggest that oral trazodone is a safe and efficacious medication that may be used to facilitate confinement and enhance behavioral calmness of dogs during the critical recovery period following orthopedic surgery. PMID:25029308

  5. Effects of Team Emotional Authenticity on Virtual Team Performance.

    PubMed

    Connelly, Catherine E; Turel, Ofir

    2016-01-01

    Members of virtual teams lack many of the visual or auditory cues that are usually used as the basis for impressions about fellow team members. We focus on the effects of the impressions formed in this context, and use social exchange theory to understand how these impressions affect team performance. Our pilot study, using content analysis (n = 191 students), suggested that most individuals believe that they can assess others' emotional authenticity in online settings by focusing on the content and tone of the messages. Our quantitative study examined the effects of these assessments. Structural equation modeling (SEM) analysis (n = 81 student teams) suggested that team-level trust and teamwork behaviors mediate the relationship between team emotional authenticity and team performance, and illuminate the importance of team emotional authenticity for team processes and outcomes.

  6. NASA Team Collaboration Pilot: Enabling NASA's Virtual Teams

    NASA Technical Reports Server (NTRS)

    Prahst, Steve

    2003-01-01

    Most NASA projects and work activities are accomplished by teams of people. These teams are often geographically distributed - across NASA centers and NASA external partners, both domestic and international. NASA "virtual" teams are stressed by the challenge of getting team work done - across geographic boundaries and time zones. To get distributed work done, teams rely on established methods - travel, telephones, Video Teleconferencing (NASA VITS), and email. Time is our most critical resource - and team members are hindered by the overhead of travel and the difficulties of coordinating work across their virtual teams. Modern, Internet based team collaboration tools offer the potential to dramatically improve the ability of virtual teams to get distributed work done.

  7. Effects of Team Emotional Authenticity on Virtual Team Performance

    PubMed Central

    Connelly, Catherine E.; Turel, Ofir

    2016-01-01

    Members of virtual teams lack many of the visual or auditory cues that are usually used as the basis for impressions about fellow team members. We focus on the effects of the impressions formed in this context, and use social exchange theory to understand how these impressions affect team performance. Our pilot study, using content analysis (n = 191 students), suggested that most individuals believe that they can assess others' emotional authenticity in online settings by focusing on the content and tone of the messages. Our quantitative study examined the effects of these assessments. Structural equation modeling (SEM) analysis (n = 81 student teams) suggested that team-level trust and teamwork behaviors mediate the relationship between team emotional authenticity and team performance, and illuminate the importance of team emotional authenticity for team processes and outcomes. PMID:27630605

  8. Employee Knowledge Sharing in Work Teams: Effects of Team Diversity, Emergent States, and Team Leadership

    ERIC Educational Resources Information Center

    Noh, Jae Hang

    2013-01-01

    Knowledge sharing in work teams is one of the critical team processes. Without sharing of knowledge, work teams and organizations may not be able to fully utilize the diverse knowledge brought into work teams by their members. The purpose of this study was to investigate antecedents and underlying mechanisms influencing the extent to which team…

  9. Putting the "Team" in the Fine Arts Team: An Application of Business Management Team Concepts

    ERIC Educational Resources Information Center

    Fisher, Ryan

    2007-01-01

    In this article, the author discusses current challenges to the idea of teamwork in fine arts teams, redefines the terms team and collaboration using a business management perspective, discusses the success of effective teams in the business world and the characteristics of those teams, and proposes the implementation of the business model of…

  10. Analysis of the Blood Consumption for Surgical Programs

    PubMed Central

    Begic, Dzenana; Mujicic, Ermina; Coric, Jozo; Zec, Svjetlana Loga; Zunic, Lejla

    2016-01-01

    Introduction: Transfusion is an activity that assures sufficient supply of blood and blood components to treat the sick and injured. In transfusion departments is necessary to timely provide adequate amounts of blood and blood products for various surgical procedures. Material and methods: To determine the total amount of preoperative requirements (BT/AB and BT/AB/MT) for blood and blood products in surgical departments of General Hospital “Prim. Dr. Abdulah Nakas” in the period from June 1, 2014 – December 31, 2014 and analyze the requirements for blood in relation to surgical procedures, surgical discipline, period, age and gender of patients. To determine the maximum consumption levels surgeries. Results: The total amount of preoperative requirements for blood and blood products in surgical departments amounted to 927. Almost the same number of requests with a slightly higher percentage was in December and October and the lowest in June. The average age of patients was 52.2±20.1 years with the youngest patient aged 9 and the oldest at the age of 97 years. Women were more prevalent with 686 or 74% of the time compared to men. The largest number of requests for surgery elective cesarean section 208 (22.5%) with delivery wards, then for surgery or hip replacement 98 (10.6%). Maximum consumption for surgical operations Hysterectomy totalis abdominals 15 doses of blood. Conclusion: The largest number of requests were for elective cesarean section 208 (22.5%) with delivery wards, then for surgery or hip replacement with 98 (10.6%). Maximum consumed doses had gynecology surgery at Hysterectomy totalis abdominals 15 doses of blood, then orthopedics surgery at Primary hip prosthesis 11 doses. PMID:27703282

  11. Dealing with innovation and costs in orthopedics: a conversation with Dane Miller. Interview by Lawton R Burns.

    PubMed

    Miller, Dane

    2006-01-01

    Rob Burns talks with Dane Miller, former CEO of Biomet, about challenges posed by new technology in the orthopedic devices area. One key challenge is the rising cost and use of orthopedic devices at a time when providers are facing decreased profitability and reimbursement for orthopedic services. Another challenge is the long-term time horizon needed to gauge product success that contrasts with payers' and providers' short-term horizon. A third challenge is heightened governmental scrutiny of device makers' relationships with orthopedic surgeons. This interview was conducted before Miller left Biomet in March 2006.

  12. [Dental orthopedic service for retirees from MD RF in medical institutions of state and municipal system of healthcare].

    PubMed

    Malykh, A B; Grebnev, G A; Butsenko, S A; Pastukhov, A G

    2012-04-01

    Financial feasibility study of dental orthopedic service for retirees of Ministry of Defence is analyzed, suggestions about the organization of dental orthopedic service for contingent in medical institution of state and municipal system of healthcare. Information about the number of retirees, index of needs in dental orthopedic service which was 40,29%, information about 2806 prosthodontics oders for retirees in military medical institution, data about the average price of production of dental in different subjects of Russian Federation is the basis of the given research. Algorithm of dental orthopedic service for retirees by stomatologies is suggested.

  13. Overcoming asymmetric goals in teams: the interactive roles of team learning orientation and team identification.

    PubMed

    Pearsall, Matthew J; Venkataramani, Vijaya

    2015-05-01

    Although members of teams share a common, ultimate objective, they often have asymmetric or conflicting individual goals that shape the way they contribute to, and pursue, the shared goal of the team. Compounding this problem, they are frequently unaware of the nature of these goal asymmetries or even the fact that such differences exist. Drawing on, and integrating, social interdependence and representational gaps theories, we identify 2 emergent states that combine interactively to enable teams to overcome asymmetric goals: team identification and team learning orientation. Using data from long-term, real-life teams that engaged in a computer simulation designed to create both asymmetric goals and representational gaps about those goals, we found that teams were most effective when they had a high learning orientation coupled with high team identification and that this effect was mediated by teams' ability to form more accurate team goal mental models and engage in effective planning processes. Implications for theory and practice are discussed.

  14. Personality and community prevention teams: Dimensions of team leader and member personality predicting team functioning.

    PubMed

    Feinberg, Mark E; Kim, Ji-Yeon; Greenberg, Mark T

    2008-11-01

    The predictors and correlates of positive functioning among community prevention teams have been examined in a number of research studies; however, the role of personality has been neglected. In this study, we examined whether team member and leader personality dimensions assessed at the time of team formation predicted local prevention team functioning 2.5-3.5 years later. Participants were 159 prevention team members in 14 communities participating in the PROSPER study of prevention program dissemination. Three aspects of personality, aggregated at the team level, were examined as predictors: Openness to Experience, Conscientiousness, and Agreeableness. A series of multivariate regression analyses were performed that accounted for the interdependency of five categories of team functioning. Results showed that average team member Openness was negatively, and Conscientiousness was positively linked to team functioning. The findings have implications for decisions about the level and nature of technical assistance support provided to community prevention teams.

  15. Model of Team Organization and Behavior and Team Description Method

    DTIC Science & Technology

    1984-10-01

    vr’rs ion re’ Ii’rsto fle , final vers iot de’veloped at’ the end of the’ first year oil fit #-4’,I lerI lot ;t elH’ hsversit’on should not he Ce...observation and study of real-world ’Army) teams and teem missionq. Unlike many previous team performance/team behavior models, the m•del described...team research to date.. Most studies of teams and team performance to date have been baiic and .exploratory: attempts to describe and exxolain the

  16. Multilevel orthopedic surgery for crouch gait in cerebral palsy: An evaluation using functional mobility and energy cost

    PubMed Central

    Ganjwala, Dhiren

    2011-01-01

    Background: The evidence for the effectiveness of orthopaedic surgery to correct crouch gait in cerebral diplegic is insufficient. The crouch gait is defined as walking with knee flexion and ankle dorsiflexion through out the stance phase. Severe crouch gait in patients with spastic diplegia causes excessive loading of the patellofemoral joint and may result in anterior knee pain, gait deterioration, and progressive loss of function. We retrospectively evaluated the effect of surgery on the mobility and energy consumption at one year or more with the help of validated scales and scores. Materials and Methods: 18 consecutive patients with mean age of 14.6 years with cerebral diplegia with crouched gait were operated for multilevel orthopaedic surgery. Decisions for surgery were made with the observations on gait analysis and physical examination. The surgical intervention consisted of lengthening of short muscle-tendon units, shortening of long muscles and correction of osseous deformities. The paired samples t test was used to compare values of physical examination findings, walking speed and physiological cost index. Two paired sample Wilcoxon signed rank test was used to compare functional walking scales. Results: After surgery, improvements in functional mobility, walking speed and physiological cost index were found. No patient was able to walk 500 meters before surgery while all were able to walk after surgery. The improvements that were noted at one year were maintained at two years. Conclusions: Multilevel orthopedic surgery for older children and adolescents with crouch gait is effective for improving function and independence. PMID:21772623

  17. Integrated Safety Analysis Teams

    NASA Technical Reports Server (NTRS)

    Wetherholt, Jonathan C.

    2008-01-01

    Today's complex systems require understanding beyond one person s capability to comprehend. Each system requires a team to divide the system into understandable subsystems which can then be analyzed with an Integrated Hazard Analysis. The team must have both specific experiences and diversity of experience. Safety experience and system understanding are not always manifested in one individual. Group dynamics make the difference between success and failure as well as the difference between a difficult task and a rewarding experience. There are examples in the news which demonstrate the need to connect the pieces of a system into a complete picture. The Columbia disaster is now a standard example of a low consequence hazard in one part of the system; the External Tank is a catastrophic hazard cause for a companion subsystem, the Space Shuttle Orbiter. The interaction between the hardware, the manufacturing process, the handling, and the operations contributed to the problem. Each of these had analysis performed, but who constituted the team which integrated this analysis together? This paper will explore some of the methods used for dividing up a complex system; and how one integration team has analyzed the parts. How this analysis has been documented in one particular launch space vehicle case will also be discussed.

  18. Selecting Team Captains

    ERIC Educational Resources Information Center

    Kent, Aubrey; Todd, Samuel

    2004-01-01

    In this article, the authors conducted a study to investigate how high school athletes perceive leadership as well as how coaches decide in selecting team captains. In their investigation, they found out what kind of leaders adolescent athletes sought. Among other things, they make recommendations for all high school coaches to consider when…

  19. Leading Strategic Leader Teams

    DTIC Science & Technology

    2008-03-25

    engage in productive vice non-productive task conflict.71 A common assessment tool such as the Myers Briggs Type Indicator (MBTI) can demonstrate...assigning an individual to observe and critique alternatives which are discussed.81 These process designs can be used to counteract the risk of teams

  20. Critical Care Team

    MedlinePlus

    ... patient, the family and the care team. A registered nurse (RN) who is certified in critical care is ... certified by the American Association of Critical-Care Nurses. Pharmacist: An expert in ... Registered dietitian: A caregiver trained and licensed in nutrition ...

  1. Heterogeneity and Work Teams

    ERIC Educational Resources Information Center

    Dyaram, Lata; Kamalanabhan, T. J.

    2008-01-01

    This paper attempts to extend and contribute to the domestic diversity literature by presenting a comprehensive model that takes into consideration the Indian work set up. It proposes to examine the effects of the composition of information systems development teams in Indian firms. Besides the conventional demographics which were studied…

  2. Aircrew team management program

    NASA Technical Reports Server (NTRS)

    Margerison, Charles; Mccann, Dick; Davies, Rod

    1987-01-01

    The key features of the Aircrew Team Management Workshop which was designed for and in consultation with Trans Australia Airlines are outlined. Five major sections are presented dealing with: (1) A profile of the airline and the designers; (2) Aircrew consultation and involvement; (3) Educational design and development; (4) Implementation and instruction; and (5) Evaluation and assessment. These areas are detailed.

  3. Making This Team

    ERIC Educational Resources Information Center

    Beitler, Alan; Bushong, Delores; Reid, Al

    2004-01-01

    As the sponsors of the Cohort at Wakefield High School in Arlington, Virginia--a program to increase the number of minority male students in Advanced Placement (AP) classes--the authors view their work with the young men in this program as very similar to coaching a team. The Cohort asks these young men to challenge and push themselves; to test…

  4. Materials Technical Team Roadmap

    SciTech Connect

    none,

    2013-08-01

    Roadmap identifying the efforts of the Materials Technical Team (MTT) to focus primarily on reducing the mass of structural systems such as the body and chassis in light-duty vehicles (including passenger cars and light trucks) which enables improved vehicle efficiency regardless of the vehicle size or propulsion system employed.

  5. High Involvement Work Teams.

    ERIC Educational Resources Information Center

    1996

    These three papers were presented at a symposium on high-involvement work teams moderated by Michael Leimbach at the 1996 conference of the Academy of Human Resource Development. "Beyond Training to the New Learning Environment: Workers on the High-Involvement Frontline" (Joseph Anthony Ilacqua, Carol Ann Zulauf) shows the link between…

  6. The Administrative Team.

    ERIC Educational Resources Information Center

    Ohio Association of Elementary School Principals, Westerville.

    Although needs of school districts vary with size, degree of teacher negotiation procedures, and type of community involvement, the administrative team model is presented as an effective, appropriate administrative organization. Based on an assumption that each level of authority in a school district possesses and exercises expertise and unique…

  7. Team Collaboration Software

    NASA Technical Reports Server (NTRS)

    Wang, Yeou-Fang; Schrock, Mitchell; Baldwin, John R.; Borden, Charles S.

    2010-01-01

    The Ground Resource Allocation and Planning Environment (GRAPE 1.0) is a Web-based, collaborative team environment based on the Microsoft SharePoint platform, which provides Deep Space Network (DSN) resource planners tools and services for sharing information and performing analysis.

  8. National Response Team

    EPA Pesticide Factsheets

    Response planning and coordination (not direct response itself) is accomplished at the federal level through the U.S. National Response Team (NRT), an interagency group co-chaired by EPA and U.S. Coast Guard. NRT distributes information, plans, and trains.

  9. Biological Strategies for Improved Osseointegration and Osteoinduction of Porous Metal Orthopedic Implants

    PubMed Central

    Riester, Scott M.; Bonin, Carolina A.; Kremers, Hilal Maradit; Dudakovic, Amel; Kakar, Sanjeev; Cohen, Robert C.; Westendorf, Jennifer J.

    2015-01-01

    The biological interface between an orthopedic implant and the surrounding host tissue may have a dramatic effect upon clinical outcome. Desired effects include bony ingrowth (osseointegration), stimulation of osteogenesis (osteoinduction), increased vascularization, and improved mechanical stability. Implant loosening, fibrous encapsulation, corrosion, infection, and inflammation, as well as physical mismatch may have deleterious clinical effects. This is particularly true of implants used in the reconstruction of load-bearing synovial joints such as the knee, hip, and the shoulder. The surfaces of orthopedic implants have evolved from solid-smooth to roughened-coarse and most recently, to porous in an effort to create a three-dimensional architecture for bone apposition and osseointegration. Total joint surgeries are increasingly performed in younger individuals with a longer life expectancy, and therefore, the postimplantation lifespan of devices must increase commensurately. This review discusses advancements in biomaterials science and cell-based therapies that may further improve orthopedic success rates. We focus on material and biological properties of orthopedic implants fabricated from porous metal and highlight some relevant developments in stem-cell research. We posit that the ideal primary and revision orthopedic load-bearing metal implants are highly porous and may be chemically modified to induce stem cell growth and osteogenic differentiation, while minimizing inflammation and infection. We conclude that integration of new biological, chemical, and mechanical methods is likely to yield more effective strategies to control and modify the implant–bone interface and thereby improve long-term clinical outcomes. PMID:25348836

  10. [Hopes for future practice of junior orthopedic surgeons in France: a sociological study].

    PubMed

    Grégory, T; Gaillard, R; Grenier, A

    2007-09-01

    Medical demographics have become a major public health issue in France since the publication of the Berlan report in 2002 which announced an upcoming shortage in the next 20 years. But demographic projections cannot be limited to an accounting of training and retirement figures. Other factors such as demographic distribution, changing societal aspirations (free time), modes and sites of occupational activities, the influence of feminization, and initial training and its effects on professional practice must be taken into consideration. The purpose of this work was to study these parameters in orthopedic and traumatology surgery. This was a sociological study designed to ascertain the aspirations of junior orthopedic surgeons. Forty-seven interns in orthopedic surgery in the Paris area were invited to complete a questionnaire in March 2003. Forty-two responded. The choice of orthopedics was an intellectual choice. The attractiveness of the specialty was particularly important during the final years of medical school. Fewer junior surgeons would rather practice in a university hospital setting, more preferring a mixed setting with a private (fees) and a public (salary) component. The desire for "free time" was particularly important. Fewer juniors wanted to practice in general hospitals. For orthopedic surgeons, private practice and payment by fees are the cornerstones of medical practice.

  11. Mobile Device Trends in Orthopedic Surgery: Rapid Change and Future Implications.

    PubMed

    Andrawis, John P; Muzykewicz, David A; Franko, Orrin I

    2016-01-01

    Mobile devices are increasingly becoming integral communication and clinical tools. Monitoring the prevalence and utilization characteristics of surgeons and trainees is critical to understanding how these new technologies can be best used in practice. The authors conducted a prospective Internet-based survey over 7 time points from August 2010 to August 2014 at all nationwide American Council for Graduate Medical Education-accredited orthopedic programs. The survey questionnaire was designed to evaluate the use of devices and mobile applications (apps) among trainees and physicians in the clinical setting. Results were analyzed and summarized for orthopedic surgeons and trainees. During the 48-month period, there were 7 time points with 467, 622, 329, 223, 237, 111, and 134 responses. Mobile device use in the clinical setting increased across all fields and levels of training during the study period. Orthopedic trainees increased their use of Smartphone apps in the clinical setting from 60% to 84%, whereas attending use increased from 41% to 61%. During this time frame, use of Apple/Android platforms increased from 45%/13% to 85%/15%, respectively. At all time points, 70% of orthopedic surgeons believed their institution/hospital should support mobile device use. As measured over a 48-month period, mobile devices have become an ubiquitous tool in the clinical setting among orthopedic surgeons and trainees. The authors expect these trends to continue and encourage providers and trainees to be aware of the limitations and risks inherent with new technology.

  12. Parametric study of orthopedic insole of valgus foot on partial foot amputation.

    PubMed

    Guo, Jun-Chao; Wang, Li-Zhen; Chen, Wei; Du, Cheng-Fei; Mo, Zhong-Jun; Fan, Yu-Bo

    2016-01-01

    Orthopedic insole was important for partial foot amputation (PFA) to achieve foot balance and avoid foot deformity. The inapposite insole orthosis was thought to be one of the risk factors of reamputation for foot valgus patient, but biomechanical effects of internal tissues on valgus foot had not been clearly addressed. In this study, plantar pressure on heel and metatarsal regions of PFA was measured using F-Scan. The three-dimensional finite element (FE) model of partial foot evaluated different medial wedge angles (MWAs) (0.0°-10.0°) of orthopedic insole on valgus foot. The effect of orthopedic insole on the internal bone stress, the medial ligament tension of ankle, plantar fascia tension, and plantar pressure was investigated. Plantar pressure on medial heel region was about 2.5 times higher than that of lateral region based on the F-Scan measurements. FE-predicted results showed that the tension of medial ankle ligaments was the lowest, and the plantar pressure was redistributed around the heel, the first metatarsal, and the lateral longitudinal arch regions when MWA of orthopedic insole ranged from 7.5° to 8.0°. The plantar fascias maintained about 3.5% of the total load bearing on foot. However, the internal stresses from foot bones increased. The simulation in this study would provide the suggestion of guiding optimal design of orthopedic insole and therapeutic planning to pedorthist.

  13. Imagery Integration Team

    NASA Technical Reports Server (NTRS)

    Calhoun, Tracy; Melendrez, Dave

    2014-01-01

    The Human Exploration Science Office (KX) provides leadership for NASA's Imagery Integration (Integration 2) Team, an affiliation of experts in the use of engineering-class imagery intended to monitor the performance of launch vehicles and crewed spacecraft in flight. Typical engineering imagery assessments include studying and characterizing the liftoff and ascent debris environments; launch vehicle and propulsion element performance; in-flight activities; and entry, landing, and recovery operations. Integration 2 support has been provided not only for U.S. Government spaceflight (e.g., Space Shuttle, Ares I-X) but also for commercial launch providers, such as Space Exploration Technologies Corporation (SpaceX) and Orbital Sciences Corporation, servicing the International Space Station. The NASA Integration 2 Team is composed of imagery integration specialists from JSC, the Marshall Space Flight Center (MSFC), and the Kennedy Space Center (KSC), who have access to a vast pool of experience and capabilities related to program integration, deployment and management of imagery assets, imagery data management, and photogrammetric analysis. The Integration 2 team is currently providing integration services to commercial demonstration flights, Exploration Flight Test-1 (EFT-1), and the Space Launch System (SLS)-based Exploration Missions (EM)-1 and EM-2. EM-2 will be the first attempt to fly a piloted mission with the Orion spacecraft. The Integration 2 Team provides the customer (both commercial and Government) with access to a wide array of imagery options - ground-based, airborne, seaborne, or vehicle-based - that are available through the Government and commercial vendors. The team guides the customer in assembling the appropriate complement of imagery acquisition assets at the customer's facilities, minimizing costs associated with market research and the risk of purchasing inadequate assets. The NASA Integration 2 capability simplifies the process of securing one

  14. Analyses and comparison of a novel, hybrid, multifunctional orthopedic composite and implant

    NASA Astrophysics Data System (ADS)

    Dicicco, Michael

    In the orthopedic/medical device industry, 2, 2' -bis-(4-(2-hydroxy-3-methacryloxypropoxy)phenyl]propane (Bis-GMA)- and diurethanedimethacrylate (DUDMA)-based polymeric biomaterials have become well-known substitutes for polymethylmethacrylate (PMMA)- and ultra-high molecular weight polyethylene (UHMWPE)-based biomaterials, respectively. The development of these polymeric biomaterials cannot continue without direct comparison studies against currently marketed materials. The initiative for this research stems wholly from developing analytical methodologies that assist in qualifying novel biomaterials under development, by evaluating their chemical properties, performance, and safety. The goals of this research were: (i) Characterize the assay/quality of every resin component and quantify elution of extractable monomers from novel, DUDMA-based RHAKOSS(TM) implant, (ii) Determine degree of conversion (alpha) and rate of polymerization (Rp) for novel, Bis-GMA-based CORTOSS(TM) composite, (iii) Assess risk for radical-induced post-surgical cytotoxicity for CORTOSS, (iv) Determine if surface radical chemistries occur for sterilized RHAKOSS and assess its oxidative stability, and (v) Quantify antibiotic elution from antibiotic-impregnated CORTOSS and identify factors that control elution. The phenomena studied necessitated the utilization of several analytical spectroscopic techniques; fluorometry, differential scanning calorimetry (DSC), electron paramagnetic resonance (EPR), ultraviolet-visible (UV-VIS), attenuated total reflectance---Fourier-transform infrared (ATR-FTIR), and high performance liquid chromatography (HPLC). A battery of lateral chemical techniques were employed as well; including molecular derivatization/tagging, phase partitioning, spin-trapping, and thermal annealing. Results demonstrated that RHAKOSS monomer percent compositions were prepared according to formulations and monomer elution was virtually undetectable, serving as an empirical gauge to

  15. Multiscale Surgical Telerobots

    SciTech Connect

    Miles, R R; Seward, K P; Benett, W J; Tendick, F; Bentley, L; Stephan, P L

    2002-01-23

    A project was undertaken to improve robotic surgical tools for telerobotic minimally invasive surgery. The major objectives were to reduce the size of the tools to permit new surgical procedures in confined spaces such as the heart and to improve control of surgical tools by locating positional sensors and actuators at the end effector rather than external to the patient as is currently the state of the technology. A new compact end-effector with wrist-like flexibility was designed. Positional sensors based on MEMS microfabrication techniques were designed.

  16. The effect of multidisciplinary team care on cancer management.

    PubMed

    Abdulrahman, Ganiy Opeyemi

    2011-01-01

    Over the past 15 years, the multidisciplinary team management of many medical conditions especially cancers has increasingly taken a prominent role in patient management in many hospitals and medical centres in the developed countries. In the United Kingdom, it began to gain prominence following the Calman-Heine report in 1995 which suggested that each Cancer Unit in a hospital should have in place arrangements for non-surgical oncological input into services, with a role for a non-surgical oncologist. The report further suggested that a lead clinician with a well established interest in cancer care should be appointed to organise and coordinate the whole range of cancer services provided within the Cancer Unit. Many people have argued that the multidisciplinary team management of patients has resulted in better care and improved survival. However, there are barriers to the optimal effectiveness of the multidisciplinary team. This paper aims to review various studies on the effectiveness of the multidisciplinary team in the management of cancer patients and also discuss some of the barriers to the multidisciplinary team.

  17. Best practice guidelines on surgical response in disasters and humanitarian emergencies: report of the 2011 Humanitarian Action Summit Working Group on Surgical Issues within the Humanitarian Space.

    PubMed

    Chackungal, Smita; Nickerson, Jason W; Knowlton, Lisa M; Black, Lynn; Burkle, Frederick M; Casey, Kathleen; Crandell, David; Demey, Didier; Di Giacomo, Lillian; Dohlman, Lena; Goldstein, Joshua; Gosney, James E; Ikeda, Keita; Linden, Allison; Mullaly, Catherine M; O'Connell, Colleen; Redmond, Anthony D; Richards, Adam; Rufsvold, Robert; Santos, Ana L R; Skelton, Terri; McQueen, Kelly

    2011-12-01

    The provision of surgery within humanitarian crises is complex, requiring coordination and cooperation among all stakeholders. During the 2011 Humanitarian Action Summit best practice guidelines were proposed to provide greater accountability and standardization in surgical humanitarian relief efforts. Surgical humanitarian relief planning should occur early and include team selection and preparation, appropriate disaster-specific anticipatory planning, needs assessment, and an awareness of local resources and limitations of cross-cultural project management. Accurate medical record keeping and timely follow-up is important for a transient surgical population. Integration with local health systems is essential and will help facilitate longer term surgical health system strengthening.

  18. Functional orthopedic magnetic appliance (FOMA) II--modus operandi.

    PubMed

    Vardimon, A D; Stutzmann, J J; Graber, T M; Voss, L R; Petrovic, A G

    1989-05-01

    A new functional appliance (FA) to correct Class II dentoskeletal malocclusions is introduced. The functional orthopedic magnetic appliance (FOMA) II uses upper and lower attracting magnetic means (Nd2Fe14B) to constrain the lower jaw in an advanced sagittal posture. In vitro, a special gauge transducer measured the magnetic attractive path and forces. In vivo, 13 prepubertal female Macaca fascicularis monkeys received facial implants and were treated for 4 months with the following appliances: conventional FA (four subjects), FOMA II (five subjects), a combined FOMA II + FA (two subjects), and sham (control) appliance (two subjects). The in vitro results showed the following: vertico-sagitally displaced upper and lower magnets attracted ultimately along an oblique line with a terminal horizonal slide to become fully superimposed; the functional performance improved when the magnetic interface acted as a magnetic inclined plane; and the magnetic force was able to guide and constrain the mandible toward the constructive protrusive closure position (CPCP) (1.2 mm, F = 570 gm) from levels below the habitual rest position (3 mm, F = 219 gm) and the electromyographic (EMG) relaxed position (8.5 mm, F = 45 gm). The in vivo results demonstrated the following: functional performance increased in FOMA II (22%) and in the combined FOMA II + FA (28%) over the conventional FA; mandibular length increased significantly in the treated animals (means = 2.83 +/- 0.70 mm) over the control animals (means = 0.43 +/- 0.08 mm); incisor proclination was lower in magnetic appliances (means = 4.57 +/- 1.76 degrees) than in the conventional FA (means = 8.75 +/- 1.85 degrees); mandibular elongation and condylar posterior inclination resulted from posterosuperior endochondral growth (increased cell proliferation and/or hyperplasia of functional chondroblasts) and by bony remodeling of the condylar neck (apposition posterior border, resorption anterior border), respectively; virtually no

  19. Prevention of Surgical Fires: A Certification Course for Healthcare Providers.

    PubMed

    Fisher, Marquessa

    2015-08-01

    An estimated 550 to 650 surgical fires occur annually in the United States. Surgical fires may have severe consequences, including burns, disfigurement, long-term medical care, or death. This article introduces a potential certification program for the prevention of surgical fires. A pilot study was conducted with a convenience sample of 10 anesthesia providers who participated in the education module. The overall objective was to educate surgical team members and to prepare them to become certified in surgical fire prevention. On completion of the education module, participants completed the 50-question certification examination. The mean pretest score was 66%; none of the participants had enough correct responses (85%) to be considered competent in surgical fire prevention. The mean post- test score was 92.80%, with all participants answering at least 85% of questions correct. A paired-samples t test showed a statistically significant increase in knowledge: t (df = 9) = 11.40; P = .001. Results of the pilot study indicate that this course can remediate gaps in knowledge of surgical fire prevention for providers. Their poor performance on the pretest suggests that many providers may not receive sufficient instruction in surgical fire prevention.

  20. Sounds like Team Spirit

    NASA Technical Reports Server (NTRS)

    Hoffman, Edward

    2002-01-01

    I recently accompanied my son Dan to one of his guitar lessons. As I sat in a separate room, I focused on the music he was playing and the beautiful, robust sound that comes from a well-played guitar. Later that night, I woke up around 3 am. I tend to have my best thoughts at this hour. The trouble is I usually roll over and fall back asleep. This time I was still awake an hour later, so I got up and jotted some notes down in my study. I was thinking about the pure, honest sound of a well-played instrument. From there my mind wandered into the realm of high-performance teams and successful projects. (I know this sounds weird, but this is the sort of thing I think about at 3 am. Maybe you have your own weird thoughts around that time.) Consider a team in relation to music. It seems to me that a crack team can achieve a beautiful, perfect unity in the same way that a band of brilliant musicians can when they're in harmony with one another. With more than a little satisfaction I have to admit, I started to think about the great work performed for you by the Knowledge Sharing team, including this magazine you are reading. Over the past two years I personally have received some of my greatest pleasures as the APPL Director from the Knowledge Sharing activities - the Masters Forums, NASA Center visits, ASK Magazine. The Knowledge Sharing team expresses such passion for their work, just like great musicians convey their passion in the music they play. In the case of Knowledge Sharing, there are many factors that have made this so enjoyable (and hopefully worthwhile for NASA). Three ingredients come to mind -- ingredients that have produced a signature sound. First, through the crazy, passionate playing of Alex Laufer, Michelle Collins, Denise Lee, and Todd Post, I always know that something startling and original is going to come out of their activities. This team has consistently done things that are unique and innovative. For me, best of all is that they are always

  1. Surgical management of hemorrhoids.

    PubMed

    Agbo, S P

    2011-07-01

    Hemorrhoids are common human afflictions known since the dawn of history. Surgical management of this condition has made tremendous progress from complex ligation and excision procedures in the past to simpler techniques that allow the patient to return to normal life within a short period. Newer techniques try to improve on the post-operative complications of older ones. The surgical options for the management of hemorrhoids today are many. Capturing all in a single article may be difficult if not impossible. The aim of this study therefore is to present in a concise form some of the common surgical options in current literature, highlighting some important post operative complications. Current literature is searched using MEDLINE, EMBASE and the Cochrane library. The conclusion is that even though there are many surgical options in the management of hemorrhoids today, most employ the ligature and excision technique with newer ones having reduced post operative pain and bleeding.

  2. Biocompatibility of surgical implants

    NASA Technical Reports Server (NTRS)

    Kaelble, D. H.

    1979-01-01

    Method of selecting biocompatible materials for surgical implants uses fracture mechanic relationships and surface energies of candidate materials in presence of blood plasma. Technique has been used to characterize 190 materials by parameters that reflect their biocompatibility.

  3. The team focus on improving blood transfusion.

    PubMed

    McMillan, D; Brady, P; Foot, C; Levy, R; Thomson, A

    2011-03-01

    The current literature pertaining to associated morbidity and mortality with homologous blood transfusion in the surgical patient seems to be pointing only in one direction, which is we must start reducing our patients exposure to homologous blood and products. There appears to be ever mounting evidence of increases in infraction, stroke, transfusion related lung injury, infection, and death that authors are associating with transfusion. A number of authors are reporting success in reducing their patients' requirements for homologous transfusion simply by working as a team or what is known as a multidisciplinary approach and following set transfusion protocols and algorithms. At our institution we have taken note of these reports and have taken the first steps in the formation of a Cardiac Surgical Transfusion Management Group where all specialties involved in the decision making process of transfusion in the cardiac surgical patient can have representation and be directly involved in the establishment of protocols, transfusion algorithms, and a transfusion audit system. The main goal of this group is to implement a change in transfusion practice and to assess the impact the change has had on transfusion requirements and make appropriate recommendations to the treating specialists.

  4. Acute Compartment Syndrome in Orthopedics: Causes, Diagnosis, and Management

    PubMed Central

    Raza, Hasnain; Mahapatra, Anant

    2015-01-01

    Almost all orthopaedic surgeons come across acute compartment syndrome (ACS) in their clinical practice. Diagnosis of ACS mostly relies on clinical findings. If the diagnosis is missed and left untreated, it can lead to serious consequences which can endanger limb and life of the patient and also risk the clinician to face lawsuits. This review article highlights the characteristic features of ACS which will help an orthopaedic surgeon to understand the pathophysiology, natural history, high risk patients, diagnosis, and surgical management of the condition. PMID:25688303

  5. Treatment Options for Orthopedic Device-related Infections.

    PubMed

    Toubes, Edna; Segreti, John

    2002-10-01

    Though uncommon, prosthetic joint infections are a devastating complication of total joint replacement surgeries and are a cause of significant morbidity. Although complete removal of all foreign material followed by a prolonged course of directed antibiotic therapy is the optimal treatment for such infections, many factors, such as patient health, cost, available bone stock, and timing of infection influence the type of treatment that is chosen. We review the different treatment options for prosthetic joint infections, including surgical modalities and antibiotic choice, duration, and suppression.

  6. [Team work in a family health care program: the team process concept and operational teams].

    PubMed

    Fortuna, Cinira Magali; Mishima, Silvana Martins; Matumoto, Silvia; Pereira, Maria José Bistafa

    2005-01-01

    This work is a theoretical revision of team work in a family Health Care Program. We define team work in the health care field as a relationship network among people, power, knowledge, affection, and wishes, when there is a possibility of identifying group processes. We deal with concepts of Operational Group from the Argentinean School, which might help health professionals to get training in team work. We have visible (spoken) and invisible (unspoken) tasks within teams, which are modified and need to be combined and known. Communication, learning, the feeling of belonging, the atmosphere, the actions' pertinence for the team's purpose and power relations may help the team to get to know and analyze each other and to build a team. External supervision may help the team to turn itself into an operational team, working towards a life care project.

  7. Smart surgical tool

    NASA Astrophysics Data System (ADS)

    Huang, Huan; Yang, Lih-Mei; Bai, Shuang; Liu, Jian

    2015-02-01

    A laser-induced breakdown spectroscopy (LIBS) guided smart surgical tool using a femtosecond fiber laser is developed. This system provides real-time material identification by processing and analyzing the peak intensity and ratio of atomic emissions of LIBS signals. Algorithms to identify emissions of different tissues and metals are developed and implemented into the real-time control system. This system provides a powerful smart surgical tool for precise robotic microsurgery applications with real-time feedback and control.

  8. Smart surgical tool.

    PubMed

    Huang, Huan; Yang, Lih-Mei; Bai, Shuang; Liu, Jian

    2015-02-01

    A laser-induced breakdown spectroscopy (LIBS) guided smart surgical tool using a femtosecond fiber laser is developed. This system provides real-time material identification by processing and analyzing the peak intensity and ratio of atomic emissions of LIBS signals. Algorithms to identify emissions of different tissues and metals are developed and implemented into the real-time control system. This system provides a powerful smart surgical tool for precise robotic microsurgery applications with real-time feedback and control.

  9. The education, role, distribution, and compensation of physician assistants in orthopedic surgery.

    PubMed

    Chalupa, Robyn L; Hooker, Roderick S

    2016-05-01

    Physician assistants (PAs) have worked alongside surgeons since the 1970s, yet little is known about their postgraduate education, roles, distribution, and compensation. In 2015, an estimated 8,900 PAs were employed in orthopedics (9.4% of all clinically active PAs in the United States). This study analyzed surveys undertaken by Physician Assistants in Orthopaedic Surgery (PAOS) from 2009 to 2015 and found that most PAs working in orthopedics (85%) reported regularly assisting in surgery. Demand for PAs in orthopedics is expected to grow because of population growth, increasing incidence of musculoskeletal conditions, shortages of surgeons, and changing technology. Improved data acquisition and more detailed analyses are needed to better understand the nature of this specialized workforce.

  10. Understanding medical practice team roles.

    PubMed

    Hills, Laura

    2015-01-01

    Do you believe that the roles your employees play on your medical practice team are identical to their job titles or job descriptions? Do you believe that team roles are determined by personality type? This article suggests that a more effective way to build and manage your medical practice team is to define team roles through employee behaviors. It provides 10 rules of behavioral team roles that can help practice managers to select and build high-performing teams, build more productive team relationships, improve the employee recruitment process, build greater team trust and understanding; and increase their own effectiveness. This article describes in detail Belbin's highly regarded and widely used team role theory and summarizes four additional behavioral team role theories and systems. It offers lessons learned when applying team role theory to practice. Finally, this article offers an easy-to-implement method for assessing current team roles. It provides a simple four-question checklist that will help practice managers balance an imbalanced medical practice team.

  11. Team Learning: Collective Reflection Processes in Teacher Teams

    ERIC Educational Resources Information Center

    Ohlsson, Jon

    2013-01-01

    Purpose: The purpose of this paper is to contribute to further studies of theoretical and conceptual understanding of teachers' team learning processes, with a main focus on team work, team atmosphere, and collective reflections. Design/methodology/approach: The empirical study was designed as a multi-case study in a research and development…

  12. Team Machine: A Decision Support System for Team Formation

    ERIC Educational Resources Information Center

    Bergey, Paul; King, Mark

    2014-01-01

    This paper reports on the cross-disciplinary research that resulted in a decision-support tool, Team Machine (TM), which was designed to create maximally diverse student teams. TM was used at a large United States university between 2004 and 2012, and resulted in significant improvement in the performance of student teams, superior overall balance…

  13. Cohesion in Online Student Teams versus Traditional Teams

    ERIC Educational Resources Information Center

    Hansen, David E.

    2016-01-01

    Researchers have found that the electronic methods in use for online team communication today increase communication quality in project-based work situations. Because communication quality is known to influence group cohesion, the present research examined whether online student project teams are more cohesive than traditional teams. We tested…

  14. Team Entitativity and Teacher Teams in Schools: Towards a Typology

    ERIC Educational Resources Information Center

    Vangrieken, Katrien; Dochy, Filip; Raes, Elisabeth; Kyndt, Eva

    2013-01-01

    In this article we summarise research that discusses "teacher teams?. The central questions guiding this study are "How is the term teacher team" used and defined in previous research? And "What types of teacher teams has previous research identified or explored?" We attempted to answer these questions by searching…

  15. Engaging in Collaboration: A Team of Teams Approach

    ERIC Educational Resources Information Center

    Young, Carol; Hill, Rachel; Morris, Greg; Woods, Fabiola

    2016-01-01

    Adapting a Team of Teams model to a school environment provides a framework for a collaborative team culture based on trust, common vision, purposeful conversations, and interconnectivity. School leaders facilitate collaboration by modeling teamwork, as well as transparency and adaptability, to create a positive school culture and thereby improve…

  16. Team Profiles and Team Performance in a Business Management Simulation.

    ERIC Educational Resources Information Center

    Perry, C.; Delahaye, B.

    1990-01-01

    A study of the effects of team roles on the success of teams in business simulations found, contrary to expectation, that teams analyzing data on the basis of beliefs and values rather than logic were more successful. Implications for use of simulation in management education are discussed. (Author/MSE)

  17. The Team Boat Exercise: Enhancing Team Communication Midsemester

    ERIC Educational Resources Information Center

    Cox, Pamela L.; Friedman, Barry A.

    2009-01-01

    This paper discusses the Team Boat Exercise, which was developed to provide students with a mechanism for addressing team problems and enhancing team communication midsemester. The inspiration for the exercise came from a video by Prentice Hall, Inc. (2001). Part III of the video, entitled "Corporate Coaching," shows senior staff members from the…

  18. Does Weather Matter? The Effect of Weather Patterns and Temporal Factors on Pediatric Orthopedic Trauma Volume

    PubMed Central

    Livingston, Kristin S.; Miller, Patricia E.; Lierhaus, Anneliese; Matheney, Travis H.; Mahan, Susan T.

    2016-01-01

    Objectives: Orthopaedists often speculate how weather and school schedule may influence pediatric orthopedic trauma volume, but few studies have examined this. This study aims to determine: how do weather patterns, day, month, season and public school schedule influence the daily frequency of pediatric orthopedic trauma consults and admissions? Methods: With IRB approval, orthopedic trauma data from a level 1 pediatric trauma center, including number of daily orthopedic trauma consults and admissions, were collected from July 2009 to March 2012. Historical weather data (high temperatures, precipitation and hours of daylight), along with local public school schedule data were collected for the same time period. Univariate and multivariate regression models were used to show the average number of orthopedic trauma consults and admissions as a function of weather and temporal variables. Results: High temperature, precipitation, month and day of the week significantly affected the number of daily consults and admissions. The number of consults and admissions increased by 1% for each degree increase in temperature (p=0.001 and p<0.001, respectively), and decreased by 21% for each inch of precipitation (p<0.001, p=0.006). Daily consults on snowy days decreased by an additional 16% compared to days with no precipitation. November had the lowest daily consult and admission rate, while September had the highest. Daily consult rate was lowest on Wednesdays and highest on Saturdays. Holiday schedule was not independently significant. Conclusion: Pediatric orthopedic trauma consultations and admissions are highly linked to temperature and precipitation, as well as day of the week and time of year. PMID:27990193

  19. Teams Do It Better!

    PubMed Central

    Antonucci, Toni C.

    2015-01-01

    I propose that interdisciplinarity and respectful team science become the norm for studying human development. This is not as simple a wish as it may seem because we tend to be trained in a single discipline. We tend to know much less about the theory, methods and findings of other disciplines. We often respect them less and minimize their contributions. It is now abundantly clear, however, that humans develop on multiple levels. Human development occurs from neurons to neighborhoods, cells to societies, and genes to geography. It is fundamentally evident that every level influences the others and all combine to constitute human development. While we may specialize, certainly a reasonable personal choice, it is critical to recognize and respect the contributions of other disciplines to the study of human development. This may best be achieved by recognizing the contributions of other disciplines and working in multidisciplinary teams. PMID:26877719

  20. Implementation team activities

    NASA Astrophysics Data System (ADS)

    Linder, F.

    2002-12-01

    The implementation Team (IT) is a body reporting to the SCSB,. It has been assigned the task of preparing and harmonising policy, standards and specification proposals for evaluation, qualification and quality control, thus enabling a coherent and cost-effective ESCC Specification System for the procurement of EEE space components. Among the 10 recommendations issued by the SCAHC, 7 have been studied under the auspices of the Implementation Team. Its main activities have been the updating and modernising of the ESA/SCC system in order to meet user needs and to be compatible with market trends. In particular it updated the technical aspects of generic specifications for the different component families and introduced the QML concept into the SCC system. It has also studied and discussed other topics such as procurement standards, a reliability system, mutual recognition, databases and the preferred parts list. A summary of the progress made in all these fields will be presented below.

  1. Team Leader System description

    SciTech Connect

    Evans, B.J.; Lundeen, T.F.; Moon, B.D.

    1996-10-01

    Purpose of the project is to design, develop, and demonstrate an advanced, prototype computer system to support on-site inspections. The system is a highly portable field computer with on-line access to facilities information, real-time communications, positioning information, and an electronic notebook for data capture. The Team Leader System provides an inspection team with a suite of advanced communication, data gathering, and data analysis tools and can be implemented on many PC-based hardware platforms. The suitcase unit is a transportable system for on-site support in a vehicle or at a stationary location at an inspection site; the personal unit is a wearable computer for in-facility or on-foot inspections.

  2. Team Participation in Environmental Biology

    ERIC Educational Resources Information Center

    Musgrave, A. J.

    1969-01-01

    Describes experiments on the nutrition of weevils suitable for student teams, each team replicating the same experiment or experiments. Gives step by step experimental procedures and useful background information on weevils. Designed to introduce students to teamwork in science. (EB)

  3. [The evolution of surgical arthroscopy in Israel and worldwide].

    PubMed

    Haviv, Barak; Bronak, Shlomo; Thein, Rafael

    2015-04-01

    Arthroscopy is a minimal invasive surgical technique to treat joint disorders with the use of fiber optics for indirect vision and small surgical tools. The first endoscopic direct inspection of the knee joint was documented at the beginning of the 20th century; however, the clinical practice of arthroscopy started only fifty years later. The "historical fathers" of surgical arthroscopy were Kenji Takagi from Japan and Eugen Bircher from Switzerland. The arthroscopes had become safer and more dependable since the 1970's with the introduction of fiber optics, while vision became easier with the invention of television. Subsequently, in the 1980's and 90's instruments were refined and arthroscopy evolved from a diagnostic to a therapeutic tool with the advantages of minimal approach, few complications and short rehabilitation. The beginning of knee arthroscopy in Israel followed the development in North America in the1970's. Within a few years, knee arthroscopy in Israel had also evolved to be therapeutic rather than diagnostic and was specifically used for partial meniscectomies. Currently, arthroscopic surgery, particularly of the knee and shoulder, has become common practice worldwide. Arthroscopic procedures constitute more than a third of all orthopedic procedures performed at the Israeli Assuta private hospitals. With the development of various technologies, it is anticipated that arthroscopic techniques will further evolve and play an ever greater role in diagnosing and treating joint pathology.

  4. Building Team Belay

    DTIC Science & Technology

    2014-09-01

    Disaster responders are exposed to continuous periods of intense stress, and as a consequence, some suffer mental or emotional adverse effects . In...mental or emotional adverse effects . In recognition of critical stress as a valid concern, many emergency service providers have attempted...2.  Current Principles and Policy: National Institute for Occupational Safety and Health , U.S. National Response Team, RAND Recommendations, and

  5. Cooperative Team Networks

    DTIC Science & Technology

    2016-06-01

    organized, either by design or by natural evolution, into structured relationships that are governed by interactions that involve power, influence, and...purpose, and differentiated member roles. Teams are organized, either by design or by natural evolution, into structured relationships that are governed...success etc. The panel discussed whether the existing structures could be used to predict success or improve task assignments. Chjan Lim (RPI

  6. Multi-detector CT imaging in the postoperative orthopedic patient with metal hardware.

    PubMed

    Vande Berg, Bruno; Malghem, Jacques; Maldague, Baudouin; Lecouvet, Frederic

    2006-12-01

    Multi-detector CT imaging (MDCT) becomes routine imaging modality in the assessment of the postoperative orthopedic patients with metallic instrumentation that degrades image quality at MR imaging. This article reviews the physical basis and CT appearance of such metal-related artifacts. It also addresses the clinical value of MDCT in postoperative orthopedic patients with emphasis on fracture healing, spinal fusion or arthrodesis, and joint replacement. MDCT imaging shows limitations in the assessment of the bone marrow cavity and of the soft tissues for which MR imaging remains the imaging modality of choice despite metal-related anatomic distortions and signal alteration.

  7. Temporomandibular joint orthopedics with anterior repositioning appliance therapy and therapeutic injections.

    PubMed

    Simmons, Clifton

    2014-08-01

    TMD orthopedics is the assessment, diagnosis and management of orthopedic disorders of the temporomandibular joint (TMJ). Anterior repositioning appliance (ARA) therapy for TMJ internal derangements is successful in long-term recapturing of disks in reducing and nonreducing joints at a rate of 64 percent and in regenerating degenerated condyles in some cases. ARA therapy for TMJ internal derangements is subjectively successful in relieving symptoms in reducing and nonreducing disk displacement TMJs in this study at an average rate of 94.5 percent.

  8. Do Astronauts have a Higher Rate of Orthopedic Shoulder Conditions than a Cohort of Working Professionals?

    NASA Technical Reports Server (NTRS)

    Laughlin, Mitzi S.; Murray, Jocelyn D.; Young, Millenia; Wear, Mary L.; Tarver, W. J.; Van Baalen, Mary

    2016-01-01

    Occupational surveillance of astronaut shoulder injuries began with operational concerns at the Neutral Buoyancy Laboratory (NBL) during Extra Vehicular Activity (EVA) training. NASA has implemented several occupational health initiatives during the past 20 years to decrease the number and severity of injuries, but the individual success rate is unknown. Orthopedic shoulder injury and surgery rates were calculated, but classifying the rates as normal, high or low was highly dependent on the comparison group. The purpose of this study was to identify a population of working professionals and compare orthopedic shoulder consultation and surgery rates.

  9. Surgical prophylaxis with gentamicin and acute kidney injury: a systematic review and meta-analysis

    PubMed Central

    Teerakanok, Jirapat; Tantrachoti, Pakpoom; Karukote, Amputch; Nugent, Kenneth

    2017-01-01

    Background Gentamicin has been increasingly used instead of cephalosporins for surgical prophylaxis in an attempt to reduce the rate of “Clostridium difficile” infection. There are limited data regarding nephrotoxicity related to gentamicin in these patients. Methods We have conducted a systematic review and meta-analysis to evaluate the risk of acute kidney injury (AKI) in gentamicin-containing surgical prophylactic regimens, compared to regimens without gentamicin, in several types of surgery. Electronic searches were performed using PubMed and Embase, including terms for “AKI, gentamicin, and surgical prophylaxis” with and without MeSH/EMTREE functions. Statistical analysis was then performed using a random-effect model; risk ratios (RR), risk differences (RD) and heterogeneity (I2) were calculated. Funnel plot was used for assessment of publication bias. Results Eleven studies with fifteen cohorts with 18,354 patients were included in the analysis. Subgroup analysis was performed according to surgery type. We have found that antibiotic prophylaxis with gentamicin containing regimen has significant risk for developing postoperative AKI in orthopedic surgery (RR 2.99; 95% CI: 1.84, 4.88). The results were inconclusive in other types of surgery. Funnel plot indicates potential publication bias. Conclusions Gentamicin-induced AKI is significant in patients undergoing orthopedic surgery. Physicians should consider risks and benefits of using this regimen in individual patients. PMID:28361065

  10. The Undergraduate ALFALFA Team

    NASA Astrophysics Data System (ADS)

    Koopmann, Rebecca A.; Higdon, S.; Balonek, T. J.; Haynes, M. P.; Giovanelli, R.

    2010-01-01

    The Undergraduate ALFALFA (Arecibo Legacy Fast ALFA) Team is a consortium of 16 institutions engaged in an NSF-sponsored program to promote undergraduate research within the extragalactic ALFALFA HI blind survey project. In the first two years of the program, more than three dozen undergraduate students have been closely involved in ALFALFA science, observing, and data analysis. A total of 34 students have attended the annual undergraduate workshops at Arecibo Observatory, interacting with faculty, their peers, ALFALFA experts, and Arecibo staff in lectures, group activities, tours, and observing runs. Team faculty have supervised 26 summer research projects and 14 academic year (e.g., senior thesis) projects. Students and faculty have traveled to Arecibo Observatory for observing runs and to national meetings to present their results. Eight Team schools have joined to work collaboratively to analyze HI properties of galaxy groups within the ALFALFA volume. (See O'Brien et al., O'Malley et al., and Odekon et al. posters, this meeting.) Students involved in this program are learning how science is accomplished in a large collaboration while contributing to the scientific goals of a major legacy survey. This work has been supported by NSF grants AST-0724918, AST-0725267, and AST-0725380.

  11. Nutrition in team sports.

    PubMed

    Mujika, Iñigo; Burke, Louise M

    2010-01-01

    Team sports are based on intermittent high-intensity activity patterns, but the exact characteristics vary between and within codes, and from one game to the next. Despite the challenge of predicting exact game demands, performance in team sports is often dependent on nutritional factors. Chronic issues include achieving ideal levels of muscle mass and body fat, and supporting the nutrient needs of the training program. Acute issues, both for training and in games, include strategies that allow the player to be well fuelled and hydrated over the duration of exercise. Each player should develop a plan of consuming fluid and carbohydrate according to the needs of their activity patterns, within the breaks that are provided in their sport. In seasonal fixtures, competition varies from a weekly game in some codes to 2-3 games over a weekend road trip in others, and a tournament fixture usually involves 1-3 days between matches. Recovery between events is a major priority, involving rehydration, refuelling and repair/adaptation activities. Some sports supplements may be of value to the team athlete. Sports drinks, gels and liquid meals may be valuable in allowing nutritional goals to be met, while caffeine, creatine and buffering agents may directly enhance performance.

  12. Toward a Naval Team Taxonomy.

    DTIC Science & Technology

    1980-12-01

    process model was then advanced, such that salient team variables, interactions among categories, and subcomponents are identified under the superordinate... model . While many team variables (e.g., team size, member proficiencies, task difficulty, and task type) are easily measured, the paucity of valid and...an attempt will be made to correlate variations in team performance with variations along specific dimensions of the model . In view of the limited

  13. Structuring Successful Global Virtual Teams

    DTIC Science & Technology

    2015-01-01

    task interdependence, and team-based rewards in virtual teams. European Journal of Work and Organizational Psychology , 13(1), 1–28. Hinsz, V. B...performance in virtual teams. Journal of Managerial Psychology , 20, 261–274. doi:10.1108/02683940510589046. Rosen, B., Furst, S., & Blackburn, R...public release; distribution is unlimited. Structuring Successful Global Virtual Teams The views, opinions and/or findings contained in this report are

  14. Leading and working in teams.

    PubMed

    O'Sullivan, Helen; Moneypenny, Michael J; McKimm, Judy

    2015-05-01

    This article considers the role of the clinical leader as a team member and leader and explores how an understanding of the purpose and functions of teams can help doctors work more effectively in the various teams with which they are involved.

  15. The Academic Evolution of Teaming

    ERIC Educational Resources Information Center

    Hansen, Spencer D.

    2009-01-01

    Developing interdisciplinary teams that function properly should be the goal of every school leader who is interested in promoting middle level reform. To accomplish that goal, individual team members should not be left on their own to sink or swim with the teaming concept, but must be guided through a transformational process that teaches them to…

  16. Team Based Engineering Design Thinking

    ERIC Educational Resources Information Center

    Mentzer, Nathan

    2014-01-01

    The objective of this research was to explore design thinking among teams of high school students. This objective was encompassed in the research question driving the inquiry: How do teams of high school students allocate time across stages of design? Design thinking on the professional level typically occurs in a team environment. Many…

  17. Team Based Engineering Design Thinking

    ERIC Educational Resources Information Center

    Mentzer, Nathan

    2012-01-01

    The objective of this research was to explore design thinking among teams of high school students. This objective is encompassed in the research question driving this inquiry: How do teams of high school students allocate time across stages of design? Design thinking on the professional level typically occurs in a team environment. Many…

  18. Enabling Team Learning in Healthcare

    ERIC Educational Resources Information Center

    Boak, George

    2016-01-01

    This paper is based on a study of learning processes within 35 healthcare therapy teams that took action to improve their services. The published research on team learning is introduced, and the paper suggests it is an activity that has similarities with action research and with those forms of action learning where teams address collective…

  19. Team Projects and Peer Evaluations

    ERIC Educational Resources Information Center

    Doyle, John Kevin; Meeker, Ralph D.

    2008-01-01

    The authors assign semester- or quarter-long team-based projects in several Computer Science and Finance courses. This paper reports on our experience in designing, managing, and evaluating such projects. In particular, we discuss the effects of team size and of various peer evaluation schemes on team performance and student learning. We report…

  20. Team effectiveness in academic primary health care teams.

    PubMed

    Delva, Dianne; Jamieson, Margaret; Lemieux, Melissa

    2008-12-01

    Primary health care is undergoing significant organizational change, including the development of interdisciplinary health care teams. Understanding how teams function effectively in primary care will assist training programs in teaching effective interprofessional practices. This study aimed to explore the views of members of primary health care teams regarding what constitutes a team, team effectiveness and the factors that affect team effectiveness in primary care. Focus group consultations from six teams in the Department of Family Medicine at Queen's University were recorded and transcribed and qualitative analysis was used to identify themes. Twelve themes were identified that related to the impact of dual goals/obligations of education and clinical/patient practice on team relationships and learners; the challenges of determining team membership including nonattendance of allied health professionals except nurses; and facilitators and barriers to effective team function. This study provides insight into some of the challenges of developing effective primary care teams in an academic department of family medicine. Clear goals and attention to teamwork at all levels of collaboration is needed if effective interprofessional education is to be achieved. Future research should clarify how best to support the changes required for increasingly effective teamwork.