Clinician-Reported Management Recommendations in Response to Universal Germline Genetic Testing in Patients With Prostate Cancer.

Purpose: Identification of pathogenic germline variants in patients with prostate cancer can help inform treatment selection, screening for secondary malignancies, and cascade testing. Limited real-world data are available on clinician recommendations following germline genetic testing in patients with prostate cancer.

Materials And Methods: Patient data and clinician recommendations were collected from unselected patients with prostate cancer who underwent germline testing through the PROCLAIM trial.

Efficacy of National Comprehensive Cancer Network Guidelines in Identifying Pathogenic Germline Variants Among Unselected Patients with Prostate Cancer: The PROCLAIM Trial.

Background: Prostate cancer (PCa) patients with pathogenic/likely pathogenic germline variants (PGVs) in cancer predisposition genes may be eligible for U.S. Food and Drug Administration-approved targeted therapies, clinical trials, or enhanced screening.

Underdiagnosis of Hereditary Breast Cancer: Are Genetic Testing Guidelines a Tool or an Obstacle?

Purpose: An estimated 10% of breast and ovarian cancers result from hereditary causes. Current testing guidelines for germ line susceptibility genes in patients with breast carcinoma were developed to identify carriers of BRCA1/ 2 variants and have evolved in the panel-testing era. We evaluated the capability of the National Comprehensive Cancer Network (NCCN) guidelines to identify patients with breast cancer with pathogenic variants in expanded panel testing.

Thrombosis incidence in unilateral vs. simultaneous bilateral total knee arthroplasty with compression device prophylaxis.

This study compares the incidence of venous thromboembolic event (VTE) in 55 patients (110 knees) undergoing simultaneous bilateral TKA with 287 patients (287 knees) undergoing unilateral TKA using a mobile compression device as monotherapy prophylaxis in both groups. All patients were clinically evaluated 3months after surgery with symptomatic confirmed VTE as an endpoint. Deep venous thrombosis (DVT) was documented by duplex ultrasound and pulmonary embolism (PE) was documented by spiral CT.

Measured flexion following total knee arthroplasty.

Postoperative flexion is an important factor in the outcome of total knee arthroplasty. Although normal activities of daily living require a minimum of 105° to 110° of flexion, patients from non-Western cultures often engage in activities such as kneeling and squatting that require higher flexion. The desire to achieve greater flexion serves as the driving force for prosthetic modifications, including high-flexion designs.

Nursing intervention using healing touch in bilateral total knee arthroplasty.

Purpose: Healing touch (HT), a nurse-initiated modality, has potential to improve postoperative pain control and restore balance to a patient's energy field to facilitate self-healing. We hypothesized that addition of HT to standard pharmacologic intervention would reduce pain, anxiety, and opioid consumption, and would improve ambulation distance, knee flexion, and patient satisfaction with quality of care in bilateral total knee arthroplasty.

Sample: Forty-one patients were prospectively randomized to an HT group (n = 20) or a standard treatment (ST) group (n = 21).

A mobile compression device compared with low-molecular-weight heparin for prevention of venous thromboembolism in total hip arthroplasty.

Introduction: Prevention of venous thromboembolism (VTE), including deep venous thrombosis (DVT) and pulmonary embolism (PE), has been at the forefront of orthopaedic care for many years for lower extremity arthroplasty, which is at high risk for VTE. Risk of bleeding increases in total hip arthroplasty (THA) with low-molecular-weight heparin (LMWH) prophylaxis. A mobile compression device (MCD) that allows patients to move freely in hospital and at home may be safer.

Patients speak out: development of an evidence-based model for managing orthopaedic postoperative pain.

Perioperative pain management after total joint replacement continues to be a concern for orthopaedic nurses. In our institution, the results of routine post-hospital stay surveys had shown below average scores in the area of pain management. This began as a quality management issue, became a pain subcommittee issue, and drew in the research nurses to ask what we can learn from this process.

Early dislocation rate in ceramic-on-ceramic total hip arthroplasty.

Wear debris from metal-on-polyethylene articulation in conventional total hip arthroplasty (THA) may limit THA longevity. Bearing surfaces made of modern ceramic material, with high wear resistance and low fracture risk, have the potential to extend the longevity of THA and make the procedure more suitable for young, active patients. Concerns regarding a ceramic-on-ceramic bearing surface have included potential for a higher incidence of dislocation caused by limited modular neck length and liner options.

Thromboprophylaxis in elderly patients undergoing major orthopaedic surgery.

The overall aging of our population and the success of total joint arthroplasty has rapidly increased the number of these surgeries performed. With total joint arthroplasty of the lower extremity, the risk of development of venous thrombosis is significant. As people age, co-morbidities and the risk of thrombosis also increase.

Developing and implementing an orthopaedic outcomes program: a step-by-step guide.

Evidence-based nursing practice provides the highest quality of patient care. In an orthopaedic setting, the study of outcomes across a patient population offers the ability to determine associations between the treatment regime and function, complication rates, patient satisfaction, and quality of life as evidence for practice. These associations give the orthopaedic nursing community valuable insight into patient results.

The use of handheld technology in nursing research and practice.

Use of handheld devices with electronic patient diaries (EPDs) can improve the quality of patient-reported information collected in clinical and research settings. EPDs have advantages compared with traditional paper-based instruments that include decreased data entry error and decreased time spent on data management. Orthopaedic pain management, which is often dependent on patient-reported pain levels, can benefit from the use of EPDs.

e-Knee: the electronic knee prosthesis.

Tibiofemoral forces determine polyethylene wear and affect the longevity of total knee prostheses. Previously, investigators relied on theoretic data from mathematical models to predict mechanical forces in the knee. Predictions of tibiofemoral forces are highly variable because of the complex interplay of the muscles involved in activities.

Rationale for low-molecular-weight heparin prophylaxis after total knee arthroplasty.

Low-molecular-weight heparin has been studied extensively in total knee arthroplasty (TKA) and provides highly effective and safe prophylaxis against deep venous thrombosis (DVT). Low-molecular-weight heparin received the highest rating (A1) in the American College of Chest Physicians recommendations for DVT prophylaxis after elective TKA. Prevalence of DVT with low-molecular-weight heparin prophylaxis was 33% in TKA data pooled from six randomized studies, with a proximal DVT rate of 7.

Patient compliance with outpatient prophylaxis: an observational study.

The need for prophylaxis against venous thromboembolic disease following lower-extremity joint replacement is well documented and accepted. Although low molecular weight heparin is approved for inpatient and extended prophylaxis beyond the hospital environment, orthopedic surgeons must determine the duration of injectable low molecular weight heparin based on the period of venous thromboembolic disease risk and on patient compliance with self-administration of medication at home. Lack of confidence in patients' ability to self-administer injections may contribute to hesitancy in prescribing injectable prophylaxis.

The efficacy of a single daily dose of enoxaparin for deep vein thrombosis prophylaxis following total knee arthroplasty.

Deep vein thrombosis (DVT) is a major risk following total knee arthroplasty (TKA). This prospective outcomes study evaluates the efficacy of enoxaparin 40 mg once daily for 7 days after TKA, by documenting symptomatic and asymptomatic outcomes using bilateral lower extremity duplex ultrasound upon hospital discharge and on postoperative day 21 (+/-2). In 60 extremities, duplex ultrasound demonstrated a DVT prevalence of 16.

Advances in DVT prophylaxis and management in major orthopaedic surgery.

Every year, approximately 2 million people experience a deep venous thrombosis (DVT). Approximately 600,000 of these people are diagnosed with a pulmonary embolism and about 10% of these die. It has been established that surgery, anesthesia, and bed rest increase the risk of DVT, and therefore, patients who undergo a major lower-extremity procedure should receive prophylaxis.

The modified beachchair position for arthroscopic shoulder surgery: the La Jolla beachchair.

Arthroscopic surgery of the shoulder is usually performed in the lateral decubitus or beachchair position. The modified beachchair position described here allows arthroscopic procedures to be performed as in the lateral position yet maintains a semiupright orientation and permits conversion to open procedures as in the beachchair position. The results of this technique are reported for 50 consecutive patients with a variety of diagnoses.

Two-dose epoetin alfa reduces blood transfusions compared with autologous donation.

This study evaluated whether patients receiving a two-dose regime of epoetin alfa received less allogeneic blood than patients donating autologous blood before primary hip arthroplasty. Consenting patients with a hemoglobin level between 12 and 15 g/dL were randomly assigned to a two-dose administration of epoetin alfa (19 patients) or autologous donation (21 patients). Sixteen percent of the patients in the epoetin alfa group and 52% of the patients in the autologous donation group received transfusions, with a mean volume of 90 cc per patient in the epoetin alfa group and 340 cc in the autologous donation group.

Unicompartmental knee arthroplasty (alias uni-knee). An overview with nursing implications.

During the past 30 years, the unicompartmental knee arthroplasty has undergone growing pains with various implant designs, refining indications, and improving surgical techniques and instrumentation. Today, studies show survivorship results comparable to the tricompartmental total knee arthroplasty and a renewed interest has emerged. Even though the unicompartmental knee arthroplasty is recommended for only a select 10-15% who have osteoarthritis of the knee, it has many advantages over the total knee arthroplasty.

Erythrocyte viability in blood salvaged during total joint arthroplasty with cement.

Background: Erythrocyte salvage, the collection of a patient's blood shed from the surgical wound, is one aspect of blood management. Previous investigators have examined salvaged blood for content; however, to our knowledge, none have examined the viability of erythrocytes after exposure to the chemical and thermal reactions produced by motorized instruments and polymethylmethacrylate during surgery. The purpose of this study was to determine the viability of salvaged erythrocytes from patients undergoing primary total joint arthroplasty with cement.