Consent and enrollment process: achieving high enrollment rates for obstetric research.

Aim: The aim was to study the development, design, and implementation of a patient consent and enrollment initiative to identify strategies that enhanced participation.

Background: Consent and enrollment of patients, especially pregnant women, remains a challenge in healthcare research. Although many barriers have been identified, strategies to consistently improve consent and enrollment are less defined.

Prevalence of Risk Factors for Coronary Artery Disease in Pennsylvania (USA) Firefighters.

Introduction: Firefighting is a physically demanding profession. Heart disease remains the number one killer of firefighters. Many firefighters have multiple risk factors, putting them at risk for sudden cardiac events.

S.M.A.R.T. self-expanding nitinol stent for the treatment of atherosclerotic lesions in the superficial femoral artery (STROLL): 1-year outcomes.

Purpose: To assess safety and efficacy of the S.M.A.

Advance care planning and proxy decision making for patients with advanced Parkinson disease.

Objectives: To examine advance care planning practices and proxy decision making by family healthcare proxies for patients with advanced Parkinson disease (PD).

Methods: Sixty-four spouses and adult children, self-designated as a/the healthcare proxy for advanced patients with PD, participated in a cross-sectional survey study.

Results: Sixty patients with PD (95%) had completed a living will, but only 38% had shared the document with a physician.

An intrepreneurial innovative role: integration of the clinical nurse specialist and infection prevention professional.

Purpose: Hospital quality and financial sustainability rely on reducing healthcare-associated events/infections, length of stay, and readmissions. This project focused on designing an integrated role for the clinical nurse specialist (CNS) and the infection prevention professional (IPP) to proactively manage the delivery of evidence-based practice to high-risk surgical patients.

Background: The healthcare industry is in the midst of a paradigm shift driven by changing health policy focusing on quality indicators, patient satisfaction, and lowering costs.

Searching the literature: a researcher's perspective.

There are many clinical questions that nurses may not have answers for in everyday practice. This dilemma leads many of them to look to the research for answers, guidance, or even more questions. Today's professional nurse should be familiar with common literature search methods.

Preliminary temporal measurement analysis of normal oropharyngeal swallowing in infants and young children.

Temporal measures of normal pediatric oropharyngeal deglutition have not been studied. Knowledge of range and variation of normative temporal measures could define abnormal deglutition and assist in design of appropriate compensatory and rehabilitative treatment techniques. The purpose of this retrospective study was to determine temporal measurements for oral filling, oral transit, onset of laryngeal closure, time of bolus arrival at the valleculae, pharyngeal delay, pharyngeal transit, and UES opening.

Long-term periprosthetic remodeling in THA shows structural preservation.

Although periprosthetic changes after THA have been well documented in short-term studies of less than 5 years, little is known about long-term changes. Long-term mineral changes must be evaluated against an unaffected limb control and for regional differences about a prosthesis. This study evaluated long-term periprosthetic remodeling using dual-energy x ray absorptiometry in a prospective study of patients who had noncemented THAs with a modular titanium alloy proximal-loading prosthesis.

Comparison of tibial rotation in fixed and mobile bearing total knee arthroplasty using computer navigation.

Tibial rotation is an important aspect of knee function and can be altered after total knee arthroplasty (TKA). These alterations include decreased internal rotation with knee flexion as compared to the normal state and paradoxical external rotation with flexion. Mobile bearing total knee prostheses may allow greater unconstrained tibial rotation.

Metrology and Standards Needs for Some Categories of Medical Devices.

With rapid advances in meso-, micro- and nano-scale technology devices and electronics, a new generation of advanced medical devices is emerging, which promises medical treatment that is less invasive and more accurate, automated, and effective. We examined the technological and economic status of five categories of medical devices. A set of metrology needs is identified for each of these categories and suggestions are made to address them.

Transepicondylar distal femoral pin placement in computer assisted surgical navigation.

Unlabelled: The use of optical tracking systems in computer assisted surgical navigation requires the rigid fixation of a dynamic reference base to the target bone to be navigated. This report presents the results of a new approach to optical tracker fixation in the distal femur. Four embalmed cadavers were evaluated for pin placement.

Six sigma analysis of computer-assisted surgery tracking protocols in TKA.

In computer-assisted surgery, efficacy relies on the overall precision of the method, of which the tracking technology is an integral feature. Does electromagnetic tracking perform clinically as well as standard optical tracking technologies? A pilot study using a computer-assisted surgery system and one lower extremity from an embalmed cadaver evaluated the mechanical axis, the transepicondylar axis, and the anteroposterior axis of Whiteside (anteroposterior axis). Using three-dimensional computed tomography and direct anatomic measurements, the baseline value for the mechanical axis was 4.

Comparison of fluoroscopic and imageless registration in surgical navigation of the acetabular component.

Objective: This study compared the repeatability and reproducibility of acetabular component positioning using imageless and fluoroscopic-referenced navigation methods.

Methods: A single cadaveric pelvis had a modular acetabular component securely fixed. Cup position was evaluated using imageless and fluoroscopic registration techniques.

Acetabular prosthetic protrusion and sepsis: case report and review of the literature.

Acetabular prosthetic protrusio is an unusual complication of total hip arthroplasty that develops from erosion of the medial acetabular wall and intrapelvic migration of the implant. This report reviews 3 cases of severe intrapelvic prosthetic migration where acute or chronic sepsis was associated with the condition. All subjects were female and involved the left hip.

Catastrophic failure of a modular revision total hip polyethylene insert.

Early catastrophic failure of a modular polyethylene component is a potential problem after revision total hip arthroplasty. We describe an unusual case of polyethylene failure that occurred within 18 months of implantation in which no obvious technical error or mechanical failure was identified. The acetabular polyethylene insert was prepared with gas plasma sterilization, and the shelf life was 4 months.

Morphological analysis of the proximal femur using quantitative computed tomography.

The anatomy of the proximal femur was studied in 35 specimens using quantitative computed tomography (QCT) and compared with anatomical sections studied by plane radiography and gross dissection. We found the primary supporting structure of the femoral head to be the primary compressive strut, which is a dense column of trabecular bone projecting from the pressure buttress of the medial femoral neck to the epiphyseal scar. Trabecular bone mushroomed from the epiphyseal scar and terminated at right angles to the cortex of the femoral head.

International multi-centre survivorship analysis of mobile bearing total knee arthroplasty.

We retrospectively reviewed the experience of a large international multi-centre study of primary total knee arthroplasty with mobile bearing design and modifications of the tibial component to allow for bicruciate preservation, posterior cruciate retention, or sacrifice. Twenty-seven surgeons performed 4,743 total knee replacements between 1981 and 1997. Implants inserted were 324 that retained both cruciate ligaments, 2,165 that retained the posterior cruciate, and 2,254 that sacrificed both cruciates.

Extended osteotomy for periprosthetic femoral fractures in total hip arthroplasty.

Total hip arthroplasty periprosthetic fractures that involve a loose prosthesis and are located at or beyond the tip of the prosthesis are difficult to manage and have higher complication and nonunion rates. In this case report, I describe a fracture-site exposure that allows simple insertion of a long, distally fixed revision prosthesis. In an extended femoral osteotomy, the entire proximal fragment opens the upper segment in "clamshell" fashion.

Accuracy of acetabular component positioning with a fluoroscopically referenced CAOS system.

Objective: This study evaluated the accuracy, repeatability, and reproducibility of a fluoroscopic referenced system used for guiding acetabular component positioning.

Methods: Calibration of the Medtronic StealthStation Treon Plus system was performed using a Weber gage block to assess linearity. Metrologic validation of repeatability and reproducibility was done using a cadaveric pelvis with an uncemented cup placed in the target position of 45 degrees inclination and 17.

A clinical overview patellofemoral joint and application to total knee arthroplasty.

The mechanical function of the patellofemoral joint is an integral part of knee biomechanics, and remains a primary source of important clinical entities. Force transmission is the most central issue and can be described by relevant anatomical and biomechanical principles. The brief review highlights these issues focusing on recent applications to total knee arthroplasty.

Revascularization of a total bulk acetabular allograft at 14 years.

This case report describes the long-term outcome of a total bulk acetabular allograft placed for bone substitution after resection of recurrent pigmented villonodular synovitis of the hip joint. After 14 years in situ, the graft had completely incorporated and showed viable bleeding bone surfaces in all areas of the acetabular implant interface. The possibility of a bulk corticocancellous allograft to undergo revascularization over a long period of time has not been previously documented.