Lui, Darren F
Handedness is perhaps the most studied human asymmetry. Laterality is the preference shown for one side and it has been studied in many aspects of medicine. Studies have shown that some orthopaedic procedures had poorer outcomes and identified laterality as a contributing factor. We developed a questionnaire to assess laterality in orthopaedic surgery and compared this to an established scoring system. Sixty-two orthopaedic surgeons surveyed with the validated Waterloo Handedness Questionnaire (WHQ) were compared with the self developed Orthopaedic Handedness Questionnaire (OHQ). Fifty-eight were found to be right hand dominant (RHD) and 4 left hand dominant (LHD). In RHD surgeons, the average WHQ score was 44.9% and OHQ 15%. For LHD surgeons the WHQ score was 30.2% and OHQ 9.4%. This represents a significant amount of time using the non dominant hand but does not necessarily determine satisfactory or successful dexterity transferable to the operating room. Training may be required for the non dominant side.
Daniels, Alan H; DePasse, J Mason; Kamal, Robin N
Burnout is a syndrome marked by emotional exhaustion, depersonalization, and low job satisfaction. Rates of burnout in orthopaedic surgeons are higher than those in the general population and many other medical subspecialties. Half of all orthopaedic surgeons show symptoms of burnout, with the highest rates reported in residents and orthopaedic department chairpersons. This syndrome is associated with poor outcomes for surgeons, institutions, and patients. Validated instruments exist to objectively diagnose burnout, although family members and colleagues should be aware of early warning signs and risk factors, such as irritability, withdrawal, and failing relationships at work and home. Emerging evidence indicates that mindfulness-based interventions or educational programs combined with meditation may be effective treatment options. Orthopaedic residency programs, departments, and practices should focus on identifying the signs of burnout and implementing prevention and treatment programs that have been shown to mitigate symptoms. PMID:26885712
... Advocacy Research Capitol Hill Days Extremity War Injuries Regulatory Science Biological Implants Biomedical Engineering Advocacy Federal Advocacy ... October, 2016 Volume 24, Number 11 Item Response Theory and Computerized Adaptive Testing for Orthopaedic Outcomes Measures ...
Plastering is one of the most ancient of the building handicrafts. Plaster is the common name for calcium sulphate hemi hydrate made by heating the mineral gypsum, the common name for sulphate of lime. In the tenth century the Arabs used liquid plaster in orthopaedic treatment. At the beginning of the nineteenth century, patients with fractures of the lower extremities-and often of the upper extremities as well-were treated in bed with restriction of all activity for many weeks until the fractures united. It was the practice of surgeons to dress wounds and fractures at frequent intervals. The bandages, pads, and splints were removed, the fractures manipulated, and the dressings reapplied. The search for simpler, less cumbersome methods of treatment led to the development of occlusive dressings, stiffened at first with starch and later with plaster of Paris. The ambulatory treatment of fractures was the direct result of these innovations. Two military surgeons, Antonius Mathijsen of the Netherlands, and Nikolai Ivanovitch Pirogov of Russia, were responsible for the introduction of the new plaster bandage technique. At the beginning of the twentieth century the technique was improved by Jean-François Calot, a French surgeon, who invented the hand manufacture of plaster bandage as a roll. During the twentieth century, walking cast and ambulation for fresh fractures were developed with plaster and pin incorporated in plaster; the open fracture care concept was introduced with plaster of Paris by Trueta before the external fixation. PMID:27055448
Bertrand, Catherine; Van Riet, Roger; Verstreken, Frederik; Michielsen, Jef
Orthopaedic surgeons should review the orthopaedic literature in order to keep pace with the latest insights and practices. A good understanding of basic statistical principles is of crucial importance to the ability to read articles critically, to interpret results and to arrive at correct conclusions. This paper explains some of the key concepts in statistics, including hypothesis testing, Type I and Type II errors, testing of normality, sample size and p values. PMID:22523921
Davis Aileen M
Full Text Available Abstract Background The ongoing process of population aging is associated with an increase in prevalence of musculoskeletal conditions with a concomitant increase in the demand of orthopaedic services. Shortages of orthopaedic services have been documented in Canada and elsewhere. This population-based study describes the number of patients seen by orthopaedic surgeons in office and hospital settings to set the scene for the development of strategies that could maximize the availability of orthopaedic resources. Methods Administrative data from the Ontario Health Insurance Plan and Canadian Institute for Health Information hospital separation databases for the 2005/06 fiscal year were used to identify individuals accessing orthopaedic services in Ontario, Canada. The number of patients with encounters with orthopaedic surgeons, the number of encounters and the number of surgeries carried out by orthopaedic surgeons were estimated according to condition groups, service location, patient's age and sex. Results In 2005/06, over 520,000 Ontarians (41 per 1,000 population had over 1.3 million encounters with orthopaedic surgeons. Of those 86% were ambulatory encounters and 14% were in hospital encounters. The majority of ambulatory encounters were for an injury or related condition (44% followed by arthritis and related conditions (37%. Osteoarthritis accounted for 16% of all ambulatory encounters. Orthopaedic surgeons carried out over 140,000 surgeries in 2005/06: joint replacement accounted for 25% of all orthopaedic surgeries, whereas closed repair accounted for 16% and reductions accounted for 21%. Half of the orthopaedic surgeries were for arthritis and related conditions. Conclusion The large volume of ambulatory care points to the significant contribution of orthopaedic surgeons to the medical management of chronic musculoskeletal conditions including arthritis and injuries. The findings highlight that surgery is only one component of the work
Busse Jason W
Full Text Available Abstract Background There is increasing interest by chiropractors in North America regarding integration into mainstream healthcare; however, there is limited information about attitudes towards the profession among conventional healthcare providers, including orthopaedic surgeons. Methods We administered a 43-item cross-sectional survey to 1000 Canadian and American orthopaedic surgeons that inquired about demographic variables and their attitudes towards chiropractic. Our survey included an option for respondants to include written comments, and our present analysis is restricted to these comments. Two reviewers, independantly and in duplicate, coded all written comments using thematic analysis. Results 487 surgeons completed the survey (response rate 49%, and 174 provided written comments. Our analysis revealed 8 themes and 24 sub-themes represented in surgeons' comments. Reported themes were: variability amongst chiropractors (n = 55; concerns with chiropractic treatment (n = 54; areas where chiropractic is perceived as effective (n = 43; unethical behavior (n = 43; patient interaction (n = 36; the scientific basis of chiropractic (n = 26; personal experiences with chiropractic (n = 21; and chiropractic training (n = 18. Common sub-themes endorsed by surgeon's were diversity within the chiropractic profession as a barrier to increased interprofessional collaboration, endorsement for chiropractic treatment of musculoskeletal complaints, criticism for treatment of non-musculoskeletal complaints, and concern over whether chiropractic care was evidence-based. Conclusions Our analysis identified a number of issues that will have to be considered by the chiropractic profession as part of its efforts to further integrate chiropractic into mainstream healthcare.
Schulz, Arndt P; Jönsson, Anders; Kasch, Richard; Jettoo, Prithee; Bhandari, Mohit
Background Manufacturers of implants and materials in the field of orthopaedics use significant amounts of funding to produce informational material to influence the decision-making process of orthopaedic surgeons with regards to choice between novel implants and techniques. It remains unclear how far orthopaedic surgeons are really influenced by the materials supplied by companies or whether other, evidence-based publications have a higher impact on their decision-making. The objective was t...
Rohman, Lebur; Hadi, Saifullah; Whitwell, George
PURPOSE. To investigate consultant surgeons' knowledge about the costs of implants for various joint surgeries. METHODS. Questionnaires were distributed to consultant orthopaedic surgeons at 2 hospitals. Respondents were asked to estimate the implant costs of any brand for low-demand and high-demand total hip replacement (THR), total knee replacement (TKR), uni-compartmental knee replacement, arthroscopy shaver blade, total anterior cruciate ligament (ACL) fixation, and meniscal repair. The actual cost of each implant was obtained from the manufacturer. RESULTS. 16 consultant surgeons completed the questionnaires. The respective mean estimated and actual costs for a low-demand THR implant were £1714 (range, £600-3000) and £1448 (range, £985- 2335), with an overestimation of 18.4%. The respective costs for a high-demand THR implant were £2172 (range, £600-6000) and £1737 (range, £1192-2335), with an overestimation of 25%. The respective costs for a TKR implant were £1550 (range, £600-6000) and £1316 (range, £995-1535), with an overestimation of 17.8%. The respective costs for a uni-compartmental knee replacement implant were £1040 (range, £600-2000) and £1296 (range, £698-1470), with an underestimation of 19.7%. The respective costs for an arthroscopy shaver blade were £110 (range, £75-150) and £94 (range, £80-100), with an overestimation of 16.6%. The respective costs for a total ACL fixation implant were £246 (range, £80-500) and £306 (range, £272-335), with an underestimation of 19.4%. The respective costs for a meniscal repair implant were £153 (range, £50-250) and £242 (range, £170-260), with an underestimation of 37%. CONCLUSION. The knowledge among consultant orthopaedic surgeons about implant costs was poor. To reduce implant costs, cooperation between surgeons and hospital managers and measures to increase surgeons' awareness about cost-reduction programmes are needed. PMID:25163960
Bumbasirević, Marko Z; Zagorac, Slavisa G; Lesić, Aleksandar R
Theodor Emil Kocher (1841-1917), born in Bern, educated in many universities in Europe. Kocher as many surgeons of that time performed orthopedic surgery, general surgery, neurosurgery and endocrine surgery, but he become famous in orthopaedic surgery and endocrine surgery. He is remember as a surgeon who described the approach to the hip joint, elbow joint, maneuver for the reduction of dislocated shoulder joint. He introduced many instruments and many of them, such as Kocher clamp is still in use. Most important Kocher work was the thyroid gland surgery, and he received the Nobel Prize for Medicine in 1909, for-in this matter. His nature of meticulous surgeon, scientific and hard working person, dedicated to his patients and students made- found him the place in a history of medicine.
The aim of the present study was to assess the radiation dose to the eye lens of orthopaedic surgeons during various orthopaedic procedures and to make efforts to ensure that radiation protection is optimised. The study was performed for Fractura femoris and Fractura cruris procedures performed in orthopaedic operating theatres, as well as for fractures of wrist, ankle and hand/ shoulder performed in the emergency trauma room. The highest mean value of the eye lens dose of 47.2 μSv and higher mean fluoroscopy time of 3 min, as well as the corresponding highest maximum values of 77.1 μSv and 5.0 min were observed for the Fractura femoris procedure performed with the Biplanar 500e fluoroscopy systems. At a normal workload, the estimated mean annual dose values do not exceed the annual occupational dose limit for the lens of eye, but at a heavy workload in the department, this dose limit could be achieved or exceeded. The use of protective lead glasses is recommended as they could reduce the radiation exposure of the lens of the eye. The phantom measurements demonstrated that the use of half-dose mode could additionally reduce dose to the operator's eye lens. (authors)
Lee, Adam K; Sethi, Manish K
Orthopaedic trauma care is intimately tied with health policy, and current changes with health care reform may change how trauma care is delivered. This article offers a brief history of modern health care and the implications of new policies on the practice of orthopaedic trauma.
Hill, Austin; Althausen, Peter L; O'Mara, Timothy J; Bray, Timothy J
The financial realities of providing trauma care to injured patients can make it difficult to produce an accurate assessment of the cumulative value orthopaedic trauma surgeons provide to healthcare and university institutions. As with many political battles in the field of medicine, physicians who have been diligently focused on providing patient care were completely unaware of the impending upheaval around them. Whether orthopaedic trauma surgeons are employed or in some type of partnership with hospitals, too often surgeons find the relationship one-sided. In order to effectively negotiate with hospitals, surgeons must demonstrate the comprehensive value they provide to their respective healthcare institutions and universities. Orthopaedic trauma surgeons make direct and indirect financial contributions to the hospital in addition to educational and community services. The sum total of these valued contributions helps fund non-revenue generating programs, provides marketing opportunities, and improves the regional and national reputation of the healthcare institution. This paper provides a comprehensive review of the value contributed to healthcare institutions by orthopaedic trauma surgeons and will serve as a blueprint for all surgeons to accurately account for and demonstrate their value to hospitals while providing efficient and compassionate care to our patients.
Hill, Austin; Althausen, Peter L; O'Mara, Timothy J; Bray, Timothy J
The financial realities of providing trauma care to injured patients can make it difficult to produce an accurate assessment of the cumulative value orthopaedic trauma surgeons provide to healthcare and university institutions. As with many political battles in the field of medicine, physicians who have been diligently focused on providing patient care were completely unaware of the impending upheaval around them. Whether orthopaedic trauma surgeons are employed or in some type of partnership with hospitals, too often surgeons find the relationship one-sided. In order to effectively negotiate with hospitals, surgeons must demonstrate the comprehensive value they provide to their respective healthcare institutions and universities. Orthopaedic trauma surgeons make direct and indirect financial contributions to the hospital in addition to educational and community services. The sum total of these valued contributions helps fund non-revenue generating programs, provides marketing opportunities, and improves the regional and national reputation of the healthcare institution. This paper provides a comprehensive review of the value contributed to healthcare institutions by orthopaedic trauma surgeons and will serve as a blueprint for all surgeons to accurately account for and demonstrate their value to hospitals while providing efficient and compassionate care to our patients. PMID:23571292
Thomsen, Marc [Stiftung Orthopaedische Universitaetsklinik Heidelberg, Schlierbacher Landstr. 200a, 69118 Heidelberg (Germany); Abel, Rainer [Stiftung Orthopaedische Universitaetsklinik Heidelberg, Schlierbacher Landstr. 200a, 69118 Heidelberg (Germany)]. E-mail: email@example.com
For treating patients with scoliosis orthopaedic surgeons need diagnostic imaging procedures in order to provide answers about a possible underlying disease, choice of treatment, and prognosis. Once treatment is instituted, imaging is also critical for monitoring changes of the deformity so as to optimize therapy. The combined effort of orthopaedic surgeons and radiologists helps detect treatable causes of scoliosis at an early stage, define the need and timing for surgery, and ensure that every precaution is taken to minimize the risks of surgery. Neurosurgical causes, with particular reference to spinal cord tumours and syringomyelia, need to be addressed before scoliosis surgery can be contemplated.
Snyman, Gretchen; Tucker, Joseph E L; Cimini, Massimo; Narine, Kishan; Fedak, Paul W M
Barriers to successful innovation can be identified and potentially addressed by exploring the perspectives of key stakeholders in the innovation process. Cardiac surgeons in Canada were surveyed for personal perspectives on biomedical innovation. Quantitative data was obtained by questionnaire and qualitative data via interviews with selected survey participants. Surgeons were asked to self-identify into 1 of 3 categories: "innovator," "early adopter," or "late adopter," and data were compared between groups. Most surgeons viewed innovation favourably and this effect was consistent irrespective of perceived level of innovativeness. Key barriers to the innovation pathway were identified: (1) support from colleagues and institutions; (2) Canada's health system; (3) sufficient investment capital; and (4) the culture of innovation within the local environment. Knowledge of the innovation process was perceived differently based on self-reported innovativeness. The majority of surgeons did not perceive themselves as having the necessary knowledge and skills to effectively translate innovative ideas to clinical practice. In general, responses indicate support for implementation of leadership and training programs focusing on the innovation process in an effort to prepare surgeons and enhance their ability to successfully innovate and translate new therapies. The perspectives of cardiac surgeons provide an intriguing portal into the challenges and opportunities for healthcare innovation in Canada. PMID:22902159
Sharif, Khalid M; Dimitriou, Rozalia; Giannoudis, Peter V
Fragility fractures are the most prevalent trauma condition that orthopaedic surgeons face today. Osteoporosis and susceptibility to falls are the key predisposing factors. Despite evidence supporting the impact of treating osteoporosis on reducing the incidence of fragility fractures, it is often left untreated. Orthopaedic surgeons are often the first physicians to assess and treat the patient after a fragility fracture. Their role therefore does not end in the skillful fixation of the fractures, but they have a unique opportunity to ensure that preventive measures are implemented. This includes falls prevention, investigation of possible causes underlying osteoporosis, attention to diet, exercise, calcium, and vitamin D supplementation as well as prescription of anti-resorptive and anabolic medication. The need for a dedicated multidisciplinary team needs to be emphasized and therefore effective communication between the different parties is of paramount importance. PMID:21566474
Elizabeth M Badley
Full Text Available BACKGROUND: This population-based cohort study has the objective to understand the sociodemographic characteristics and health conditions of patients who do not receive surgery within 18 months following an ambulatory visit to an orthopaedic surgeon. METHODS: Administrative healthcare databases in Ontario, Canada were linked to identify all patients making an initial ambulatory visit to orthopaedic surgeons between October 1(st, 2004 and September 30(th, 2005. Logistic regression was used to examine predictors of not receiving surgery within 18 months. RESULTS: Of the 477,945 patients in the cohort 49% visited orthopaedic surgeons for injury, and 24% for arthritis. Overall, 79.3% did not receive surgery within 18 months of the initial visit, which varied somewhat by diagnosis at first visit (84.5% for injury and 73.0% for arthritis with highest proportions in the 0-24 and 25-44 age groups. The distribution by income quintile of patients visiting was skewed towards higher incomes. Regression analysis for each diagnostic group showed that younger patients were significantly more likely to be non-surgical than those aged 65+ years (age 0-24: OR 3.45 95%CI 3.33-3.57; age 25-44: OR 1.30 95%CI 1.27-1.33. The odds of not getting surgery were significantly higher for women than men for injury and other conditions; the opposite was true for arthritis and bone conditions. CONCLUSION: A substantial proportion of referrals were for expert diagnosis or advice on management and treatment. The findings also suggest socioeconomic inequalities in access to orthopaedic care. Further research is needed to investigate whether the high caseload of non-surgical cases affects waiting times to see a surgeon. This paper contributes to the development of evidence-based strategies to streamline access to surgery, and to develop models of care for non-surgical patients to optimize the use of scarce orthopaedic surgeon resources and to enhance the management of
Keith, R G
Since its inception in 1977, the Canadian Association of General Surgeons (CAGS) has struggled with its responsibility to represent general surgeons in practices across this country. The CAGS has tended to be mute in the presentation of many of its accomplishments, which have improved the role of specialists in community practice, training programs and the subspecialties of general surgery. With the forthcoming changes in direction for the Royal College of Physicians and Surgeons of Canada, based on a recent external survey, the CAGS has a golden opportunity to advocate for a clear identity, autonomous from the Royal College for the purposes of scientific meetings, continuing professional development, scientific and practice affiliation with other surgical specialty societies, and new developments with corporate sector support for advancements in science technology and education. Advocacy for general surgery must be stressed as the priority for the CAGS into the future.
Javed, Mustafa; Moulder, Elizabeth; Mohsen, Amr
This article outlines some of the key concepts in leadership (both styles and theories) to provide a platform for further learning and to help the modern day orthopaedic surgeons to apply these concepts to their current practice. It is focused on two major aspects: management of medical organizations and effective twenty-first century care by surgeons through proper leadership guide and aimed in improving patient care outcomes. Practicing proper leadership skills based on evidence resulted in effective management of organization. Thus achieving patient's satisfaction. PMID:26208560
Javed, Mustafa; Moulder, Elizabeth; Mohsen, Amr
This article outlines some of the key concepts in leadership (both styles and theories) to provide a platform for further learning and to help the modern day orthopaedic surgeons to apply these concepts to their current practice. It is focused on two major aspects: management of medical organizations and effective twenty-first century care by surgeons through proper leadership guide and aimed in improving patient care outcomes. Practicing proper leadership skills based on evidence resulted in effective management of organization. Thus achieving patient's satisfaction.
Markatos, Konstantinos; Efstathopoulos, Nikolaos; Kaseta, Kiriaki Maria; Nikolaou, Vasileios; Tsoucalas, Gregory; Sgantzos, Markos
The purpose of our study was to summarize all the knowledge concerning the innovative pioneer in the field of orthopaedic surgery, Nicholas J. Giannestras (1908-1978). A thorough study of texts, medical books and reports, in the field of history of medicine, together with a review of the available literature in PubMed, was undertaken. Giannestras left his mark in the history of orthopaedics with his clinical work and his publications, mainly his treatise "Foot Disorders: Medical and Surgical Management" (1973), while his name lingers in Greece with the introduction of spine fusion with the use of metallic implants. He was an eminent university clinical professor of orthopaedics who had harmonically combined academic writing, teaching and clinical research in every field of orthopaedic surgery. PMID:26255057
Wong Shaun KS; Oakley J; Kumar AJ Shyam; Philips Steve J
Abstract Background Induction programme for trainee doctors in the UK generally do not focus on the surgical aspects of their jobs. In this context we decided to conduct a telephonic survey among the hospitals belonging to three orthopaedic training regions in the UK from the point of view of the diversity of instrumentations and implants used for index procedures. Results We chose four index trauma & orthopaedic procedures (Total hip replacement, total knee replacement, intramedullary nailin...
Full Text Available Abstract Background In order to get sickness benefit a sick-listed person need a medical certificate issued by a physician; in Sweden after one week of self-certification. Physicians experience sick-listing tasks as problematic and conflicts may arise when patients regard themselves unable to work due to complaints that are hard to objectively verify for the physician. Most GPs and orthopaedic surgeons (OS deal regularly with sick-listing issues in their daily practice. The aim of this study was to explore perceived problems and coping strategies related to tasks of sickness certification among general practitioners (GP and orthopaedic surgeons (OS. Methods A cross-sectional study about sickness certification in two Swedish counties, with 673 participating GPs and 149 OSs, who answered a comprehensive questionnaire. Frequencies together with crude and adjusted (gender and working years Odds ratios were calculated. Results A majority of the GPs and OSs experienced problems in sickness certification every week. To assess the patient's work ability, to handle situations when they and the patient had different opinions about the need for sickness absence, and to issue prolongation certificates when the previous was issued by another physician were reported as problematic by a majority in both groups. Both GPs and OSs prolonged sickness certifications due to waiting times in health care or at Social Insurance Office (SIO. To handle experienced problems they used different strategies; OSs issued sickness certificates without personal appointment more often than the GPs, who on the other hand reported having contact with SIO more often than the OSs. A higher rate of GPs experienced support from management and had a common strategy for handling sickness certification at the clinic than the OSs. Conclusion Most GPs and OSs handled sickness certification weekly and reported a variety of problems in relation to this task, generally GPs to a higher extent
Wong Shaun KS
Full Text Available Abstract Background Induction programme for trainee doctors in the UK generally do not focus on the surgical aspects of their jobs. In this context we decided to conduct a telephonic survey among the hospitals belonging to three orthopaedic training regions in the UK from the point of view of the diversity of instrumentations and implants used for index procedures. Results We chose four index trauma & orthopaedic procedures (Total hip replacement, total knee replacement, intramedullary nailing and external fixator systems for long bone fractures. A telephonic survey was done in six NHS trust hospitals which were part of an orthopaedic training rotation (2 from England, 2 from Wales and 2 from Scotland. In total there were 39 different instrumentation systems for these 4 index procedures in the 6 trusts (see table 1. These comprise 12 Total hip replacement (THR systems, 14 total knee replacement (TKR systems, 9 intra-medullary nailing systems, and 4 external fixator systems. The number of different systems for each trust ranged from 7 to 19. There is a vast array of implants and instrumentation systems in each trust, as highlighted by our survey. The surgical tools are not the same in each hospitals. This situation is more complicated when trainees move to new hospitals as part of training rotations. Table 1 Number of implants/instrumentations used in each of the 6 UK trusts (3 training regions. IMPLANT E1 E2 W1 W2 S1 S2 Total Knee Replacement 4 5 2 4 3 2 Total Hip Replacement 3 4 3 6 3 3 Intramnedullary nailing 2 1 1 6 2 3 External fixators 2 3 2 2 1 1 TOTAL 11 13 8 18 9 9 E = England, W = Wales, S = Scotland Conclusion In view of this we feel that more focused theatre based induction programmes for higher surgical trainees is advocated in each hospital trust so trainees can familiarise themselves with the tools available to them. This could include discussion with the consultants and senior theatre staff along with representatives from the
Sanjay Meena; Vivek Trikha; Pramod Saini; Rakesh Kumar; Buddhadev Chowdhary
Intramedullary interlocking nailing is the gold standard for treatment of tibial shaft fractures.The growing use of intramedullary nailing has resulted in an increased number of tibial nailing in daily clinical practice.Despite adequate surgeon experience,tibial nailing is not without complications if proper techniques are not followed.A case of iatrogenic talar neck and medial malleolus fractures during intramedullary nailing of tibia in a 24-year-old male is reported.It is believed to be caused by forceful hammering of insertion zig with foot dorsiflexed.To the best of our knowledge,no such case has been reported in the literature.It is possible to reduce the risk of this complication by adoption of preventive measures.
Increasing Capacity for the Treatment of Common Musculoskeletal Problems: A Non-Inferiority RCT and Economic Analysis of Corticosteroid Injection for Shoulder Pain Comparing a Physiotherapist and Orthopaedic Surgeon
Bisset, Leanne; Comans, Tracy; Thomas, Michael; Ng, Shu Kay; O’Leary, Shaun; Conaghan, Philip G.; Scuffham, Paul A.
Background Role substitution is a strategy employed to assist health services manage the growing demand for musculoskeletal care. Corticosteroid injection is a common treatment in this population but the efficacy of its prescription and delivery by physiotherapists has not been established against orthopaedic standards. This paper investigates whether corticosteroid injection given by a physiotherapist for shoulder pain is as clinically and cost effective as that from an orthopaedic surgeon. Methods A double blind non-inferiority randomized controlled trial was conducted in an Australian public hospital orthopaedic outpatient service, from January 2013 to June 2014. Adults with a General Practitioner referral to Orthopaedics for shoulder pain received subacromial corticosteroid and local anaesthetic injection prescribed and delivered independently by a physiotherapist or a consultant orthopaedic surgeon. The main outcome measure was total Shoulder Pain and Disability Index (SPADI) score at baseline, six and 12 weeks, applying a non-inferiority margin of 15 points. Secondary outcomes tested for superiority included pain, shoulder movement, perceived improvement, adverse events, satisfaction, quality of life and costs. Results 278 participants were independently assessed by the physiotherapist and the orthopaedic surgeon, with 64 randomised (physiotherapist 33, orthopaedic surgeon 31). There were no significant differences in baseline characteristics between groups. Non-inferiority of injection by the physiotherapist was declared from total SPADI scores at 6 and 12 weeks (upper limit of the 95% one-sided confidence interval 13.34 and 7.17 at 6 and 12 weeks, respectively). There were no statistically significant differences between groups on any outcome measures at 6 or 12 weeks. From the perspective of the health funder, the physiotherapist was less expensive. Conclusions Corticosteroid injection for shoulder pain, provided by a suitably qualified physiotherapist is
Appoo, Jehangir J; Bozinovski, John; Chu, Michael W A; El-Hamamsy, Ismail; Forbes, Thomas L; Moon, Michael; Ouzounian, Maral; Peterson, Mark D; Tittley, Jacques; Boodhwani, Munir
In 2014, the Canadian Cardiovascular Society (CCS) published a position statement on the management of thoracic aortic disease addressing size thresholds for surgery, imaging modalities, medical therapy, and genetics. It did not address issues related to surgical intervention. This joint Position Statement on behalf of the CCS, Canadian Society of Cardiac Surgeons, and the Canadian Society for Vascular Surgery provides recommendations about thoracic aortic disease interventions, including: aortic valve repair, perfusion strategies for arch repair, extended arch hybrid reconstruction for acute type A dissection, endovascular management of arch and descending aortic aneurysms, and type B dissection. The position statement is constructed using Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology, and has been approved by the primary panel, an international secondary panel, and the CCS Guidelines Committee. Advent of endovascular technology has improved aortic surgery safety and extended the indications of minimally invasive thoracic aortic surgery. The combination of safer open surgery with endovascular treatment has improved patient outcomes in this rapidly evolving subspecialty field of cardiovascular surgery.
Skedros John G
Full Text Available Abstract Background Variations in corticosteroid/anesthetic doses for injecting shoulder conditions were examined among orthopaedic surgeons, rheumatologists, and primary-care sports medicine (PCSMs and physical medicine and rehabilitation (PMRs physicians to provide data needed for documenting inter-group differences for establishing uniform injection guidelines. Methods 264 surveys, sent to these physicians in our tri-state area of the western United States, addressed corticosteroid/anesthetic doses and types used for subacromial impingement, degenerative glenohumeral and acromioclavicular arthritis, biceps tendinitis, and peri-scapular trigger points. They were asked about preferences regarding: 1 fluorinated vs. non-fluorinated corticosteroids, 2 acetate vs. phosphate types, 3 patient age, and 4 adjustments for special considerations including young athletes and diabetics. Results 169 (64% response rate, RR surveys were returned: 105/163 orthopaedic surgeons (64%RR, 44/77 PCSMs/PMRs (57%RR, 20/24 rheumatologists (83%RR. Although corticosteroid doses do not differ significantly between specialties (p > 0.3, anesthetic volumes show broad variations, with surgeons using larger volumes. Although 29% of PCSMs/PMRs, 44% rheumatologists, and 41% surgeons exceed "recommended" doses for the acromioclavicular joint, >98% were within recommendations for the subacromial bursa and glenohumeral joint. Depo-Medrol® (methylprednisolone acetate and Kenalog® (triamcinolone acetonide are most commonly used. More rheumatologists (80% were aware that there are acetate and phosphate types of corticosteroids as compared to PCSMs/PMRs (76% and orthopaedists (60%. However, relatively fewer rheumatologists (25% than PCSMs/PMRs (32% or orthopaedists (32% knew that phosphate types are more soluble. Fluorinated corticosteroids, which can be deleterious to soft tissues, were used with these frequencies for the biceps sheath: 17% rheumatologists, 8% PCSMs/PMRs, 37
Barlow, T.; Wight, A.; Barlow, D
Objectives To determine if current validated psychometric evaluations could determine a difference in basic behavioural characteristics between surgical and medical specialties. Design Cross-sectional study. Setting Two district general hospitals and one University teaching hospital in England, UK. Participants Internal medicine (16) and trauma and orthopaedic (20) consultants. Main outcome measures Aggression levels as assessed by the Buss and Warren questionnaire. The self-administered ques...
Full Text Available BACKGROUND: In February 2007, a general surgeon in Charlottetown, Prince Edward Island, tested positive for hepatitis C virus (HCV. The surgeon’s infection onset date could not be determined; however, episodic hepatic enzyme elevations were first detected in November 2004 and again in February 2007. HCV transmission during surgery, alhough rare, has been documented. A phased look-back HCV screening program was conducted to detect HCV transmission from this surgeon to patients who underwent the highest-risk procedures in the three years before his positive test.
McEvenue, Giancarlo; Copeland, Andrea; Devon, Karen M; Semple, John L
The internet and social media are increasingly being used by patients not only for health-related research, but also for obtaining information on their surgeon. Having an online presence via a website and social media profile is one-way plastic surgeons can meet this patient driven demand. The authors sought to document current website and social media usage of Canadian plastic surgeons and to determine if this usage correlated with years in practice. A Google search was performed using publicly available lists of all plastic surgeons registered with the Royal College of Physicians and Surgeons of Canada (RCPSC) and the Canadian Society for Aesthetic Plastic Surgery (CSAPS). This search found 42% (268/631) of RCPSC plastic surgeons had a website and 85% (536/631) had a profile on social media. Younger RCPSC surgeons (registered for less years) were significantly more likely to have a website (12.8 vs. 21.9 years, P social media profile (16.2 vs. 23.9 years, P social media platform most used was RateMDs (81%) followed in decreasing order by: LinkedIn (28%), RealSelf (22%), Facebook (20%), Google+ (17%) and Twitter (16%). Dual RCPSC-CSAPS members were more likely than RCPSC-only members to have a website (56 vs. 36%, P social media profile (P social media presence by Canadian plastic surgeons is comparable to counterparts in the US and UK. It may be possible to better optimize online presence through education of current search engine technology and becoming active on multiple social media platforms.
... QUALIFIED The Orthopaedic Distinction The American Orthopaedic Foot & Ankle Society (AOFAS) is an organization of more than 2,200 orthopaedic surgeons from the US and abroad who specialize in the medical and ...
Philipsen, A B; Ellitsgaard, N; Krogsgaard, M R;
Orthopaedic shoes are individually handmade after a prescription from an orthopaedic surgeon, hence relatively expensive. Bad compliance is mentioned in the literature but not investigated. In order to evaluate patient compliance and the effect of orthopaedic shoes, 85 patients who were prescribe...
Do geography and resources influence the need for colostomy in Hirschsprung′s disease and anorectal malformations? A Canadian association of paediatric surgeons: Association of paediatric surgeons of Nigeria survey
Lukman O. Abdur-Rahman
Full Text Available Background: This survey compared surgical management of Hirschsprung′s disease (HD and anorectal malformations (ARM in high and low resource settings. Materials and Methods: An online survey was sent to 208 members of the Canadian Association of Paediatric Surgeons (CAPS and the Association of Paediatric Surgeons of Nigeria (APSON. Results: The response rate was 76.8% with 127 complete surveys (APSON 34, CAPS 97. Only 29.5% of APSON surgeons had frozen section available for diagnosis of HD. They were more likely to choose full thickness rectal biopsy (APSON 70.6% vs. CAPS 9.4%, P < 0.05 and do an initial colostomy for HD (APSON 23.5% vs. CAPS 0%, P < 0.05. Experience with trans-anal pull-through for HD was similar in both groups (APSON 76.5%, CAPS 66.7%. CAPS members practising in the United States were more likely to perform a one-stage pull-through for HD during the initial hospitalization (USA 65.4% vs. Canada 28.3%, P < 0.05. The frequency of colostomy in females with vestibular fistula varied widely independent of geography. APSON surgeons were less likely to have enterostomal therapists and patient education resources. Conclusions: Local resources which vary by geographic location affect the management of HD and ARM including colostomy. Collaboration between CAPS and APSON members could address resource and educational needs to improve patient care.
Maniadakis, N; Gray, A
It is becoming widely accepted that research which considers only the outcome and not the costs associated with new technologies in health care, is of limited value in making decisions about the use of scarce resources. Economic evaluation is becoming a standard feature of clinical research but many published economic evaluations fall short of best practice in their methodology. We have described the essential features of economic evaluation, using published studies in orthopaedics, in order to try to improve the ability of orthopaedic surgeons to read, understand and appraise such studies critically, and to encourage them to consider including economic evaluation in future investigations. PMID:10697306
Mamczak, Christiaan N; Born, Christopher T; Obremskey, William T; Dromsky, David M
Current combat battlefield injuries are among the most complex and challenging orthopaedic cases. These injuries carry high risks for exsanguination and global contamination of extensive soft-tissue and complicated bony injuries. Military orthopaedic surgeons must employ the latest advances in acute combat casualty care to achieve favorable outcomes. Adaptive changes over the past 10 years of war have given today's surgeons the armamentarium to optimize patient care. Innovative methods of damage control resuscitation and surgery have led to increased survival. However, the fundamentals of surgical hemostasis and decontamination remain critical to successful management. The acute treatment of combat casualties involves a continuum of care from the point of injury through transport out of theater. Future research and education are paramount to better prepare military orthopaedic surgeons to further increase survivability and enhance the outcomes of service members with complex wounds.
Tan, S. L. E.
Stereoscopy was used in medicine as long ago as 1898, but has not gained widespread acceptance except for a peak in the 1930's. It retains a use in orthopaedics in the form of Radiostereogrammetrical Analysis (RSA), though this is now done by computer software without using stereopsis. Combining computer assisted stereoscopic displays with both conventional plain films and reconstructed volumetric axial data, we are reassessing the use of stereoscopy in orthopaedics. Applications include use in developing nations or rural settings, erect patients where axial imaging cannot be used, and complex deformity and trauma reconstruction. Extension into orthopaedic endoscopic systems and teaching aids (e.g. operative videos) are further possibilities. The benefits of stereoscopic vision in increased perceived resolution and depth perception can help orthopaedic surgeons achieve more accurate diagnosis and better pre-operative planning. Limitations to currently available stereoscopic displays which need to be addressed prior to widespread acceptance are: availability of hardware and software, loss of resolution, use of glasses, and image "ghosting". Journal publication, the traditional mode of information dissemination in orthopaedics, is also viewed as a hindrance to the acceptance of stereoscopy - it does not deliver the full impact of stereoscopy and "hands-on" demonstrations are needed.
Pidgeon, Tyler S; Ramirez, Jose M; Schiller, Jonathan R
Spasticity is a common manifestation of many neurological conditions including multiple sclerosis, stroke, cerebral palsy, traumatic brain injury, and spinal cord injuries. Management of spasticity seeks to reduce its burden on patients and to limit secondary complications. Non-operative interventions including stretching/splinting, postural management, physical therapy/strengthening, anti-spasticity medications, and botulinum toxin injections may help patients with spasticity. Surgical management of these conditions, however, is often necessary to improve quality of life and prevent complications. Orthopaedic surgeons manage numerous sequelae of spasticity, including joint contractures, hip dislocations, scoliosis, and deformed extremities. When combined with the efforts of rehabilitation specialists, neurologists, and physical/occupational therapists, the orthopaedic management of spasticity can help patients maintain and regain function and independence as well as reduce the risk of long-tem complications. PMID:26623452
Lang, J E; Mannava, S; Floyd, A J; Goddard, M S; Smith, B P; Mofidi, A; Seyler, T M; Jinnah, R H
Robots have been used in surgery since the late 1980s. Orthopaedic surgery began to incorporate robotic technology in 1992, with the introduction of ROBODOC, for the planning and performance of total hip replacement. The use of robotic systems has subsequently increased, with promising short-term radiological outcomes when compared with traditional orthopaedic procedures. Robotic systems can be classified into two categories: autonomous and haptic (or surgeon-guided). Passive surgery systems, which represent a third type of technology, have also been adopted recently by orthopaedic surgeons. While autonomous systems have fallen out of favour, tactile systems with technological improvements have become widely used. Specifically, the use of tactile and passive robotic systems in unicompartmental knee replacement (UKR) has addressed some of the historical mechanisms of failure of non-robotic UKR. These systems assist with increasing the accuracy of the alignment of the components and produce more consistent ligament balance. Short-term improvements in clinical and radiological outcomes have increased the popularity of robot-assisted UKR. Robot-assisted orthopaedic surgery has the potential for improving surgical outcomes. We discuss the different types of robotic systems available for use in orthopaedics and consider the indication, contraindications and limitations of these technologies. PMID:21969424
Wong, Seng Juong; Robertson, Greg A.; Connor, Katie L.; Brady, Richard R.; Wood, Alexander M
Background With the advent of smartphones together with their downloadable applications (apps), there is increasing opportunities for doctors, including orthopaedic sports surgeons, to integrate such technology into clinical practice. However, the clinical reliability of these medical apps remains questionable. We reviewed available apps themed specifically towards Orthopaedic Sports Medicine and related conditions and assessed the level of medical professional involvement in their design and...
Kiesau, Carter D; Heim, Kathryn A; Parekh, Selene G
Leadership and business challenges have become increasingly present in the practice of medicine. Orthopaedic residency programs are at the forefront of educating and preparing orthopaedic surgeons. This study attempts to quantify the number of orthopaedic residency programs in the United States that include leadership or business topics in resident education program and to determine which topics are being taught and rate the importance of various leadership characteristics and business topics. A survey was sent to all orthopaedic department chairpersons and residency program directors in the United States via e-mail. The survey responses were collected using a survey collection website. The respondents rated the importance of leadership training for residents as somewhat important. The quality of character, integrity, and honesty received the highest average rating among 19 different qualities of good leaders in orthopaedics. The inclusion of business training in resident education was also rated as somewhat important. The topic of billing and coding received the highest average rating among 14 different orthopaedically relevant business topics. A variety of topics beyond the scope of clinical practice must be included in orthopaedic residency educational curricula. The decreased participation of newly trained orthopaedic surgeons in leadership positions and national and state orthopaedic organizations is concerning for the future of orthopaedic surgery. Increased inclusion of leadership and business training in resident education is important to better prepare trainees for the future. PMID:21838073
Kiesau, Carter D; Heim, Kathryn A; Parekh, Selene G
Leadership and business challenges have become increasingly present in the practice of medicine. Orthopaedic residency programs are at the forefront of educating and preparing orthopaedic surgeons. This study attempts to quantify the number of orthopaedic residency programs in the United States that include leadership or business topics in resident education program and to determine which topics are being taught and rate the importance of various leadership characteristics and business topics. A survey was sent to all orthopaedic department chairpersons and residency program directors in the United States via e-mail. The survey responses were collected using a survey collection website. The respondents rated the importance of leadership training for residents as somewhat important. The quality of character, integrity, and honesty received the highest average rating among 19 different qualities of good leaders in orthopaedics. The inclusion of business training in resident education was also rated as somewhat important. The topic of billing and coding received the highest average rating among 14 different orthopaedically relevant business topics. A variety of topics beyond the scope of clinical practice must be included in orthopaedic residency educational curricula. The decreased participation of newly trained orthopaedic surgeons in leadership positions and national and state orthopaedic organizations is concerning for the future of orthopaedic surgery. Increased inclusion of leadership and business training in resident education is important to better prepare trainees for the future.
Ulf Martin Schilling
Objective: To assess the capability of operating abdominal and orthopaedic surgeons to analyze a set of standardized ECG. Methods: Twenty operating abdominal and orthopaedic surgeons at a university hospital were included. Each participant analyzed a set of five standardized ECG with an answering scheme for eight different items, giving a maximum score of 40. The answers were matched according to specialty and experience of the doctors of less than 5 years, between 5 and 10 years or more than 10 years. The reference standard was set by two independent consultants in cardiology. Results: The mean overall score was 25.25 (63.13%±4.78%) varying between 38 (95%) and 20(50%). Abdominal surgeons performed a mean score of 27.625 (69.06%±9.53%), and orthopaedic surgeons 23.67 points (59.17%±3.69%). The difference between the performance of abdominal and orthopaedic surgeons was not significant (P=0.09). 20/20 surgeons identified ST-elevation and no surgeon accepted the ECG showing acute ST-elevation myocardial infarction as normal. Conclusions: Abdominal and orthopaedic surgeons provided an answering scheme are able to interprete the ECG and identify both the normal and the ECG showing life-threatening pathology. The hypothesis that surgeons were unable to interprete the ECG must be rejected.
Saleh, Khaled J.; James Campbell QUICK; Sime, Wesley E.; Novicoff, Wendy M.; Einhorn, Thomas A.
Stress, emotional exhaustion, and burnout are widespread in the medical profession in general and in orthopaedic surgery in particular. We attempted to identify variables associated with burnout as assessed by validated instruments. Surveys were sent to 282 leaders from orthopaedic surgery academic departments in the United States by e-mail and mail. Responses were received from 195 leaders for a response rate of 69%. The average surgeon worked 68.3 hours per week and more than ½ of this time...
Atesok, Kivanc; Mabrey, Jay D; Jazrawi, Laith M; Egol, Kenneth A
Mastering rapidly evolving orthopaedic surgical techniques requires a lengthy period of training. Current work-hour restrictions and cost pressures force trainees to face the challenge of acquiring more complex surgical skills in a shorter amount of time. As a result, alternative methods to improve the surgical skills of orthopaedic trainees outside the operating room have been developed. These methods include hands-on training in a laboratory setting using synthetic bones or cadaver models as well as software tools and computerized simulators that enable trainees to plan and simulate orthopaedic operations in a three-dimensional virtual environment. Laboratory-based training offers potential benefits in the development of basic surgical skills, such as using surgical tools and implants appropriately, achieving competency in procedures that have a steep learning curve, and assessing already acquired skills while minimizing concerns for patient safety, operating room time, and financial constraints. Current evidence supporting the educational advantages of surgical simulation in orthopaedic skills training is limited. Despite this, positive effects on the overall education of orthopaedic residents, and on maintaining the proficiency of practicing orthopaedic surgeons, are anticipated. PMID:22751160
Baat, P. de; Baat, C. de; Bessems, J.H.
For several decades, distraction osteogenesis has been applied in orthopaedics for lengthening limbs. Other indications for distraction osteogenesis in orthopaedics are nonunions, open fractures, oncologic defects, and ankle osteoarthritis. The main principle of distraction osteogenesis is that, wit
Mittlmeier, T; Bonnaire, F; Grützner, P A; Lill, H; Matthes, G; Prokop, A; Seifert, J; Voigt, C; Walcher, F; Wölfl, C; Siebert, H
The lack of clinical residents especially in the surgical domains, including orthopaedics and trauma surgery, is not only omnipresent but also a topic of lively discussions. This lack originates from sociopolitical and healthcare policy issues as well as from a loss of attractiveness of all surgical disciplines. The loss is caused by the high workload and disadvantageous working hours especially in those disciplines with a high rate of emergencies, e.g. trauma surgery. Moreover, it is caused by the poorly structured and unpredictable period of residency. In order to anticipate the bottleneck in supply due to the lack of trainees, a number of structural and contextual measures have to be taken to improve both undergraduate und postgraduate surgical training. Due to the numerous facets of the topic the first part of this analysis refers to the period until the trainee decides on the field of training.A basic insight into the field of orthopaedics and trauma surgery can already be offered far before the period of medical studies itself. During undergraduate medical education the existing structures should be modified, the characteristics of the discipline should be emphasized and the charm of combining theory and practical skills should be highlighted in order to enhance student's perception of the discipline. This might begin during preclinical training and should be continued throughout clinical training and elective courses (basic wound care, TEAM approach, AO course for students and seminars for M.D. candidates). Contextual and structural improvements of the practical year are indispensable to arouse students' interest in our discipline. These options conjoined with the actual offers for students provided by our scientific society, such as guided tours during the annual congress, travelling grants and the recently inaugurated summer school, might provide the basis for clearly structured information and offer a distinct stimulus to apply for residency in our field
Daniels, Alan H; Ritterman, Scott A; Rubin, Lee E
Paralytic ileus is marked by the cessation of bowel motility. This condition is a major clinical concern that may lead to severe patient morbidity in orthopaedic surgery and trauma patients. Ileus most commonly occurs following spinal surgery, traumatic injury, or lower extremity joint reconstruction, but it may also occur following minor orthopaedic procedures. Possible consequences of ileus include abdominal pain, malnutrition, prolonged hospital stay, hospital readmission, bowel perforation, and death. Therapies used in the treatment of ileus include minimization of opioids, early patient mobilization, pharmacologic intervention, and multidisciplinary care. Orthopaedic surgeons should be aware of the clinical signs and symptoms of paralytic ileus and should understand treatment principles of this relatively common adverse event. PMID:25917235
Warwick, D.; Dahl, O.E.; Fisher, W.D.;
research into 'evidence-based' advice. Guidelines should, in theory, benefit patient care by ensuring that every patient routinely receives the best prophylaxis; without guidelines, it is argued, patients may fail to receive treatment or be exposed to protocols which are ineffective, dangerous or expensive....... Guidelines, however, have not been welcomed or applied universally. In the United States, orthopaedic surgeons have published their concerns about the thromboprophylaxis guidelines prepared by the American College of Chest Physicians. In Britain, controversy persists with many surgeons unconvinced...
Full Text Available Introduction. The Royal College of Surgeons in England published guidelines in 2008 outlining the information that should be documented at each surgery. St. James’s Hospital uses a standard operation sheet for all surgical procedures and these were examined to assess documentation standards. Objectives. To retrospectively audit the hand written orthopaedic operative notes according to established guidelines. Methods. A total of 63 operation notes over seven months were audited in terms of date and time of surgery, surgeon, procedure, elective or emergency indication, operative diagnosis, incision details, signature, closure details, tourniquet time, postop instructions, complications, prosthesis, and serial numbers. Results. A consultant performed 71.4% of procedures; however, 85.7% of the operative notes were written by the registrar. The date and time of surgery, name of surgeon, procedure name, and signature were documented in all cases. The operative diagnosis and postoperative instructions were frequently not documented in the designated location. Incision details were included in 81.7% and prosthesis details in only 30% while the tourniquet time was not documented in any. Conclusion. Completion and documentation of operative procedures were excellent in some areas; improvement is needed in documenting tourniquet time, prosthesis and incision details, and the location of operative diagnosis and postoperative instructions.
Marcus, Randall E.; Zenty, Thomas F.; Adelman Esq., Harlin G.
For 30 years, the orthopaedic faculty at Case Western Reserve University worked as an independent private corporation within University Hospitals Case Medical Center (Hospital). However, by 2002, it became progressively obvious to our orthopaedic practice that we needed to modify our business model to better manage the healthcare regulatory changes and decreased reimbursement if we were to continue to attract and retain the best and brightest orthopaedic surgeons to our practice. In 2002, our...
Conclusion: This project demonstrated a good model of multidisciplinary R&D of surgical robotics led by orthopaedic surgeons, in collaboration with mechanical and electronic engineers and industrial designers.
Paul Briars, North West regional director for independent engineering, IT, and facilities services business, NG Bailey (pictured), discusses the company's part in a major redevelopment at one of the UK's top orthopaedic hospitals, Wrightington Hospital in Lancashire --famous as the site, in the early 1960s, of first ever hip replacement operations, by pioneering surgeon, Professor Sir John Charnley (HEJ --April 2013).
Watters, William; Rethman, Michael P; Hanson, Nicholas Buck; Abt, Elliot; Anderson, Paul A; Carroll, Karen C; Futrell, Harry C; Garvin, Kevin; Glenn, Stephen O; Hellstein, John; Hewlett, Angela; Kolessar, David; Moucha, Calin; O'Donnell, Richard J; O'Toole, John E; Osmon, Douglas R; Evans, Richard Parker; Rinella, Anthony; Steinberg, Mark J; Goldberg, Michael; Ristic, Helen; Boyer, Kevin; Sluka, Patrick; Martin, William Robert; Cummins, Deborah S; Song, Sharon; Woznica, Anne; Gross, Leeaht
The Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures evidence-based clinical practice guideline was codeveloped by the American Academy of Orthopaedic Surgeons (AAOS) and the American Dental Association. This guideline replaces the previous AAOS Information Statement, "Antibiotic Prophylaxis in Bacteremia in Patients With Joint Replacement," published in 2009. Based on the best current evidence and a systematic review of published studies, three recommendations have been created to guide clinical practice in the prevention of orthopaedic implant infections in patients undergoing dental procedures. The first recommendation is graded as Limited; this recommendation proposes that the practitioner consider changing the long-standing practice of routinely prescribing prophylactic antibiotic for patients with orthopaedic implants who undergo dental procedures. The second, graded as Inconclusive, addresses the use of oral topical antimicrobials in the prevention of periprosthetic joint infections. The third recommendation, a Consensus statement, addresses the maintenance of good oral hygiene.
Operative surgery exposes the surgeon to possible blood-borne infections. Risks include pen-etrating injuries and conjunctival contact with infected blood. Visor masks worn during orthopaedic trauma procedures were assessed for blood contamination using computer analysis. This was found to be present on 86% of masks, of which only 15% was recognized by the surgeon intraoperatively. Of the blood splashes 80% were less than 0.6mm in diameter. We conclude that power instrumentation produces a blood particulate mist causing considerable microscopic, facial contamination which is a significant risk to the surgeon.
Brinker, M R; Pierce, P; Siegel, G
The purpose of the current investigation was to present a standard method by which an orthopaedic practice can analyze its practice expenses. To accomplish this, a five-step process was developed to analyze practice expenses using a modified version of activity-based costing. In this method, general ledger expenses were assigned to 17 activities that encompass all the tasks and processes typically performed in an orthopaedic practice. These 17 activities were identified in a practice expense study conducted for the American Academy of Orthopaedic Surgeons. To calculate the cost of each activity, financial data were used from a group of 19 orthopaedic surgeons in Houston, Texas. The activities that consumed the largest portion of the employee work force (person hours) were service patients in office (25.0% of all person hours), maintain medical records (13.6% of all person hours), and resolve collection disputes and rebill charges (12.3% of all person hours). The activities that comprised the largest portion of the total expenses were maintain facility (21.4%), service patients in office (16.0%), and sustain business by managing and coordinating practice (13.8%). The five-step process of analyzing practice expenses was relatively easy to perform and it may be used reliably by most orthopaedic practices. PMID:10738440
Yan, J.; MacDonald, A.; Baisi, L-P.; Evaniew, N.; Bhandari, M.
Objectives Despite the fact that research fraud and misconduct are under scrutiny in the field of orthopaedic research, little systematic work has been done to uncover and characterise the underlying reasons for academic retractions in this field. The purpose of this study was to determine the rate of retractions and identify the reasons for retracted publications in the orthopaedic literature. Methods Two reviewers independently searched MEDLINE, EMBASE, and the Cochrane Library (1995 to current) using MeSH keyword headings and the ‘retracted’ filter. We also searched an independent website that reports and archives retracted scientific publications (www.retractionwatch.com). Two reviewers independently extracted data including reason for retraction, study type, journal impact factor, and country of origin. Results One hundred and ten retracted studies were included for data extraction. The retracted studies were published in journals with impact factors ranging from 0.000 (discontinued journals) to 13.262. In the 20-year search window, only 25 papers were retracted in the first ten years, with the remaining 85 papers retracted in the most recent decade. The most common reasons for retraction were fraudulent data (29), plagiarism (25) and duplicate publication (20). Retracted articles have been cited up to 165 times (median 6; interquartile range 2 to 19). Conclusion The rate of retractions in the orthopaedic literature is increasing, with the majority of retractions attributed to academic misconduct and fraud. Orthopaedic retractions originate from numerous journals and countries, indicating that misconduct issues are widespread. The results of this study highlight the need to address academic integrity when training the next generation of orthopaedic investigators. Cite this article: J. Yan, A. MacDonald, L-P. Baisi, N. Evaniew, M. Bhandari, M. Ghert. Retractions in orthopaedic research: A systematic review. Bone Joint Res 2016;5:263–268. DOI: 10
Although the need for orthopaedic shoes is increasing, the number of skilled shoemakers has declined. This has led to the development of a CAD/CAM system to design and fabricate, orthopaedic footwear. The NASA-developed RIM database management system is the central repository for CUSTOMLAST's information storage. Several other modules also comprise the system. The project was initiated by Langley Research Center and Research Triangle Institute in cooperation with the Veterans Administration and the National Institute for Disability and Rehabilitation Research. Later development was done by North Carolina State University and the University of Missouri-Columbia. The software is licensed by both universities.
Stefanie N Hofstede
Full Text Available International evidence-based guidelines for the management of patients with hip and knee osteoarthritis (OA recommend to start with (a combination of non-surgical treatments, and using surgical intervention only if a patient does not respond sufficiently to non-surgical treatment options. Despite these recommendations, there are strong indications that non-surgical treatments are not optimally used in orthopaedic practice. To improve the adoption of non-surgical treatments, more insight is needed into barriers and facilitators of these treatments. Therefore, this study assessed which barriers and facilitators are associated with the use and prescription of different non-surgical treatments before hip and knee OA in orthopaedic practice among patients and orthopaedic surgeons in the Netherlands.We performed two internet-based surveys among 172 orthopaedic surgeons and 174 OA patients. Univariate association and multivariable regression techniques are used to identify barriers and facilitators associated with the use of non-surgical treatments.Most barriers and facilitators among patients were associated with the use of physical therapy, lifestyle advice and dietary therapy. Among orthopaedic surgeons, most were associated with prescription of acetaminophen, dietary therapy and physical therapy. Examples of barriers and facilitators among patients included "People in my environment had positive experiences with a surgery" (facilitator for education about OA, and "Advice of people in my environment to keep on moving" (facilitator for lifestyle and dietary advice. For orthopaedic surgeons, examples were "Lack of knowledge about guideline" (barrier for lifestyle advice, "Agreements/ deliberations with primary care" and "Easy communication with a dietician" (facilitators for dietary therapy. Also the belief in the efficacy of these treatments was associated with increased prescription.Strategies to improve non-surgical treatment use in orthopaedic
Full Text Available Abstract Background Globally, injuries cause approximately as many deaths per year as HIV/AIDS, tuberculosis and malaria combined, and 90% of injury deaths occur in low- and middle- income countries. Given not all injuries kill, the disability burden, particularly from orthopaedic injuries, is much higher but is poorly measured at present. The orthopaedic services and orthopaedic medical devices needed to manage the injury burden are frequently unavailable in these countries. Corruption is known to be a major barrier to access of health care, but its effects on access to orthopaedic services is still unknown. Methods A qualitative case study of 45 open-ended interviews was conducted to investigate the access to orthopaedic health services and orthopaedic medical devices in Uganda. Participants included orthopaedic surgeons, related healthcare professionals, industry and government representatives, and patients. Participants’ experiences in accessing orthopaedic medical devices were explored. Thematic analysis was used to analyze and code the transcripts. Results Analysis of the interview data identified poor leadership in government and corruption as major barriers to access of orthopaedic care and orthopaedic medical devices. Corruption was perceived to occur at the worker, hospital and government levels in the forms of misappropriation of funds, theft of equipment, resale of drugs and medical devices, fraud and absenteeism. Other barriers elicited included insufficient health infrastructure and human resources, and high costs of orthopaedic equipment and poverty. Conclusions This study identified perceived corruption as a significant barrier to access of orthopaedic care and orthopaedic medical devices in Uganda. As the burden of injury continues to grow, the need to combat corruption and ensure access to orthopaedic services is imperative. Anti-corruption strategies such as transparency and accountability measures, codes of conduct
Fayaz, Hangama C; Haas, Norbert; Kellam, James; Bavonratanavech, Suthorn; Parvizi, Javad; Dyer, George; Pohlemann, Tim; Jerosch, Jörg; Prommersberger, Karl-Josef; Pape, Hans Christoph; Smith, Malcolm; Vrahas, Marc; Perka, Carsten; Siebenrock, Klaus; Elhassan, Bassem; Moran, Christopher; Jupiter, Jesse B
The international orthopaedic community aims to achieve the best possible outcome for patient care by constantly modifying surgical techniques and expanding the surgeon's knowledge. These efforts require proper reflection within a setting that necessitates a higher quality standard for global orthopaedic publication. Furthermore, these techniques demand that surgeons acquire information at a rapid rate while enforcing higher standards in research performance. An international consensus exists on how to perform research and what rules should be considered when publishing a scientific paper. Despite this global agreement, in today's "Cross Check Era", too many authors do not give attention to the current standards of systematic research. Thus, the purpose of this paper is to describe these performance standards, the available choices for orthopaedic surgeons and the current learning curve for seasoned teams of researchers and orthopaedic surgeons with more than three decades of experience. These lead to provide an accessible overview of all important aspects of the topics that will significantly influence the research development as we arrive at an important globalisation era in orthopaedics and trauma-related research.
Young, Jason David; Gelbs, Jared Craig; Zhu, David Shiyu; Gallacher, Stacey Elisa; Sutton, Karen Michelle; Blaine, Theodore Alton
Background: Despite the common nature of orthopaedic injuries in equestrian sports, there is no published review to specifically characterize orthopaedic injuries in equestrian athletes. Purpose: To characterize orthopaedic injury patterns in equine sports–related injuries and their treatment. Study Design: Systematic review; Level of evidence, 4. Methods: This review was performed through a PubMed, EMBASE, and Scopus query (from 1978 to June 2014) in the English literature using search terms...
The Society of Reproductive Surgeons Home About Us About SRS Mission Statement Officers The Role of Reproductive Surgeons For ... Fact Sheets and Booklets SRS is an affiliated society to the American Society for Reproductive Medicine . Below ...
... by oral and maxillofacial surgeons and orthodontists. Having Orthognathic Surgery The AAOMS and AAO present "Having Orthognathic ... by oral and maxillofacial surgeons and orthodontists. Having Orthognathic Surgery The AAOMS and AAO present "Having Orthognathic ...
... So You Want to Be a Surgeon Resident Resources Teaching Resources Online Guide to Choosing a Surgical Residency Clinical ... Patient Safety Advanced Skills Course for Rural Surgeons Support the Work of the Nora Institute ... Advocacy Advocacy Overview Quality Payment Program QPP Resource Center QPP Resource Center What Surgeons Can Do ...
... So You Want to Be a Surgeon Resident Resources Teaching Resources Online Guide to Choosing a Surgical Residency Clinical ... Patient Safety Advanced Skills Course for Rural Surgeons Support the Work of the Nora Institute ... Advocacy Advocacy Overview Quality Payment Program QPP Resource Center QPP Resource Center What Surgeons Can Do ...
Thromboembolic events are a post-operative complication of arthroplasty surgery for up to 3 months. The incidence however, is not fully known. Some form of prophylaxis should be provided to all arthroplasty patients. Clinicians are wary of side effects, compliance profile and the associated cost. The objective of this study is to investigate practice patterns and their relevance to 3 risk groups. Ninety questionnaires were sent to orthopaedic surgeons with 3 hypothetical clinical scenarios and 10 prophylaxis regimes for thromboembolism across different risk groups. The response rate was 81\\/90 (90%). The most popular options in all 3 cases were early mobilisation, thrombo-embolism deterrant (TED) stockings and low molecular weight heparin (LMWH) (51\\/81, 62% of all cases). An inconsistent relationship exists between preferred practice and relevant guidelines. Preferred practice does not correlate with each level of risk.
LU Lu; WANG Yiran
Military surgeons are a special group of doctors. They are both medical workers and soldiers.Their mission is to serve the wounded on the battlefield.And there is no doubt that military surgeons will save our comrades in the army. However,should a military surgeon save the wounded enemy? It is indeed a dilemma.Some may save the wounded enemy because military surgeons are doctors after all and they can't possibly abandon anybody to his fate,but some refuse to do so because military surgeons are soldiers.Therefore,some situations on the battlefield are discussed and advice is suggested for military surgeons,with heartfelt anticipation for there being less casualties on the battlefield as well as alleviating human suffering caused by war.
Mechanical Engineer Michael Guerrero works on the Robot Brain Surgeon testbed in the NeuroEngineering Group at the Ames Research Center, Moffett Field, California. Principal investigator Dr. Robert W. Mah states that potentially the simple robot will be able to feel brain structures better than any human surgeon, making slow, very precise movements during an operation. The brain surgery robot that may give surgeons finer control of surgical instruments during delicate brain operations is still under development.
In orthopaedic and trauma surgery, the rapid evolution of biomedical research has fundamentally changed the perception of the musculoskeletal system. Here, the rigor of basic science and the art of musculoskeletal surgery have come together to create a new discipline -experimental orthopaedics- that holds great promise for the causative cure of many orthopaedic conditions. The Journal of Experimental Orthopaedics intends to bridge the gap between orthopaedic basic science and clinical relevan...
Abstract Background Despite having access to medically necessary care available through publicly funded provincial health care systems, some Canadians travel for treatment provided at international medical facilities as well as for-profit clinics found in several Canadian provinces. Canadians travel abroad for orthopaedic surgery, bariatric surgery, ophthalmologic surgery, stem cell injections, “Liberation therapy” for multiple sclerosis, and additional interventions. Both responding to publi...
Shirley, Eric D; Sabharwal, Sanjeev; Schwend, Richard M; Cabral, Cristina; Spiegel, David
The burden of musculoskeletal conditions, especially injuries, is increasing in low-income and middle-income countries. Road traffic injuries have become epidemic. There are multiple barriers to accessing surgical services at both the individual (utilization) and the health system (availability) levels, and deficiencies in education and training of health providers. Specialty societies such as the Pediatric Orthopaedic Society of North America (POSNA) have an opportunity to play an important role through teaching and training. The POSNA Children's Orthopedics in Underserved Regions (COUR) committee has supported the Visiting Scholars Program, which invites surgeons from the developing world to attend a scientific meeting and facilitates the scholar's visit to North American pediatric orthopaedic centers. POSNA members have held global educational courses that support an educational exchange between lecturers and attendees. The COUR web site allows for submission of trip reports that document successes and obstacles experienced by members performing overseas clinical care and teaching. The web site also provides educational resources relevant to providing care in these environments. POSNA collaborates with other societies, such as the American Academy of Orthopaedic Surgeons and the Society of Military Orthopaedic Surgeons, to provide education in disaster management. In addition to increasing member involvement, specialty societies have the opportunity for continued data collection from overseas care, application of US registry data to disease processes in the developing world, and further collaboration with one another. PMID:26296220
... of the Month September 2016 32-Year-Old Female with Numbness How would you treat this month's ... All Events Corporate Partners Learn More About Our Industry Allies Council Partners Congress of Neurological Surgeons 10 ...
... December 1 – 3, 2016. This year’s course includes didactic lectures by outstanding surgeons and educators who are ... held in high esteem by other medical societies. Education Evidence-Based Medicine article published in OBG Mangement ...
Guryel, E; Acton, K; Patel, S
INTRODUCTION Clinical audit plays an important role in the drive to improve the quality of patient care and thus forms a cornerstone of clinical governance. Assurance that the quality of patient care has improved requires completion of the audit cycle. A considerable sum of money and time has been spent establishing audit activity in the UK. Failure to close the loop undermines the effectiveness of the audit process and wastes resources. PATIENTS AND METHODS We analysed the effectiveness of audit in trauma and orthopaedics at a local hospital by comparing audit projects completed over a 6-year period to criteria set out in the NHS National Audit and Governance report. RESULTS Of the 25 audits performed since 1999, half were presented to the relevant parties and only 20% completed the audit cycle. Only two of these were audits against national standards and 28% were not based on any standards at all. Only a third of the audits led by junior doctors resulted in implementation of their action plan compared to 75% implementation for consultant-led and 67% for nurse-led audits. CONCLUSIONS A remarkably large proportion of audits included in this analysis failed to meet accepted criteria for effective audit. Audits completed by junior doctors were found to be the least likely to complete the cycle. This may relate to the lack of continuity in modern medical training and little incentive to complete the cycle. Supervision by permanent medical staff, principally consultants, and involvement of the audit department may play the biggest role in improving implementation of change. PMID:18828963
Full Text Available Road traffic accidents are increasing at an alarming rate and have become a major public health concern in India. In addition, there is a lack of trauma research output and reliable data from India. There are several issues and challenges that have presented an opportunity for researchers and surgeons in India to develop a collaborative aimed at improving the quality and productivity of orthopaedic trauma research. Establishing a network of surgical researchers across India is a necessary first step towards global leadership in orthopaedic surgery trials.
Stuyts, Bart; Van den Eeden, Elke; Fennema, Peter
In contemporary orthopaedics, surgical site infections (SSIs) can have significant negative consequences for both patients and the healthcare system overall. To date, most efforts at combating the risk of SSIs have focused on the role of the surgeon, yet recent data suggest that a more expansive approach is warranted. The current review offers an overview of the most-relevant factors associated with SSIs in orthopaedic surgery, and the crucial role that the full surgical staff can play in addressing them.
Willy, Christian; Schneider, Peter; Engelhardt, Michael; Hargens, Alan R; Mubarak, Scott J
Richard von Volkmann (1830-1889), one of the most important surgeons of the 19(th) century, is regarded as one of the fathers of orthopaedic surgery. He was a contemporary of Langenbeck, Esmarch, Lister, Billroth, Kocher, and Trendelenburg. He was head of the Department of Surgery at the University of Halle, Germany (1867-1889). His popularity attracted doctors and patients from all over the world. He was the lead physician for the German military during two wars. From this experience, he compared the mortality of civilian and war injuries and investigated the general poor hygienic conditions in civilian hospitals. This led him to introduce the "antiseptic technique" to Germany that was developed by Lister. His powers of observation and creativity led him to findings and achievements that to this day bear his name: Volkmann's contracture and the Hueter-Volkmann law. Additionally, he was a gifted writer; he published not only scientific literature but also books of children's fairy tales and poems under the pen name of Richard Leander, assuring him a permanent place in the world of literature as well as orthopaedics. PMID:18196438
This book provides a cohesive overview of the current technological advances in computational radiology, and their applications in orthopaedic interventions. Contributed by the leading researchers in the field, this volume covers not only basic computational radiology techniques such as statistical shape modeling, CT/MRI segmentation, augmented reality and micro-CT image processing, but also the applications of these techniques to various orthopaedic interventional tasks. Details about following important state-of-the-art development are featured: 3D preoperative planning and patient-specific instrumentation for surgical treatment of long-bone deformities, computer assisted diagnosis and planning of periacetabular osteotomy and femoroacetabular impingement, 2D-3D reconstruction-based planning of total hip arthroplasty, image fusion for computer-assisted bone tumor surgery, intra-operative three-dimensional imaging in fracture treatment, augmented reality based orthopaedic interventions and education, medica...
Hawkey, S; Ghaffar, S
Thioureas, often contained within neoprene to provide water resistance, are an important cause of allergic contact dermatitis (ACD) in those who use neoprene products. We wish to present three cases of thiourea-induced ACD from three different orthopaedic supports containing neoprene. The first case was a 67-year-old woman who developed an itchy rash on her heel three weeks after using a neoprene insole for plantar fasciitis. The second case was a 47-year-old man who developed an itchy rash on his wrist after wearing neoprene wrist splints for psoriatic arthropathy. The third case was a 77-year-old woman who experienced a severe erythematous rash with blistering from a neoprene elbow brace she received following a humeral fracture. All patients were patch tested to the British Society of Cutaneous Allergy Standard and rubber series and a cut piece from all the relevant supports. At 96 hours, all patients had a + reaction to mixed dialkylthiourea, diethylthiourea, and the supports' material. No other positive patch test reactions were identified. As neoprene is fast becoming one of the most popular materials used for orthopaedic supports, awareness of this reaction and close liaison between dermatologists and orthopaedic surgeons are therefore essential to allow for early recognition of this complication. PMID:26236520
Full Text Available Thioureas, often contained within neoprene to provide water resistance, are an important cause of allergic contact dermatitis (ACD in those who use neoprene products. We wish to present three cases of thiourea-induced ACD from three different orthopaedic supports containing neoprene. The first case was a 67-year-old woman who developed an itchy rash on her heel three weeks after using a neoprene insole for plantar fasciitis. The second case was a 47-year-old man who developed an itchy rash on his wrist after wearing neoprene wrist splints for psoriatic arthropathy. The third case was a 77-year-old woman who experienced a severe erythematous rash with blistering from a neoprene elbow brace she received following a humeral fracture. All patients were patch tested to the British Society of Cutaneous Allergy Standard and rubber series and a cut piece from all the relevant supports. At 96 hours, all patients had a + reaction to mixed dialkylthiourea, diethylthiourea, and the supports’ material. No other positive patch test reactions were identified. As neoprene is fast becoming one of the most popular materials used for orthopaedic supports, awareness of this reaction and close liaison between dermatologists and orthopaedic surgeons are therefore essential to allow for early recognition of this complication.
Stirling, Euan R B; Lewis, Thomas L; Ferran, Nicholas A
Changing patterns of health care delivery and the rapid evolution of orthopaedic surgical techniques have made it increasingly difficult for trainees to develop expertise in their craft. Working hour restrictions and a drive towards senior led care demands that proficiency be gained in a shorter period of time whilst requiring a greater skill set than that in the past. The resulting conflict between service provision and training has necessitated the development of alternative methods in order to compensate for the reduction in 'hands-on' experience. Simulation training provides the opportunity to develop surgical skills in a controlled environment whilst minimising risks to patient safety, operating theatre usage and financial expenditure. Many options for simulation exist within orthopaedics from cadaveric or prosthetic models, to arthroscopic simulators, to advanced virtual reality and three-dimensional software tools. There are limitations to this form of training, but it has significant potential for trainees to achieve competence in procedures prior to real-life practice. The evidence for its direct transferability to operating theatre performance is limited but there are clear benefits such as increasing trainee confidence and familiarity with equipment. With progressively improving methods of simulation available, it is likely to become more important in the ongoing and future training and assessment of orthopaedic surgeons. PMID:25523023
Piposar, Jonathan R; Easley, Mark; Nunley, James A; DeOrio, James K; Talusan, Paul G; Gubler, Kyle E; Reach, John S
Musculoskeletal ultrasound (MSK-US) is a quick and effective imaging tool that can be utilized by orthopaedic surgeons to identify common musculoskeletal pathology such as ankle tendinopathy. This study evaluated the ability of 15 orthopaedic surgery residents to identify and measure ankle tendons after attending a multimedia tutorial on MSK-US. Afterwards, proficiency of usage was assessed by identification and quantification of three ankle tendons (Achilles, tibialis posterior, and flexor hallucis longus) in a cadaver limb. Resident comfort level and plan for future use were also assessed. After completing the tutorial, accuracy measuring the Achilles, tibialis posterior, and flexor hallucis longus tendons was 94.8%, 90.2%, and 90.1%, respectively. Resident comfort level improved from a level of 2.3 before the tutorial to 6.8 afterwards. Seventy-one percent of residents plan to use ultrasound in clinical practice. These results show that orthopaedic surgery residents can identify and assess tendon size via MSK-US with sufficient accuracy after a multimedia tutorial. PMID:25830266
Developmental Orthopaedic Diseases (DOD) is seen frequently in horses which completed their maturity. Osteochondrosis, physitis, angular limb deformities, flexural deformities, juvenil arthritis, cervical vertebral anomalies, cuboidal bone abnormalities are problems investigated under Developmental Orthopaedic Diseases title. This diseases can develop single or some together in fast growing, heavy animals (especially Arabian and English Thoroughbreds). Multifactorial causes of this diseases etiopathogenesis can be listed as genetic predisposition, trauma, nutrition, vitamins/minerals and endocrine disorders. But the exact causes of these diseases are not known. In this review detailed information are given about the diseases mentioned above
Glatt, E.; Wenz, W.; Reinbold, W.D.
CT has been proved as routine method in diagnostic imaging of many orthopaedic diseases, concerning complex spine trauma, spinal disc herniation, bone neoplasmas and chronic inflammatory diseases. MR-Imaging gives further information of the spinal chord and the subarachnoid space and of early diagnostic of inflammatory bone and articular diseases.
Surgeons and clinical staff, theatre circulation and scrub personnel, and anaesthetists, as well as the estates and facilities team at Kent's Maidstone Hospital, have worked with specialist supplier of integrated audio, video, and instrumentation systems for the operating room, Olympus Medical, to develop what is claimed is among the UK's most advanced operating theatres yet built for laparoscopic and endoscopic surgery. HEJ editor Jonathan Baillie discussed the project with Amir Nisar, the surgeon who championed efforts to get the facility built, and Olympus Medical national sales manager, systems integration, James Watts. PMID:20839526
Shrestha, B M
General Surgery is a broad surgical specialty that focuses on diseases related to abdominal organs, skins and hernias, both in elective and emergency settings. With the prevalent trend for increasing subspecialisation in today's surgical practice, general surgery has lost some of its former glory and scope. This has led to suffering of the image of the general surgeons (GS) in the eyes of trainees, peers, the public and even GS themselves. A comprehensive review of literature is presented to address the controversy surrounding the role and future of general and specialist surgeons in the current perspectives. PMID:20795470
Ramasamy, Arul; Eardley, W G P; Edwards, D S; Clasper, J C; Stewart, M P M
The First World War (1914-1918) was the first truly industrial conflict in human history. Never before had rifle fire and artillery barrage been employed on a global scale. It was a conflict that over 4 years would leave over 750,000 British troops dead with a further 1.6 million injured, the majority with orthopaedic injuries. Against this backdrop, the skills of the orthopaedic surgeon were brought to the fore. Many of those techniques and systems form the foundation of modern orthopaedic trauma management. On the centenary of 'the War to end all Wars', we review the significant advances in wound management, fracture treatment, nerve injury and rehabilitation that were developed during that conflict.
Parts of the socioscientific career of Jules Guérin, an orthopaedic surgeon, are presented in this article. The aim is to deepen the comprehension of intricate processes like specialisation and professionalisation of medicine and development of medical gymnastics. From this point of view Guérin's biography is very informative. The intention is to highlight the institutionalisation process of orthopaedics during two decades: the 1830s and 1840s. For the analysis the author tries to associate historical elements taken from the medical field and the socioeconomic context, however, without digressing too far from Guérin himself. First, Guérin's part in the institutionalisation process will be studied, second, his influence as a surgeon and theorist of spinal deformities and then his role as a controversial figure in the medical field.
Kesavachandran Chandrasekharan Nair
Full Text Available Abstract Background Various procedures, especially minimal invasive techniques using fluoroscopy, pose a risk of radiation exposure to orthopaedic staff. Anatomical sites such as the eyes, thyroid glands and hands are more vulnerable to radiation considering the limited use of personal protective devices in the workplace. The objective of the study is to assess the annual mean cumulative and per procedure radiation dose received at anatomical locations like eyes, thyroid glands and hands in orthopaedic staff using systematic review. Methods The review of literature was conducted using systematic search of the database sources like PUBMED and EMBASE using appropriate keywords. The eligibility criteria and the data extraction of literature were based on study design (cohort or cross-sectional study, study population (orthopaedic surgeons or their assistants, exposure (doses of workplace radiation exposure at hands/fingers, eye/forehead, neck/thyroid, language (German and English. The literature search was conducted using a PRISMA checklist and flow chart. Results Forty-two articles were found eligible and included for the review. The results show that radiation doses for the anatomical locations of eye, thyroid gland and hands were lower than the dose levels recommended. But there is a considerable variation of radiation dose received at all three anatomical locations mainly due to different situations including procedures (open and minimally invasive, work experience (junior and senior surgeons,distance from the primary and secondary radiation, and use of personal protective equipments (PPEs. The surgeons receive higher radiation dose during minimally invasive procedures compared to open procedures. Junior surgeons are at higher risk of radiation exposure compared to seniors. PPEs play a significant role in reduction of radiation dose. Conclusions Although the current radiation precautions appear to be adequate based on the low dose radiation
Miles-Board, Timothy; Carr, Leslie; Wills, Gary; Power, Guillermo; Bailey, Christopher; Hall, Wendy; Stenning, Matthew; Grange, Simon
A digital archive, together with its users and its contents, does not exist in isolation; there is a cycle of activities which provides the context for the archive's existence. In arguing for the broadening of the traditional view of digital libraries as merely collections towards the processes of collecting and deploying, we have developed an extend ed digital library environment for orthopaedic surgeons which bridges the gap between the undertaking of experimental work and the dissemination of its results through electronic publication.
Prokuski, Laura; Clyburn, Terry A; Evans, Richard P; Moucha, Calin S
The use of prophylactic antibiotics in orthopaedic surgery has been proven effective in reducing surgical site infections after hip and knee arthroplasty, spine procedures, and open reduction and internal fixation of fractures. To maximize the beneficial effect of prophylactic antibiotics, while minimizing any adverse effects, the correct antimicrobial agent must be selected, the drug must be administered just before incision, and the duration of administration should not exceed 24 hours.
Problems encountered by orthopedic surgeons treating the mentally retarded are identified, and cooperation among pediatricians, psychiatrists, psychologists, social workers, physiotherapists, occupational therapists, and orthopedic surgeons is recommended. (GW)
Homini verminoso or Dr. Worm were the nicknames that Nicholas Aindry won in life for his consecration to the study of intestinal worms and for his bad temper, which led him to fiercely attack the surgeons. The article reassumes the studies and contributions that gave Andry the title of Father of Parasitology and the candidacy to Father of Orthopaedics, and mentions some other candidates to this honor. Quite a man, he had -besides his biological one- two famous daughters, growing till our days; wrote at least three valuable books; and planted the immortal "tree of Andry", the symbol of Orthopaedics.
Matzon, Jonas L; Lutsky, Kevin F; Ricci, Emily K; Beredjiklian, Pedro K
Radiographic imaging of the pregnant patient represents a diagnostic and management dilemma for the orthopaedic surgeon. Imaging is often necessary in the setting of trauma; however, in utero radiation exposure can result in deleterious developmental effects in the embryo and fetus. The likelihood of a negative effect is proportional to the radiation dose and the gestational age of the embryo or fetus at the time of exposure. Ionizing radiation doses >100 mGy in the first trimester of pregnancy may lead to spontaneous abortion, malformation, and mental retardation. Whereas plain radiographs of the extremities and cervical spine expose the fetus to minimal doses of radiation of MRI, are alternatives for evaluation in the clinical setting. PMID:26116850
Phillips, Donna P; Zuckerman, Joseph D; Kalet, Adina; Egol, Kenneth A
The Accreditation Council of Graduate Medical Education requires that residency programs teach and assess trainees in six core competencies. Assessments are imperative to determine trainee competence and to ensure that excellent care is provided to all patients. A structured, direct observation program is feasible for assessing nontechnical core competencies and providing trainees with immediate constructive feedback. Direct observation of residents in the outpatient setting by trained faculty allows assessment of each core competency. Checklists are used to document residents' basic communication skills, clinical reasoning, physical examination methods, and medical record keeping. Faculty concerns regarding residents' professionalism, medical knowledge, fatigue, or ability to self-assess are tracked. Serial observations allow for the reinforcement and/or monitoring of skills and attitudes identified as needing improvement. Residents who require additional coaching are identified early in training. Progress in educational milestones is recorded, allowing an individualized educational program that ensures that future orthopaedic surgeons excel across all domains of medical and surgical competence. PMID:27479831
Full Text Available In October 2013, the International Combined Orthopaedic Research Societies (ICORS; http://i-cors.org was founded with inaugural member organisations from the previous Combined Orthopaedic Research Society, which had sponsored combined meetings for more than 2 decades. The ICORS is dedicated to the stimulation of orthopaedic and musculoskeletal research in fields such as biomedical engineering, biology, chemistry, and veterinary and human clinical research. The ICORS seeks to facilitate communication with member organisations to enhance international research collaborations and to promote the development of new international orthopaedic and musculoskeletal research organisations. Through new categories of membership, the ICORS represents the broadest coalition of orthopaedic research organisations globally.
Anderson, Robert W
Orthopaedic surgery residents should be exposed during their clinical training to the processes of creativity and innovation that are the basis of research. The definition of a research experience for surgery residents should be broad and include not only traditional bench research in a basic science environment but also translational and clinical research to move innovation from bench to bedside and validate its value in a scientific manner. Additionally, there are enormous opportunities for surgeons to study healthcare delivery and policy and to develop new approaches to educating colleagues, other medical personnel, and patients. The question that must be addressed is how can the knowledge and human resources residing in orthopaedic surgery best be used to meet the challenges future residents will face as healthcare undergoes profound changes? How these issues are managed in a rapidly changing environment is the critical issue and the challenge faced by surgical training programs wishing to remain viable and provide trainees with the opportunity to adapt and be successful in the future. What is state of the art today will not be tomorrow and unless trainees are encouraged and taught to be creative and innovative they risk becoming surgical dinosaurs.
OBJECTIVE: To report on the perceptions of a group of orthopaedic trainees and trainers on perceived effects of the proposed introduction of European Working Time Directive (EWTD) restrictions into Ireland and on the use of simulators in training orthopaedic skills. METHODS: A structured questionnaire was developed to evaluate the opinions of a group of orthopaedic surgeons and trainees at the annual national orthopaedic conference. RESULTS: There were 44 participants [12 consultants, 32 trainees (15 specialist registrars, 8 registrars, 9 senior house officers)]. Seventy-five percent of participants felt that both the quality of patient care and training would be negatively affected. A higher proportion of consultants than trainees felt that quality of life would be affected. A high proportion of participants (81.8%) had used a simulator or model to learn a surgical skill and 100% would consider using them again. CONCLUSIONS: While we wait for the full introduction of the EWTD hours the perception is that both quality of patient care and training will be affected. Models and simulators are well perceived as a method of training.
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Brioschi, Valentina; Cook, Jodie; Arthurs, Gareth I
Objectives To investigate whether a surgeon can drill accurately a specified angle and whether surgeon experience, task repetition, drill bit size and perceived difficulty influence drilling angle accuracy. Methods The sample population consisted of final-year students (n=25), non-specialist veterinarians (n=22) and board-certified orthopaedic surgeons (n=8). Each participant drilled a hole twice in a horizontal oak plank at 30°, 45°, 60°, 80°, 85° and 90° angles with either a 2.5 or a 3.5 mm drill bit. Participants then rated the perceived difficulty to drill each angle. The true angle of each hole was measured using a digital goniometer. Results Greater drilling accuracy was achieved at angles closer to 90°. An error of ≤±4° was achieved by 84.5 per cent of participants drilling a 90° angle compared with approximately 20 per cent of participants drilling a 30–45° angle. There was no effect of surgeon experience, task repetition or drill bit size on the mean error for intended versus achieved angle. Increased perception of difficulty was associated with the more acute angles and decreased accuracy, but not experience level. Clinical significance This study shows that surgeon ability to drill accurately (within ±4° error) is limited, particularly at angles ≤60°. In situations where drill angle is critical, use of computer-assisted navigation or custom-made drill guides may be preferable. PMID:27547423
Trøstrup, Jeanette; Mikkelsen, Lone Ramer; Juhl, Carsten
Trøstrup J1, Mikkelsen LR1, Juhl CB2 1 Center for Planlagt Kirurgi, Regionshospitalet Silkeborg 2 Forskningsenheden for Muskuloskeletal Funktion og Fysioterapi (FoF), Institut for idræt og biomekanik, Syddansk Universitet Aim: To evaluate the effectiveness of clinical assessment of patients...... with musculoskeletal complaint performed by Clinical Specialist Physiotherapists (CSP) compared to Orthopaedic Surgeons (OS) on diagnostic agreement, economic cost and patient satisfaction. Methods: A systematic review was performed by searching in MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL......), EMBASE, CINAHL, PEDro and reference lists of included studies and previously published systematic reviews. Studies evaluating 1) adults (18+) with a musculoskeletal complaint referred to orthopaedic outpatient assessment and 2) patient assessment performed by CSP were included. Studies conducted...
Giannini, S; Donati, D.M.; Frisoni, T.; Cevolani, L.; Chiarello, E.
In recent years, cell therapy for bone regeneration has been found to have different indications in orthopaedic surgery, such as delayed fracture consolidation and the treatment of bone cysts and osteonecrosis.
Dong, C-H; Wang, Z-M; Zhao, X-L; Wang, A-M
Hip surgeries count to the most frequent orthopaedic operations in older patients. Nonelective surgeries for hip fractures cause substantial economic burden because of high costs of medical treatment and high associated mortality. Surgery for hip fracture in the elderly comorbid patient still presents a challenge to orthopaedic surgeons. It is recommended that this surgery is performed within 48 hours after sustaining the hip fracture to decrease mortality. Yet the recommended early surgery (i.e. 48 hours after the incident) is not always feasible due to the frequent overall frailty of the patients or conditions of concomitant disease. The care of patients unfit for early surgery has been not adequately addressed in the literature. We have previously introduced an algorithm based on ASA-PS and P-POSSUM scores to stratify elderly comorbid patients for early vs delayed hip surgery, and used principles of Damage Control Orthopaedics to minimized negative sequelae of surgery delay (Dong C et al., PLoS One 2016). In this paper, we elaborate on Damage Control Orthopaedics and the proposed approach in the context of frequent comorbidities in the elderly orthopaedic patients. Further studies on this subject are urgently needed to establish international consensus on hip fracture surgery delayed due to overall patient frailty or extensive comorbidities. PMID:27383299
Vinícius Ynoe de Moraes
Full Text Available INTRODUCTION: Previous reviews have demonstrated that patient outcomes following orthopaedic surgery are strongly influenced by the presence of Workers' Compensation. However, the variability in the reviews' methodology may have inflated the estimated strength of this association. The main objective of this meta-analysis is to evaluate the influence of Workers' Compensation on the outcomes of orthopaedic surgical procedures. METHODS: We conducted a systematic search of the literature published in this area from 1992-2012, with no language restrictions. The following databases were used MEDLINE (Ovid, Embase (Ovid, CINAHL, Google Scholar, LILACS and Pubmed. We also hand-searched the reference sections of all selected papers. We included all prospective studies evaluating the effect of compensation status on outcomes in adult patients who had undergone surgery due to orthopaedic conditions or diseases. Outcomes of interest included disease specific, region specific and/or overall quality of life scales/questionnaires and surgeons' personal judgment of the results. We used an assessment tool to appraise the quality of all included studies. We used Review Manager to create forest plots to summarize study data and funnel plots for the assessment of publication bias. RESULTS: Twenty studies met our eligibility criteria. The overall risk ratio for experiencing an unsatisfactory result after orthopaedic surgery for patients with compensation compared to non-compensated patients is 2.08 (95% CI 1.54-2.82. A similar association was shown for continuous data extracted from the studies using assessment scales or questionnaires (Standard Mean Difference = -0.70 95% CI -0.97- -0.43. CONCLUSIONS: Among patients who undergo orthopaedic surgical procedures, those receiving Workers' Compensation experience a two-fold greater risk of a negative outcome. Our findings show a considerably lower estimate of risk compared to previous reviews that include retrospective
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Miller, Daniel J; Blum, Alexander B; Levine, William N; Ahmad, Christopher S; Popkin, Charles A
The preparticipation evaluation (PPE) is a widely used tool for detecting health conditions that may delay or disqualify athletic participation. The medical interview is the most valuable tool for identifying athletes who may be at increased risk for injury. Physical examination is tailored to identifying cardiac abnormalities or factors that may place an athlete at increased risk for injury. Although practiced in Europe, universal cardiac screening with electrocardiography is not currently recommended in the United States largely due to the high rate of false-positive results. Neuropsychological testing for management of concussion and laboratory testing for sickle cell trait may be indicated in select groups of athletes. Health care providers should view the PPE as a chance for anticipatory guidance and athlete-directed health counseling. Despite widespread acceptance of the PPE, the quality of such examinations varies significantly, which is an area for possible improvement and further research. PMID:26330569
Bhardwaj, A.; Sivapathasundaram, N; Yusof, MF; Minghat, AH; Swe, KMM; Sinha, NK
Abstract Background :Accidental needle-stick injuries (NSIs) are a hazard for health-care workers and general public health. Orthopaedic surgeons may be more prone to NSIs due to the prevalence of bone spikes in the operative field and the use of sharp orthopaedic instruments such as drills, saws and wires. A hospital-based cross sectional study was conducted in the orthopedic wards of Melaka General Hospital. The prevalence of NSIs was 32 (20.9%) and majority of it occurred during assisting ...
Tan, S K
The surgeon of the new millennium has come a long way from his humble beginnings in the Middle Ages as the lowly barber-surgeon. The skills and techniques developed by outstanding surgeons like Astley Cooper of the 19th century have withstood the test of time and have been refined by subsequent generations of surgical masters. The scientific basis of modern surgery was put on a firm footing in the early 19th century through the discovery of anaesthesia and microorganisms as a cause of many diseases and surgical complications. The 20th century brought about rapid progress in medicine, information technology (IT) and the life sciences, and closed with a big bang with the completion of the sequencing of the human genome. For the surgeon of the 21st century to remain relevant, he must embrace the concept of the Total Surgeon. Not doing so will render him irrelevant in the course of time, for having good surgical technique alone is insufficient. He must also lead in scientific endeavours to push the frontiers of the life sciences in attempts to solve the insoluble, and be scholarly in thought, attitude and behaviour. In other words, he must be a Surgeon-Scientist-Scholar.
Fluoroscopy is frequently used in orthopaedic surgery, particularly in a trauma setting. Exposure of patients and staff to ionising radiation has been studied extensively; however, little work has been done to evaluate current knowledge and practices among orthopaedic trainees.
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O'Malley, N T
While the quality and efficiency of out-patient orthopaedic referrals are well documented in the literature, there is little on the standard and appropriateness of inpatient orthopaedic consultations.
Full Text Available Based on the development of digital medicine and digital anatomy, the concept of “digital orthopaedics” was raised by Pei Guo-Xian in China in 2006. The most striking feature of digital orthopaedics is the combination of basic and clinical orthopaedic knowledge with digital technology. In this review, we summarised the development of digital orthopaedics in China in recent years with respect to: the foundation of the Chinese Association of Digital Orthopedics, virtual human project (VHP, three-dimensional (3D reconstruction, finite element simulation, navigation in orthopaedic operations, and robot-assisted orthopaedic operations. In addition, we briefly reviewed digital orthopaedics in world leading institutes. We also looked into the future of digital orthopaedics in China and proposed the major challenges in digital technology and application in orthopaedics.
Full Text Available Over the past half-century, biomaterials have been used in orthopaedic surgery world widely, but orthopaedic implant-associated infections (OIAIs are still a puzzle for orthopaedic surgeons, which may result in prolonged hospitalisation, poor functional status and high costs. The presence of implants increases the risk of microbial infection; moreover, the formation of bacterial biofilm leads to a higher resistance to antibiotics and local immune response. In such cases, conventional systemic delivery of drugs seems to be fairly inefficient and out-dated. Owing to this, debridement and/or removing the implant always become the only solution. Hence, it needs a simple, minimally invasive and effective therapy to eradicate the problem. There are abundant evidences showing that extracorporeal shock wave therapy (ESWT has favourable effects on stimulating callus formation, inducing angiogenesis, promoting osteogenesis and relieving pain. Studies also indicated that ESWs have a significant bactericidal effect on bacterial strains of bone- and implant-associated infections. Therefore, a hypothesis proposed herein is that ESWT may well be an effective adjuvant treatment for OIAI by controlling infection, inducing bone regeneration and promoting re-osseointegration.
Banks, L N
British Trainees have gradually had their working week curtained over the last 8 years. The Republic of Ireland Trainees have not been subjected to the European Working Time Directive prior to 2009 and have therefore worked on average, more hours than their British counterparts. We wanted to see if the differing schemes had an impact on recruiting and training orthopaedic surgeons. We surveyed Republic of Ireland orthopaedic specialist registrars (SpRs) and North West (NW) British SpRs\\/specialist trainees (ST3 and above) to see if there were any discernable differences in working patterns and subsequent training exposure. A standard proforma was given to Irish Trainees and to NW SpRs\\/STs at their National or regional teaching (January\\/February 2009). 62% of Irish and 47% of British NW Trainees responded. Irish trainees were more likely to have obtained a post-graduate degree (p = 0.03). The Irish worked more hours per week (p < 0.001) doing more trauma operative lists (p = 0.003) and more total cases per 6 months than the NW British (p = 0.003). This study suggests that more hours worked, equals more operative exposure, without detriment to the academic side of training. Obviously it is not possible to say whether fewer operations make for a poorer surgeon, but the evidence suggests that it may be true.
Pellegrini, Vincent D
A mentor serves as role model, counselor, and advocate for an understudy or protégé. The art and science of mentoring have been investigated most thoroughly in the educational literature, yet there are unique situational and individual considerations in the surgical arena that may warrant special consideration. The general attributes of successful mentors are not foreign to academic surgeons but may require deliberate cultivation to optimize mentorship in the context of academic medicine. Moreover, the stages of productive mentoring may be counter to the learned adaptive behaviors and instinctive personality traits of some accomplished surgeon educators. Indeed, examples of failed mentorship are common in our medical centers and, specifically, in surgical training programs. The behavioral adaptation that supports surgical decision-making under conditions of incomplete data and unusual stress often devalues succession planning and derivation of satisfaction from the success of other members of the team. Accordingly, fostering effective mentoring relationships in academic surgery will require a concerted effort to develop appropriate behaviors conducive to the mentoring process. The personal and professional growth of our students as well as the succession planning for our specialty are dependent upon the successful creation of an environment conducive to mentoring in academic orthopaedics. PMID:16760803
This article is dedicated to the Canadian international surgeon, Norman Bethune (1890-1939). International surgery is defined as a humanitarian branch of medicine concerned with the treatment of bodily injuries or disorders by incision or manipulations, emphasizing cooperation and understanding among nations and involving education, research, development and advocacy. In this article I review the colonial past, the dark ages following the Declaration of Alma-Ata, the progress made and the present challenges in international surgery. I present a definition of international surgery that recognizes the current era of surgical humanitarianism, validates a global understanding of surgical issues and promotes cooperation among nations. Included are the principles of international surgery: education, research, infrastructure development and advocacy. International surgical projects are classified according to type (clinical, relief, developmental) and integration strategy (vertical or horizontal). Also reviewed are the Canadian practice of international surgery by nongovernmental, professional and academic organizations and the requirements of international and Canadian funding agencies, the development concepts basic to all projects, including results-based management and the cross-cutting themes of gender equity, environmental protection and human safety. I recommend formalizing international surgery into a discipline as a means of promoting surgical care in low-income countries. If international surgery is to be sustained in Canada, infrastructure and support from Canadian surgeons is particularly important. An understanding of the history, definition and classification of international surgery should promote surgical care in low-income countries.
MacLean, L D
Most countries have mastered the art of cost containment by global budgeting for public expenditure. It is not as yet clear whether the other option, managed care, or managed competition will accomplish cost control in America. Robert Evans, a Canadian health care expert, remains skeptical. He says, "HMO's are the future, always have been and always will be." With few exceptions, the amount spent on health care is not a function of the system but of the gross domestic product per person. Great Britain is below the line expected for expenditure, which may be due to truly impressive waiting lists. The United States is above the line, which is probably related to the overhead costs to administer the system and the strong demand by patients for prompt and highly sophisticated diagnostic measures and treatments. Canada is on the line, but no other country has subscribed to the Canadian veto on private insurance. Reform or changes are occurring in all countries and will continue to do so. For example, we are as terrified of managed care in Canada as you are of our brand of socialized insurance. We distrust practice by protocol just as you abhor waiting lists. From my perspective as a surgeon, I envision an ideal system that would cover all citizens, would maintain choice of surgeon by patients, would provide mechanisms for cost containment that would have the active and continuous participation of the medical profession, and would provide for research and development. Any alteration in health care delivery in the United States that compromises biomedical research and development will be a retrogressive, expensive step that could adversely affect the health of nations everywhere. Finally, a continuing priority of our training programs must be to ensure that the surgeon participating in this system continues to treat each patient as an individual with concern for his or her own needs.
The number of medical students who aspire to become surgeons has been decreasing in recent years. With a vicious spiral in the decreasing number and the growing deterioration of surgeons' working conditions, there is fear of deterioration of surgical care and subsequent disintegration of overall health care in Japan. The purpose of this issue is to devise a strategy for improving surgeons' image and their working conditions to attract future medical students. However, we cannot expect a quick cure for the problem of the decreasing number of applicants for surgery since this issue is deeply related to many fundamental problems in the health care system in Japan. The challenge for surgical educators in coming years will be to solve the problem of chronic sleep deprivation and overwork of surgery residents and to develop an efficient program to meet the critical educational needs of surgical residents. To solve this problem it is necessary to ensure well-motivated surgical residents and to develop an integrated research program. No discussion of these issues would be complete without attention to the allocation of scarce medical resources, especially in relation to financial incentives for young surgeons. The authors, who are conscientious representatives of this society, would like to highlight these critical problems and issues that are particularly relevant to our modern surgical practice, and it is our sincere hope that all members of this society fully recognize these critical issues in the Japanese health care system to take leadership in improving the system. With the demonstration of withholding unnecessary medical conducts we may be able to initiate a renewal of the system and eventually to fulfill our dreams of Japan becoming a nation that can attract many patients from all over the world. Furthermore, verification of discipline with quality control and effective surgical treatment is needed to avoid criticism by other disciplines for being a self
Tait, Mark Adam; Petrus, Cara; Barnes, C Lowry
The purpose of this study was to determine the publication rate of manuscripts presented at the Southern Orthopaedic Association's (SOA) annual meetings. An extensive literature search was performed using Google Scholar and PubMed search engines and all accepted abstracts (posters or podium presentations) presented at an SOA annual meeting from 2005 to 2011 were evaluated. A total of 568 abstracts were presented at SOA meetings between 2005 and 2011. Of these, 234 (41%) were published in the peer-reviewed literature. The publication rate was 66% in 2005 and 28% in 2010. The average time from presentation to peer-reviewed publication was 1.6 ± 0.24 years (range, 2 years in 2006 to 1 year in 2011). The SOA publication rate was comparable with other major orthopaedic conference publication rates, yet more than half of all abstracts remain unpublished. SOA attendees should be aware that approximately 40% of all accepted presentations will go unpublished. PMID:27518291
Hansen, Erik; Bozic, Kevin J.
The US healthcare system is currently facing daunting demographic and economic challenges. Because musculoskeletal disorders and disease represent a substantial and growing portion of this healthcare burden, novel approaches will be needed to continue to provide high-quality, affordable, and accessible orthopaedic care to our population. The concept of “disruptive innovations,” which has been studied and popularized by Harvard Business School Professor Clayton Christensen, may offer a potenti...
Kateros Konstantinos; Doulgerakis Christos; Galanakos Spyridon P; Sakellariou Vasileios I; Papadakis Stamatios A; Macheras George A
Abstract Backround This retrospective study was undertaken to determine the incidence of kidney dysfunction (KD) and to identify potential risk factors contributing to development of KD in orthopaedic population following an elective or emergency surgery. Methods A total of 1025 patients were admitted in our institution over a period of one year with various indications. Eight hundred and ninety-three patients (87.1%) had a surgical procedure. There were 42 (52.5%) male and 38 (47.5%) female ...
Shantz Jesse A
Full Text Available Abstract Background A recently published meta-analysis comparing metallic staples to sutures in orthopaedic procedures revealed three fold increase in risk for infection in stapled wounds. The studies included in the meta-analysis are at risk of bias due to experimental design limitations. A large randomized controlled trial is proposed to direct orthopaedic surgeons in their choice of wound closure material. Methods/Design A parallel group randomized controlled trial with institutional review board approval will be conducted. Patients will be randomized intraoperatively to have skin wounds closed with sutures or staples. Dressings will be used to maintain blinding outcome assessors. The primary outcome measure will be a composite all-cause wound complication outcome measure composed of: infection, wound drainage, wound necrosis, blistering, dehiscence, suture abscess and material sensitivity reaction. An independent review board blinded to treatment assignment will adjudicate suspected complications based on clinical data. All deceased patients will also be reviewed. An interim analysis of complications will take place after half of the patients have been recruited. All data will be analyzed by a blinded statistician. Dichotomous primary and secondary outcome measures will be analyzed using the Chi-squared statistic. Continuous outcome measures will be analyzed using Student's t-test. Subgroup analysis will compare infection rates using sutures versus staples in each anatomic area (upper extremity, pelvis/acetabulum, hip/femur, knee, ankle. A further subgroup analysis will be conducted comparing trauma patients to elective surgery patients. Non-infected revision surgery will also be compared to primary surgery. Discussion Wound closure material is an afterthought for many orthopaedic surgeons. The combined results of several comparative trials suggests that the choice of wound closure materials may have an impact on the rate of surgical site
Yule, Steven; Paterson-Brown, Simon
The importance of non-technical skills to surgical performance is gaining wide acceptance. This article discusses the core cognitive and social skills categories thought to underpin medical knowledge and surgical expertise, and describes the rise of non-technical skill models of assessment in surgery. Behavior rating systems such as NOTSS (Non-Technical Skills for Surgeons) have been developed to support education and assessment in this regard. We now understand more about these critical skills and how they impact surgery. The challenge in the future is to incorporate them into undergraduate teaching, postgraduate training, workplace assessment, and perhaps even selection.
@@ With the development of medical science,orthopaedic traumatology, which derives from orthopaedics, becomes an important sub-discipline.Orthopedic traumatology includes: (1) fracture of limbs and spine; (2) injury to blood vessels, nerves, muscles and tendons; (3) traumatic skin defects of the limbs; (4)the limb injury and spinal cord injury, etc. Since the end of the 20th century, the orthopaedic tranmatology field has been developing rapidly, and is becoming one of the four major sub-groups of orthopaedics along with musculoskeletal and tumor surgery, spinal surgery, and joint surgery. 1-4
... Antitrust Division United States v. Idaho Orthopaedic Society, Timothy Doerr, Jeffrey Hessing, Idaho Sports.... Idaho Orthopaedic Society, Timothy Doerr, Jeffrey Hessing, Idaho Sports Medicine Institute, John Kloss..., Plaintiffs, vs. Idaho Orthopaedic Society, Timothy Doerr, Jeffrey Hessing, Idaho Sports Medicine...
Full Text Available As the cost of healthcare continue to rise, orthopaedic surgeons are being pressured to practice cost-effective healthcare. Consequently, economic evaluation of treatment options are being reported more commonly in medical and surgical literature. As new orthopaedic procedures and treatments may improve patient outcome and function over traditional treatment options, the effect of the potentially higher costs of new treatments should be formally evaluated. Unfortunately, the resources available for healthcare spending are typically limited. Therefore, cost-effectiveness analyses have become an important and useful tool in informing which procedure or treatment to implement into practice. Cost-effectiveness analysis is a type of economic analysis that compares both the clinical outcomes and the costs of new treatment options to current treatment options or standards of care. For a clinician to be able to apply the results of a cost-effectiveness analysis to their practice, they must be able to critically review the available literature. Conducting an economic analysis is a challenging process, which has resulted in a number of published economic analyses that are of lower quality and may be fraught with bias. It is important that the reader of an economic analysis or cost-effectiveness analysis have the skills required to properly evaluate and critically appraise the methodology used before applying the recommendations to their practice. Using the principles of evidence-based medicine and the questions outlined in the Journal of the American Medical Association′s Users′ Guide to the Medical Literature, this article attempts to illustrate how to critically appraise a cost-effectiveness analysis in the orthopaedic surgery literature.
Dineen, P F
Antiplatelet agents are widely prescribed for the primary and secondary prevention of cardiovascular events. A common clinical problem facing orthopaedic and trauma surgeons is how to manage patients receiving these agents who require surgery, either electively or following trauma. The dilemma is to balance the risk of increased blood loss if the antiplatelet agents are continued peri-operatively against the risk of coronary artery\\/stent thrombosis and\\/or other vascular event if the drugs are stopped. The traditional approach of stopping these medications up to two weeks before surgery appears to pose significant danger to patients and may require review. This paper covers the important aspects regarding the two most commonly prescribed antiplatelet agents, aspirin and clopidogrel.
Full Text Available Robotics has shown its potential not only in assisting the surgeon during an intervention but also as a tool for training and for surgical procedure's evaluation. Thus, robotics can constitute an extension of simulators that are based on the high capabilities of computer graphics. In addition, haptics has taken a first step in increasing the performance of current virtual reality systems based uniquely on computer simulation and their corresponding interface devices. As a further step in the field of training and learning in surgery, this work describes a robotic experimental workstation composed of robots and specific measuring devices, together with their corresponding control and monitoring strategies for orthopaedic surgery. Through a case study, humerus arthroplasty, experimental evaluation shows the possibilities of having a test bed available for repetitive and quantifiable trials, which make a reliable scientific comparison between different surgical strategies possible.
Althausen, Peter L; Bray, Timothy J; Hill, Austin D
The Reno Orthopaedic Center (ROC) Trauma Fellowship business curriculum is designed to provide the fellow with a graduate level business practicum and research experience. The time commitments in a typical 12-month trauma fellowship are significant, rendering a traditional didactic master's in business administration difficult to complete during this short time. An organized, structured, practical business education can provide the trauma leaders of tomorrow with the knowledge and experience required to effectively navigate the convoluted and constantly changing healthcare system. The underlying principle throughout the curriculum is to provide the fellow with the practical knowledge to participate in cost-efficient improvements in healthcare delivery. Through the ROC Trauma Fellowship business curriculum, the fellow will learn that delivering healthcare in a manner that provides better outcomes for equal or lower costs is not only possible but a professional and ethical responsibility. However, instilling these values without providing actionable knowledge and programs would be insufficient and ineffective. For this reason, the core of the curriculum is based on individual teaching sessions with a wide array of hospital and private practice administrators. In addition, each section is equipped with a suggested reading list to maximize the learning experience. Upon completion of the curriculum, the fellow should be able to: (1) Participate in strategic planning at both the hospital and practice level based on analysis of financial and clinical data, (2) Understand the function of healthcare systems at both a macro and micro level, (3) Possess the knowledge and skills to be strong leaders and effective communicators in the business lexicon of healthcare, (4) Be a partner and innovator in the improvement of the delivery of orthopaedic services, (5) Combine scientific and strategic viewpoints to provide an evidence-based strategy for improving quality of care in a
Roche, Simon J; Funk, Lennard; Sciascia, Aaron; Kibler, W Ben
The scapula fulfils many roles to facilitate optimal function of the shoulder. Normal function of the shoulder joint requires a scapula that can be properly aligned in multiple planes of motion of the upper extremity. Scapular dyskinesis, meaning abnormal motion of the scapula during shoulder movement, is a clinical finding commonly encountered by shoulder surgeons. It is best considered an impairment of optimal shoulder function. As such, it may be the underlying cause or the accompanying result of many forms of shoulder pain and dysfunction. The present review looks at the causes and treatment options for this indicator of shoulder pathology and aims to provide an overview of the management of disorders of the scapula. PMID:27582990
Mullan, C J; Pagoti, R; Davison, H; McAlinden, M G
Introduction Patients receiving musculoskeletal allografts may be at risk of postoperative infection. The General Medical Council guidelines on consent highlight the importance of providing patients with the information they want or need on any proposed investigation or treatment, including any potential adverse outcomes. With the increased cost of defending medicolegal claims, it is paramount that adequate, clear informed patient consent be documented. Methods We retrospectively examined the patterns of informed consent for allograft bone use during elective orthopaedic procedures in a large unit with an onsite bone bank. The initial audit included patients operated over the course of 1 year. Following a feedback session, a re-audit was performed to identify improvements in practice. Results The case mix of both studies was very similar. Revision hip arthroplasty surgery constituted the major subgroup requiring allograft (48%), followed by foot and ankle surgery (16.3%) and revision knee arthroplasty surgery (11.4%) .On the initial audit, 17/45 cases (38%) had either adequate preoperative documentation of the outpatient discussion or an appropriately completed consent form on the planned use of allograft. On the re-audit, 44/78 cases (56%) had adequate pre-operative documentation. There was little correlation between how frequently a surgeon used allograft and the adequacy of consent (Correlation coefficient -0.12). Conclusions Although the risk of disease transmission with allograft may be variable, informed consent for allograft should be a routine part of preoperative discussions in elective orthopaedic surgery. Regular audit and feedback sessions may further improve consent documentation, alongside the targeting of high volume/low compliance surgeons. PMID:26924483
Mullan, C J; Pagoti, R; Davison, H; McAlinden, M G
Introduction Patients receiving musculoskeletal allografts may be at risk of postoperative infection. The General Medical Council guidelines on consent highlight the importance of providing patients with the information they want or need on any proposed investigation or treatment, including any potential adverse outcomes. With the increased cost of defending medicolegal claims, it is paramount that adequate, clear informed patient consent be documented. Methods We retrospectively examined the patterns of informed consent for allograft bone use during elective orthopaedic procedures in a large unit with an onsite bone bank. The initial audit included patients operated over the course of 1 year. Following a feedback session, a re-audit was performed to identify improvements in practice. Results The case mix of both studies was very similar. Revision hip arthroplasty surgery constituted the major subgroup requiring allograft (48%), followed by foot and ankle surgery (16.3%) and revision knee arthroplasty surgery (11.4%) .On the initial audit, 17/45 cases (38%) had either adequate preoperative documentation of the outpatient discussion or an appropriately completed consent form on the planned use of allograft. On the re-audit, 44/78 cases (56%) had adequate pre-operative documentation. There was little correlation between how frequently a surgeon used allograft and the adequacy of consent (Correlation coefficient -0.12). Conclusions Although the risk of disease transmission with allograft may be variable, informed consent for allograft should be a routine part of preoperative discussions in elective orthopaedic surgery. Regular audit and feedback sessions may further improve consent documentation, alongside the targeting of high volume/low compliance surgeons.
Berthelsen, Connie Bøttcher; Hølge-Hazelton, Bibi
of acceptance from colleagues and section head nurses and a shortage of time. This study forms a baseline as a part of a larger study and contributes knowledge useful to other orthopaedic departments with an interest in optimizing nursing research to improve orthopaedic nursing care quality....
Yagmurlu, Bilge; Yavuz, H. Melis
The aim of the study was to investigate social competence in children with orthopaedic disability and its concurrent relations to child's temperament, health condition, and maternal warmth. Participants were 68 Turkish children (mean = 5.94 years) with chronic orthopaedic disability and their mothers coming from disadvantaged backgrounds.…
During his surgical career between 1896 and 1934, Harvey Cushing made eight visits to Canada. He had a broad impact on Canadian medicine and neurosurgery. Cushing's students Wilder Penfield and Kenneth McKenzie became outstanding leaders of the two major centers in Canada for neurosurgical treatment and training. On his first trip to Canada, shortly after completing his surgical internship in August 1896, Cushing traveled with members of his family through the Maritime Provinces and visited hospitals in Quebec and Montreal. Eight years later, in February 1904, as a successful young neurosurgeon at the Johns Hopkins Hospital, he reported to the Montreal Medico-Chirurgical Society on his surgical experience in 20 cases of removal of the trigeminal ganglion for neuralgia. In 1922, as the Charles Mickle Lecturer at the University of Toronto, Cushing assigned his honorarium of $1000 to support a neurosurgical fellowship at Harvard. This was awarded to McKenzie, then a general practitioner, for a year's training with Cushing in 1922-1923. McKenzie returned to initiate the neurosurgical services at the Toronto General Hospital, where he developed into a master surgeon and teacher. On Cushing's second visit to McGill University in October 1922, he and Sir Charles Sherrington inaugurated the new Biology Building of McGill's Medical School, marking the first stage of a Rockefeller-McGill program of modernization. In May 1929, Cushing attended the dedication of the Osler Library at McGill. In September 1934, responding to the invitation of Penfield, Cushing presented a Foundation Lecture-one of his finest addresses on the philosophy of neurosurgery-at the opening of the Montreal Neurological Institute. On that same trip, Cushing's revisit to McGill's Osler Library convinced him to turn over his own treasure of historical books to Yale University.
Full Text Available An epidemiological study was undertaken to study the incidence and distribution of orthopaedic manifestations of filariasis in an endemic area. A total of 207 cases were clinically examined and investigated. Patients were divided into three groups , viz., Group A: Orthopaedic manifestations with no history of filariasis . Group B: Orthopaedic manifestations with history of filariasis such as microfilaraemia or filarial fevers etc., Group C: Orthopaedic manifestations with chronic manifestations such as elephantiasis, hydrocele etc. To confirm filarial etiology, all the cases were examined for the presence of filarial antibody by indirect ELISA using wuchereda bancrofti microfilarial excretory- secretary antigen (wd Mf ESAg . A total of 61 of 102 patients of Group A, 14 of 21 patients of group B, and 73 of 84 patients of Group C were positive for filarial antibody. This study showed the prevalence of filarial antibody in about 71.4% of various orthopaedic manifestations.
Schep, Niels Willem Luitzen
To create an environment where surgeons receive real-time feedback about their instrument position, computer technologies were integrated in surgical procedures. This type of surgical technology is referred to as Computer Assisted Surgery (CAS). CAS offers the possibility to continuously monitor the
Awada, T; Liverneaux, P
In 1954, Michel Latarjet, anatomist and surgeon of Lyon, developed an original surgical technique to treat the unstable shoulder . This technique since kept his name: "Latarjet". He was a character in 1000 facets: highly skilled anatomist, skillful surgeon, talented sportsman, accomplished musician, big traveler, and many others... An eclectic life, symbol of an abundant XXth century. PMID:20303312
Awada, T; Liverneaux, P
In 1954, Michel Latarjet, anatomist and surgeon of Lyon, developed an original surgical technique to treat the unstable shoulder . This technique since kept his name: "Latarjet". He was a character in 1000 facets: highly skilled anatomist, skillful surgeon, talented sportsman, accomplished musician, big traveler, and many others... An eclectic life, symbol of an abundant XXth century.
Callahan, Charles D; Adair, Daniel; Bozic, Kevin J; Manning, Blaine T; Saleh, Jamal K; Saleh, Khaled J
Morrison argued that demography, economy, and technology drive the evolution of industries from a formative first-generation state ("First Curve") to a radically different way of doing things ("Second Curve") that is marked by new skills, strategies, and partners. The current health-reform movement in the United States reflects these three key evolutionary trends: surging medical needs of an aging population, dramatic expansion of Medicare spending, and care delivery systems optimized through powerful information technology. Successful transition from a formative first-generation state (First Curve) to a radically different way of doing things (Second Curve) will require new skills, strategies, and partners. In a new world that is value-driven, community-centric (versus hospital-centric), and prevention-focused, orthopaedic surgeons and health-care administrators must form new alliances to reduce the cost of care and improve durable outcomes for musculoskeletal problems. The greatest barrier to success in the Second Curve stems not from lack of empirical support for integrated models of care, but rather from resistance by those who would execute them. Porter's five forces of competitive strategy and the behavioral analysis of change provide insights into the predictable forms of resistance that undermine clinical and economic success in the new environment of care. This paper analyzes the components that will differentiate orthopaedic care provision for the Second Curve. It also provides recommendations for future-focused orthopaedic surgery and health-care administrative leaders to consider as they design newly adaptive, mutually reinforcing, and economically viable musculoskeletal care processes that drive the level of orthopaedic care that our nation deserves-at a cost that it can afford. PMID:24990985
Panesar Sukhmeet S
Full Text Available Abstract Background Orthopaedic surgery is a high-risk specialty in which errors will undoubtedly occur. Patient safety incidents can yield valuable information to generate solutions and prevent future cases of avoidable harm. The aim of this study was to understand the causative factors leading to all unnecessary deaths in orthopaedics and trauma surgery reported to the National Patient Safety Agency (NPSA over a four-year period (2005–2009, using a qualitative approach. Methods Reports made to the NPSA are categorised and stored in the database as free-text data. A search was undertaken to identify the cases of all-cause mortality in orthopaedic and trauma surgery, and the free-text elements were used for thematic analysis. Descriptive statistics were calculated based on the incidents reported. This included presenting the number of times categories of incidents had the same or similar response. Superordinate and subordinate categories were created. Results A total of 257 incident reports were analysed. Four main thematic categories emerged. These were: (1 stages of the surgical journey – 118/191 (62% of deaths occurred in the post-operative phase; (2 causes of patient deaths – 32% were related to severe infections; (3 reported quality of medical interventions – 65% of patients experienced minimal or delayed treatment; (4 skills of healthcare professionals – 44% of deaths had a failure in non-technical skills. Conclusions Most complications in orthopaedic surgery can be dealt with adequately, provided they are anticipated and that risk-reduction strategies are instituted. Surgeons take pride in the precision of operative techniques; perhaps it is time to enshrine the multimodal tools available to ensure safer patient care.
Callahan, Charles D; Adair, Daniel; Bozic, Kevin J; Manning, Blaine T; Saleh, Jamal K; Saleh, Khaled J
Morrison argued that demography, economy, and technology drive the evolution of industries from a formative first-generation state ("First Curve") to a radically different way of doing things ("Second Curve") that is marked by new skills, strategies, and partners. The current health-reform movement in the United States reflects these three key evolutionary trends: surging medical needs of an aging population, dramatic expansion of Medicare spending, and care delivery systems optimized through powerful information technology. Successful transition from a formative first-generation state (First Curve) to a radically different way of doing things (Second Curve) will require new skills, strategies, and partners. In a new world that is value-driven, community-centric (versus hospital-centric), and prevention-focused, orthopaedic surgeons and health-care administrators must form new alliances to reduce the cost of care and improve durable outcomes for musculoskeletal problems. The greatest barrier to success in the Second Curve stems not from lack of empirical support for integrated models of care, but rather from resistance by those who would execute them. Porter's five forces of competitive strategy and the behavioral analysis of change provide insights into the predictable forms of resistance that undermine clinical and economic success in the new environment of care. This paper analyzes the components that will differentiate orthopaedic care provision for the Second Curve. It also provides recommendations for future-focused orthopaedic surgery and health-care administrative leaders to consider as they design newly adaptive, mutually reinforcing, and economically viable musculoskeletal care processes that drive the level of orthopaedic care that our nation deserves-at a cost that it can afford.
Boulay, C; Finidori, G
Although the clinical picture and the natural progression of Duchenne muscular dystrophy (DMD) and Becker muscular dystrophy (BMD) differ, borderline forms exist. Classical orthopaedic treatment is based on self-rehabilitation (by the parents and the patient), physical therapy, posture alignment with orthotics, ergotherapy to set up technical aides, notably positioning in an electric wheelchair to provide more satisfactory autonomy. The functional aspect predominates over pure orthopaedics. Although surgical indications have evolved for the lower limbs, pelvic-spinal arthrodesis for treatment of scoliosis remains the reference treatment, but the methods have evolved since the advent of corticotherapy for DMD. Corticotherapy slows the progression of motor deficits, the age at which walking ability is lost is delayed (shifting from 10 years to 13-14 years depending on the studies), scoliosis progresses later, respiratory insufficiency is better controlled, and therefore survival is prolonged (between 20 and 40 years). However, although this functional aspect seems to respond better to the progress in overall treatment, it also results from a multidisciplinary approach to the disease. Nevertheless, assessment is required, not at a time t as reflected by the scales currently in use, but during daily activities as proposed by qualitative and quantitative monitoring seeking to model nyctohemeral functional motor skills. The principle is to characterize the type of activity (sitting, standing, lying down, walking), its duration, its intensity (walking speed), its frequency (number of activity changes, number of walking episodes), and their sequence (temporal sequence, organization of activity variation). The goal is to identify the variety of functional motor skills and their occurrence over time to determine whether treatment contributes a functional benefit and whether this benefit is put into practice daily. PMID:26773586
Ozturk, Sinan; Karagoz, Huseyin; Zor, Fatih
Since the days of Sushruta, innovation has shaped the history of plastic surgery. Plastic surgeons have always been known as innovators or close followers of innovations. With this descriptive international survey study, the authors aimed to evaluate the future of plastic surgeons by analyzing how plastic surgery and plastic surgeons will be affected by new trends in medicine. Aesthetic surgery is the main subclass of plastic surgery thought to be the one that will change the most in the future. Stem cell therapy is considered by plastic surgeons to be the most likely "game changer." Along with changes in surgery, plastic surgeons also expect changes in plastic surgery education. The most approved assumption for the future of plastic surgery is, "The number of cosmetic nonsurgical procedures will increase in the future." If surgeons want to have better outcomes in their practice, they must at least be open minded for innovations if they do not become innovators themselves. Besides the individual effort of each surgeon, international and local plastic surgery associations should develop new strategies to adopt these innovations in surgical practice and education.
The clinical and scientific level of Japanese surgeons leads the world needless to say, in the field of early gastric cancer, supported by double-contrast roentgenogram, endoscopy and surgical procedure including lymph node dissection with good outcomes. Surgical skills of Japanese surgeons have been improved by watching of cine or videotaped programs at the academic assemblies, breaking through apprenticeship. Ambitious young surgeons could freely learned excellent technical procedure from the pictures. Young surgeon must be an ever-thinking surgeon to get any hint on the film. Even though medical examinations and treatments including surgical procedures are on the way of standardization through EBM, manuals, guidelines and DPC payment system, medical doctors including surgeons must critically continue to think and seek for better treatment for the patients. Since the every patient differs in terms of age. sex, stage of disease, complicated conditions and social background, the treatment should be different, patient to patient, as tailor made fashion. Unless any progress is made, science and arts of medicine will decline. As another advice for a young surgeon from my experience you should write an operation protocol of every procedure by your self, even if that operation is the first experience or you joined as an assistant. After you wrote, you read the protocol by your instructor. Then you learn many knowledge and surgical know-how. Certainly, the book of the protocols will be your valuable treasure. Furthermore, you should not aim to be a skillful surgeon, but to be a good surgeon performing reliable and gentle operations for the patients. PMID:15176525
Doll, Kemi M; Milad, Magdy P; Gossett, Dana R
Annual surgeon case volume has been linked to patient outcome in a variety of surgical fields, although limited data focus on gynecologic surgery performed by general gynecologists. Herein we review the literature addressing the associations between intraoperative injury, postoperative morbidity, and resource use among surgeons performing a low vs high volume of hysterectomies. Although study design and populations differ, individual and composite morbidity outcomes consistently favored high-volume surgeons. Given the growing emphasis on competency-based evaluation in surgery, gynecology departments may soon consider volume requirements a component of privileging. PMID:23622760
Amirian, Ilda; Andersen, Lærke T; Rosenberg, Jacob;
Scale and Visual Analog Scale of fatigue, general well-being, and sleep quality. RESULTS: For both metabolite of melatonin and cortisol, a significant difference (P ...BACKGROUND: Chronic sleep deprivation combined with work during the night is known to affect performance and compromise residents' own safety. The aim of this study was to examine markers of circadian rhythm and the sleep-wake cycle in surgeons working night shifts. METHODS: Surgeons were monitored...... and on PC1. For all subjective measures, a marked deterioration was seen on PC1. CONCLUSION: Surgeons' circadian rhythm was affected by working night shifts....
White, Jonathan J E; Houghton-Clemmey, Robert; Marval, Paul
Enhanced recovery after surgery (ERAS) is a programme that aims to improve the care of elective surgical patients. Accelerated care pathways are delivered using a multidisciplinary approach, leading to reduced lengths of hospital stay, improved quality of treatment, and better outcomes. These programmes have gained considerable popularity in orthopaedics recently, however their widespread adoption remains to be seen. This article highlights the key evidence concerning ERAS in orthopaedic surgery. PMID:24279038
Dalager, Tina; Søgaard, Karen; Bech, Katrine Tholstrup;
Background: A large proportion of surgeons performing minimally invasive surgery (MIS) experience musculoskeletal pain in the upper body possibly due to awkward and long-term static positions. This can be detrimental for workability and health. The objective of the present review is to sum up...... in surgeons performing MIS is high and derives mainly from static postures. Positioning of monitor, adjustment of table height and instrument design also contribute substantially. Robotic assisted laparoscopy seems less physically demanding for the surgeon compared with conventional laparoscopy. However, some...... alongside patient safety. The present literature study supports the need for a randomized controlled trial evaluating the effect of an individually designed training program for surgeons performing MIS....
Tribute to Sir Donald Ross by David Wheatley, as read by Robert Kleinloog, President, Society of Cardiothoracic Surgeons of South Africa at the Annual Congress of the South African Heart Association 19 October 2014.
Full Text Available Abstract Background Evidence-based medicine posits that health care research is founded upon clinically important differences in patient centered outcomes. Statistically significant differences between two treatments may not necessarily reflect a clinically important difference. We aimed to quantify the sample sizes and magnitude of treatment effects in a review of orthopaedic randomized trials with statistically significant findings. Methods We conducted a comprehensive search (PubMed, Cochrane for all randomized controlled trials between 1/1/95 to 12/31/04. Eligible studies include those that focused upon orthopaedic trauma. Baseline characteristics and treatment effects were abstracted by two reviewers. Briefly, for continuous outcome measures (ie functional scores, we calculated effect sizes (mean difference/standard deviation. Dichotomous variables (ie infection, nonunion were summarized as absolute risk differences and relative risk reductions (RRR. Effect sizes >0.80 and RRRs>50% were defined as large effects. Using regression analysis we examined the association between the total number of outcome events and treatment effect (dichotomous outcomes. Results Our search yielded 433 randomized controlled trials (RCTs, of which 76 RCTs with statistically significant findings on 184 outcomes (122 continuous/62 dichotomous outcomes met study eligibility criteria. The mean effect size across studies with continuous outcome variables was 1.7 (95% confidence interval: 1.43–1.97. For dichotomous outcomes, the mean risk difference was 30% (95%confidence interval:24%–36% and the mean relative risk reduction was 61% (95% confidence interval: 55%–66%; range: 0%–97%. Fewer numbers of total outcome events in studies was strongly correlated with increasing magnitude of the treatment effect (Pearson's R = -0.70, p Conclusion Our review suggests that statistically significant results in orthopaedic trials have the following implications-1 On average
Payumo, Francis C.; Kim, Hyun D.; Sherling, Michael A.; Smith, Lee P.; Powell, Courtney; Wang, Xiao; Keeping, Hugh S.; Valentini, Robert F.; Vandenburgh, Herman H.
With current technology, tissue-engineered skeletal muscle analogues (bioartificial muscles) generate too little active force to be clinically useful in orthopaedic applications. They have been engineered genetically with numerous transgenes (growth hormone, insulinlike growth factor-1, erythropoietin, vascular endothelial growth factor), and have been shown to deliver these therapeutic proteins either locally or systemically for months in vivo. Bone morphogenetic proteins belonging to the transforming growth factor-beta superfamily are osteoinductive molecules that drive the differentiation pathway of mesenchymal cells toward the chondroblastic or osteoblastic lineage, and stimulate bone formation in vivo. To determine whether skeletal muscle cells endogenously expressing bone morphogenetic proteins might serve as a vehicle for systemic bone morphogenetic protein delivery in vivo, proliferating skeletal myoblasts (C2C12) were transduced with a replication defective retrovirus containing the gene for recombinant human bone morphogenetic protein-6 (C2BMP-6). The C2BMP-6 cells constitutively expressed recombinant human bone morphogenetic protein-6 and synthesized bioactive recombinant human bone morphogenetic protein-6, based on increased alkaline phosphatase activity in coincubated mesenchymal cells. C2BMP-6 cells did not secrete soluble, bioactive recombinant human bone morphogenetic protein-6, but retained the bioactivity in the cell layer. Therefore, genetically-engineered skeletal muscle cells might serve as a platform for long-term delivery of osteoinductive bone morphogenetic proteins locally.
White, A A
America is founded on high humanitarian, democratic ideals. The historic facts of slavery, discrimination, and segregation challenge and taint these democratic principles. Although progress has been made, serious racial problems remain. In 1997, the United States had 474 active hate groups, up 20% from 1996. African American males who have the same education as white males doing the same work earn approximately 75% of what their white counterparts earn. America, as predicted by the Kerner Commission Report, is two societies: black and white, separate, and unequal. Some astonishing disparities in healthcare exist. Peer reviewed medical literature documents that African Americans have higher infant mortality rates, shorter life expectancies, fewer joint replacements, and more amputations than whites. Communications within a diverse group of students and teachers enriches the educational experience. The late Supreme Court Justice Lewis Powell, LLD, asserted that a medical student from a particular background may enrich classmates' understanding of people whose cultures are different from their own, and improve their ability to serve a heterogeneous patient population. Diversity on clinical teams can enhance rapport between patient and physician, and can diminish unthinking insults to patients, born of physician ethnic insensitivity. Healthcare facilities with diverse staffs are more likely than homogeneous facilities to attract and successfully serve the nation's diverse population. A University of California at Davis School of Medicine study showed that diversity can be achieved without compromising quality of patient care. Clinically and ideologically, diversity in orthopaedics is good for patients and for the country. PMID:10335274
Moroz, Paul J; Spiegel, David A
Road traffic crash-related death, injury, and chronic disability continue to be a major worldwide burden to drivers, pedestrians, and users of mass transit, especially in low- and middle-income countries (LMIC). Projections predict worsening of this burden, and while motorization of LMIC increases exponentially, a corresponding improvement in prehospital and acute in-hospital trauma care has not been seen. The WHO now has 2 programs that address different elements of this challenge, namely, the Violence and Injury Prevention department (prevention) and the Emergency and Essential Surgical Care project (treatment). Activities of Violence and Injury Prevention have included developing guidelines for prehospital and essential trauma care, whereas activities of the Emergency and Essential Surgical Care have included developing the Integrated Management of Emergency and Essential Surgical Care toolkit and a textbook, "Surgical Care at the District Hospital." Organized surgical institutions in high-income countries-trauma associations, university departments, surgical nongovernmental organizations, etc.-can benefit from the infrastructure and tools the WHO has developed to better address the deficits in surgical services to improve the equitable distribution of surgical care services and resources to LMIC.
This conference presentation presented charts and graphs on the market for Canadian oil. Graphs included crude oil and natural gas prices and heavy oil discount differential. Graphs depicting heavy oil economics such as bitumen blending with condensate were also included along with global crude oil reserves by country. Information on oil sands projects in the Athabasca, Peace River, and Cold Lake deposits was presented along with graphs on oil sands supply costs by recovery type; Canadian production for conventional, oil sands and offshore oil; new emerging oil sands crude types; and 2003 market demand by crude type in the United States and Canada. Maps included Canada and United States crude oil pipelines; western Canadian crude oil markets; long term oil pipeline expansion projects; Canadian and United States crude oil pipeline alternatives; and potential tanker markets for Canadian oil sands production. Lastly, the presentation provided graphs on 2003 refinery crude demand and California market demand. tabs., figs
Greig, Paul D; Rotstein, Ori D
Dr. Bernard Langer's induction into the Canadian Medical Hall of Fame acknowledges his profound effect on medicine and surgery in Canada and an impact that has been truly international. In this brief biography, we highlight the major accomplishments that have made Dr. Langer a pre-eminent leader, innovator, teacher and exemplary surgeon. PMID:25799243
Greig, Paul D.; Rotstein, Ori D.
Summary Dr. Bernard Langer’s induction into the Canadian Medical Hall of Fame acknowledges his profound effect on medicine and surgery in Canada and an impact that has been truly international. In this brief biography, we highlight the major accomplishments that have made Dr. Langer a pre-eminent leader, innovator, teacher and exemplary surgeon. PMID:25799243
Janssen, S.J.; Teunis, T.; Guitton, T.G.; Ring, D.; Biert, J.
BACKGROUND: There is substantial unexplained geographical and surgeon-to-surgeon variation in rates of surgery. One would expect surgeons to treat patients and themselves similarly based on best evidence and accounting for patient preferences. QUESTIONS/PURPOSES: (1) Are surgeons more likely to reco
Full Text Available Abstract Backround This retrospective study was undertaken to determine the incidence of kidney dysfunction (KD and to identify potential risk factors contributing to development of KD in orthopaedic population following an elective or emergency surgery. Methods A total of 1025 patients were admitted in our institution over a period of one year with various indications. Eight hundred and ninety-three patients (87.1% had a surgical procedure. There were 42 (52.5% male and 38 (47.5% female with a mean age of 72 years (range: 47 to 87 years. We evaluated the following potential risk factors: age, comorbidities, shock, hypotension, heart failure, medications (antibiotics, NSAIDs, opiates, rhabdomyolysis, imaging contrast agents and pre-existing KD. Results The overall incidence of KD was 8.9%. Sixty-eight patients developed acute renal injury (AKI and 12 patients developed acute on chronic kidney disease (CKD. In sixty-six (82.5% patients renal function was reversed to initial preoperative status. Perioperative dehydration (p = 0.002, history of diabetes mellitus (p = 0.003, pre-existing KD (p = 0.004, perioperative shock (p = 0.021 and administration of non-steroid anti-inflammatory drugs (NSAIDs (p = 0.028 or nephrotoxic antibiotics (p = 0.037 were statistically significantly correlated with the development of postoperative KD and failure to gain the preoperative renal function. Conclusion We conclude that every patient with risk factor for postoperative KD should be under closed evaluation and monitoring.
Memon, Anjuman Gul; Naeem, Zahid; Zaman, Atif; Zahid, Faryal
The surgeon's daily workload renders him/her susceptible to a variety of the common work-related illness. They are exposed to a number of occupational hazards in their professional work. These hazards include sharp injuries, blood borne pathogens, latex allergy, laser plumes, hazardous chemicals, anesthetic gases, equipment hazards, static postures, and job related stressors. However, many pay little attention to their health, and neither do they seek the appropriate help when necessary. It is observed that occupational hazards pose a huge risk to the personal well-being of surgeons. As such, the importance of early awareness and education alongside prompt intervention is duly emphasized. Therefore, increased attention to the health, economic, personal, and social implications of these injuries is essential for appropriate management and future prevention. These risks are as great as any other occupational hazards affecting surgeons today. The time has come to recognize and address them. PMID:27103909
Edwards, Hellen; Jørgensen, Lars Nannestad
BACKGROUND AND AIM: Advancements in minimally invasive surgery have led to increases in popularity of single-incision laparoscopic surgery (SILS) and natural orifice translumenal surgery (NOTES(®); American Society for Gastrointestinal Endoscopy [Oak Brook, IL] and Society of American...... Gastrointestinal and Endoscopic Surgeons [Los Angeles, CA]) due to their postulated benefits of better cosmesis, less pain, and quicker recovery. This questionnaire-based study investigated Danish surgeons' attitudes toward these new procedures. SUBJECTS AND METHODS: A 26-item questionnaire was developed...... become standard techniques for cholecystectomy within 6 years. CONCLUSIONS: The importance of risk of complications has not surprisingly a high priority among surgeons in this questionnaire. Why this is has to be investigated further before implementing SILS and NOTES as standard of care....
Kingsberg, Jessica G; Halpern, Alan A; Hill, Brian C
Increasing numbers of patients who have undergone bariatric surgery are now presenting to orthopedic surgeons for elective arthroplasties. In addition, orthopedic surgeons themselves are referring more patients for consideration of bariatric surgery in anticipation of future elective procedures. Although the full effects of bariatric surgery on metabolism are not yet known, the altered digestion associated with these surgeries poses several issues for orthopedic surgeons. In this article, we address 3 aspects of care of this class of patient: review of the most commonly performed procedures and their metabolic consequences; suggested preoperative assessment of bariatric patients for any conditions that should be corrected before surgery; and evaluation of outcomes of elective procedures performed after bariatric surgery. Awareness of the unique characteristics of this group of patients helps minimize the potential for complications of planned orthopedic surgeries.
Delaney, R A
The health benefits of exercise may be attenuated by sports and recreation related injury (SRI). Though the majority of SRI are mild and self-limiting, a significant number are serious and require orthopaedic intervention. The aims of this study were to assess the burden of these serious injuries on the orthopaedic inpatient service, and to investigate potential target areas for injury prevention. All 1,590 SRI seen in the ED over a 3-month period were analysed using the Patient Information Management System to determine which patients received inpatient orthopaedic care. The medical records of those 63 patients who required inpatient care under orthopaedics were reviewed and data collected on demographic features, history, operative procedure and theatre resources, and length of hospital stay. Data were analyzed using SPSS. SRI accounted for 12.3% of all ED presentations. The principal activities resulting in injury requiring orthopaedic care were soccer, hurling and informal play e.g. trampoline. Falls made up 37% of the overall mechanism of injury but 68% of the injuries severe enough to require operative management. Most operative procedures were performed as part of a routine day trauma list but 20% were performed out of hours. This group of injuries places a significant burden on a busy trauma service. Injury prevention measures such as public education regarding falls in sport may have a role in reducing this burden.
Bert, Jack M
The delivery of high quality medical services is approaching a crisis situation in the United States. As physician reimbursements decline and overhead increases, orthopedic surgeons must seek additional sources of revenue to remain financially viable and control the quality of medical care that they deliver. The orthopedic surgeon group is well positioned to control its own service lines and deliver excellent patient care as a result. This article reviews the possibilities of multiple types of ancillary service lines available for the orthopedic group practice. PMID:18061762
Full Text Available Abstract Background Orthopaedic surgeons disagree considerably when classifying fractures of the proximal humerus. However, the clinical implications of low observer agreement remain unclear. The purpose of the study was to compare the agreement on Neer classification with the agreement on treatment recommendations. Methods We conducted a multi-centre observer-study. Five experienced shoulder surgeons independently assessed a consecutive series of 193 radiographs at two occasions three months apart. All pairs of radiographs were classified according to Neer. Subsequently, the observers were asked to recommend one of three treatment modalities for each case: non-operative treatment, locking plate osteosynthesis, or hemiarthroplasty. Results At both classification rounds mean kappa-values for inter-observer agreement on treatment recommendations (0.48 and 0.52 were significantly higher than the agreement on Neer classification (0.33 and 0.36 (p Conclusions We found a significantly higher agreement on treatment recommendations compared to agreement on fracture classification. The low observer agreement on the Neer classification reported in several observer studies may have less clinical importance than previously assumed. However, inter-observer agreement did not exceed moderate levels.
Stoodley, M A; Sikorski, J M
Medical auditing based on individual diagnoses or specific therapies is well established. Auditing of all medical activity has an expanding role in quality assurance and research. In an attempt to overcome the limitations of existing auditing systems, a fundamentally different, flexible, high quality and easily accessible orthopaedic auditing system has been developed. This records a description of each component of patients' orthopaedic diagnoses, records treatment and complications, produces discharge letters and surgical log books and allows flexible and comprehensive audits. It has been in use in an orthopaedic service since January 1990 and has been successful in identifying problems and monitoring the effectiveness of changes. It is anticipated that the system will become more widely used and provide the basis for a 'user group' which will share the accumulated data and further development costs. PMID:1757163
Netten, van Jaap J.; Jannink, Michiel J.A.; Hijmans, Juha M.; Geertzen, Jan H.B.; Postema, Klaas
Objective: To investigate the association between patients’ expectations and the actual use of custom-made orthopaedic shoes. - Design: A prospective cohort study with internal comparison. - Setting: Twelve orthopaedic shoe companies. - Patients: During six months, consecutive patients who were p
Karthik, K; Colegate-Stone, T; Dasgupta, P; Tavakkolizadeh, A; Sinha, J
The use of robots in orthopaedic surgery is an emerging field that is gaining momentum. It has the potential for significant improvements in surgical planning, accuracy of component implantation and patient safety. Advocates of robot-assisted systems describe better patient outcomes through improved pre-operative planning and enhanced execution of surgery. However, costs, limited availability, a lack of evidence regarding the efficiency and safety of such systems and an absence of long-term high-impact studies have restricted the widespread implementation of these systems. We have reviewed the literature on the efficacy, safety and current understanding of the use of robotics in orthopaedics. PMID:25737510
Hockenberry, Jason M; Helmchen, Lorens A
To test how practice interruptions affect worker productivity, we estimate how temporal breaks affect surgeons' performance of coronary artery bypass grafting (CABG). Examining 188 surgeons who performed 56,315 CABG surgeries in Pennsylvania between 2006 and 2010, we find that a surgeon's additional day away from the operating room raised patients' inpatient mortality by up to 0.067 percentage points (2.4% relative effect) but reduced total hospitalization costs by up to 0.59 percentage points. Among emergent patients treated by high-volume providers, where temporal distance is most plausibly exogenous, an additional day away raised mortality risk by 0.398 percentage points (11.4% relative effect) but reduced cost by up to 1.4 percentage points. This is consistent with the hypothesis that as temporal distance increases, surgeons are less likely to recognize and address life-threatening complications. Our estimates imply additional intraprocedural treatment intensity has a cost per life-year preserved of $7871-18,500, well within conventional cost-effectiveness cutoffs. PMID:24973949
Osman Ersoy; Bulent Sivri; Yusuf Bayraktar
Capsule endoscopy is a new technology that, for the first time, allows complete, non-invasive endoscopic imaging of the small bowel. The efficacy of capsule endoscopy in the diagnosis of suspected small bowel diseases has been established. Important applications for surgeons include observations of obscure gastrointestinal bleeding and small bowel neoplasms.
Hockenberry, Jason M; Helmchen, Lorens A
To test how practice interruptions affect worker productivity, we estimate how temporal breaks affect surgeons' performance of coronary artery bypass grafting (CABG). Examining 188 surgeons who performed 56,315 CABG surgeries in Pennsylvania between 2006 and 2010, we find that a surgeon's additional day away from the operating room raised patients' inpatient mortality by up to 0.067 percentage points (2.4% relative effect) but reduced total hospitalization costs by up to 0.59 percentage points. Among emergent patients treated by high-volume providers, where temporal distance is most plausibly exogenous, an additional day away raised mortality risk by 0.398 percentage points (11.4% relative effect) but reduced cost by up to 1.4 percentage points. This is consistent with the hypothesis that as temporal distance increases, surgeons are less likely to recognize and address life-threatening complications. Our estimates imply additional intraprocedural treatment intensity has a cost per life-year preserved of $7871-18,500, well within conventional cost-effectiveness cutoffs.
Pradeep K. Singh; Sandeep Shrivastva; Rajesh Dulani; Abhishek Yadav
@@ Infection and Clinical Microbiology in Orthopaedics Surgeries in Wound infections resulting from contamination during major orthopaedics surgery continues to be a vital issue.In this study, specimens of pus,draining fluids or suspected pus from the wounds of surgical patients who had been undergone major orthopaedics surgical procedure were cultured.
Full Text Available OBJECTIVES: Analysis of discrepancies between patient and surgeon expectations before total hip arthroplasty (THA should enable a better understanding of motives of dissatisfaction about surgery, but this question has been seldom studied. Our objectives were to compare surgeons' and patients' expectations before THA, and to study factors which affected surgeon-patient agreement. METHODS: 132 adults (mean age 62.8+/-13.7 years, 52% men on waiting list for THA in three tertiary care centres and their 16 surgeons were interviewed to assess their expectations using the Hospital for Special Surgery Total Hip Replacement Expectations Survey (range 0-100. Patients' and surgeons' answers were compared, for the total score and for the score of each item. Univariate analyses tested the effect of patients' characteristics on surgeons' and patients' expectations separately, and on surgeon-patient differences. RESULTS: Surgeon and patient expectations' mean scores were high (respectively 90.9+/-11.1 and 90.0+/-11.6 over 100. Surgeons' and patients' expectations showed no systematic difference, but there was little agreement on Bland and Altman graph and correlation coefficient was low. Patients had higher expectations than surgeons for sports. Patients rated their expectations according to trust in physician and mental quality of life, surgeons considered disability. More disabled patients and patients from a low-income professional category were often "more optimistic" than their surgeons. CONCLUSION: Surgeons and patients often do not agree on what to expect from THA. More disabled patients expect better outcomes than their surgeons.
Ma, Zhen-Sheng; Zhang, Hong-Ju; Yu, Tao; Ren, Gang; Du, Guo-Sheng; Wang, Yong-Hua
Traditional continuing medical education (CME) depended primarily on periodic courses and conferences. The cost-effectiveness of these courses has not been established, and often the content is not tailored to best meet the needs of the students. Internet training has the potential to accomplish these goals. Over the last 10 years, we have developed a Web site entitled "Orthochina.org," based upon the wiki concept, which uses an interactive, case-based format. We describe the development of online case discussions, and various technical and administrative requirements. As of December 31, 2007, there were 33,984 registered users, 9,759 of which passed the confirmation procedures. In 2007, an average of 211 registrants visited daily. The average number of first page clicks was 4,248 per day, and the average number of posts was 70 per day. All cases submitted for discussion include the patient's complaint, physical examination findings, and relevant images based on specific criteria for case discussion. The case discussions develop well professionally. No spam posting or unauthorized personal advertisement is permitted. In conclusion, online academic discussions proceed well when the orthopaedic surgeons who participate have established their identities. PMID:18685911
Rivera, Jessica C; Greer, Renee M; Wenke, Joseph C; Ficke, James R; Johnson, Anthony E
The Military Orthopaedic Trauma Registry (MOTR) orginally began as part of the Department of Defense Trauma Registry (DoDTR) and became a live registry in 2013. As a quality improvement process, this study examined MOTR data for 20 female amputees compared with DoDTR data. The DoDTR provided diagnosis and procedure codes as a list but no details. The MOTR provided additional data, including specific limb, fracture classifications, and associated injuries per limb. The MOTR allowed for construction of a treatment time line for each limb, including number and timing of debridements, antibiotics, and implant types. Orthopaedic-specific complications were also coded more frequently in the MOTR and clearly identified with a specific injury and treatment. During initial quality control checks, the MOTR provides a greater volume and granularity of detail for orthopaedic-specific injury and treatment information, indicating that the MOTR is on track to provide a valuable repository for data-driven orthopaedic management of combat injury. PMID:27518292
Vogely, Henri Charles
The diagnostic difficulties, variability in outcome and the heterogeinity of the problem of orthopaedic infections stimulated the author to a study of the literature, and several clinical and experimental studies. The diagnosis prosthesis-related infection can only be reached with an acceptable d
Bouvier, J.F.; Lafon, J.C.; Colin, M.; Chatelut, J.; Beaubatie, F. (Hopital Universitaire Dupuytren, Limoges (France))
99m Tc-labeled heparin test was performed for early detection of phlebitis or pulmonary embolism after orthopaedic prothesis. Heparinic treatment and surgery per se were demonstrated to have no effect on the results. If this test demonstrates a statistical difference for pathologic patients, it is of greater value to consider ratio between rates before and after intervention.
Full Text Available Smartphones have the ability to benefit plastic surgeons in all aspects of patient care and education. With the sheer number of applications available and more being created everyday, it is easy to miss out on apps which could be of great relevance. Moreover, the range of android applications available has not been extensively discussed in the literature. To this end, we have compiled an exhaustive list of android smartphone applications, which we feel can help our day to day functioning. The apps have been extensively reviewed and neatly described along with all their potential uses. In addition, we have made an effort to highlight ′non-medical′ or efficiency apps which can improve departmental functioning. These apps have not been described in prior articles, and their functionality might not be known to all. We believe that the technology savvy plastic surgeon can make maximum use of these apps to his benefit.
The facial plastic surgeon potentially has a conflict of interest when confronted with the patients requesting surgery, due to the personal gain attainable by agreeing to perform surgery. The aim of this review is to discuss the potential harm the surgeon can inflict by carrying out facial plastic surgery, beyond the standard surgical complications of infection or bleeding. It will discuss the desire for self-improvement and perfection and increase in the prevalence facial plastic surgery. We address the principles of informed consent, beneficence and non-maleficence, as well as justice and equality and how the clinician who undertakes facial plastic surgery is at risk of breaching these principles without due care and diligence. PMID:26254909
Nasir, Amir R; Brenner, Sara A
The purpose of this article is to introduce the topic of nanotechnology to plastic surgeons and to discuss its relevance to medicine in general and plastic surgery in particular. Nanotechnology will be defined, and some important historical milestones discussed. Common applications of nanotechnology in various medical and surgical subspecialties will be reviewed. Future applications of nanotechnology to plastic surgery will be examined. Finally, the critical field of nanotoxicology and the safe use of nanotechnology in medicine and plastic surgery will be addressed.
Bernstein, Joseph; Derman, Peter
The Balanced Budget Act of 1997 mandated reductions in physician reimbursement. This reduction in payments could be envisioned to limit expenditures on 2 counts: first, individual fees would be lower, producing inherent savings. Furthermore, reducing fees should depress the incentive to work, thereby generating additional savings from reduced output. A rival point of view holds that lower fees might paradoxically lead to greater spending because surgeons compensate for per-case reductions by performing more cases. If this income-targeting hypothesis is correct, lower per-case fees leads to increased volume. Increased work output has particularly sizable economic effects in fields like orthopedic surgery because the total cost of orthopedic interventions is usually many times larger than the physician's fee (largely owing to the cost of implants). As such, increases in work volume more than negate the potential savings from lower surgeon's fees.This phenomenon was studied in the context of total knee arthroplasty. In the decade spanning 1996 to 2005, inflation-adjusted physician reimbursement decreased by approximately 5% per year, leading to a cumulative drop in reimbursement from $2847 to $1685. Nonetheless, because the number of procedures performed increased from 253,841 to 498,169 and because payments to hospitals far exceeded payments to surgeons, total expenditures for total knee arthroplasty increased dramatically: more than $7.1 billion additional was spent on hospital payments. Continuing to pay surgeons less is apt to continue to cost more. Counter to intuition, the best strategy for controlling overall spending might be higher, not lower, surgical fees.
... External link, please review our exit disclaimer . Subscribe Technologies Enhance Tumor Surgery Helping Surgeons Spot and Remove ... over time. NIH-funded researchers are developing new technologies to help surgeons determine exactly where tumors end ...
Full Text Available Abstract Background Despite having access to medically necessary care available through publicly funded provincial health care systems, some Canadians travel for treatment provided at international medical facilities as well as for-profit clinics found in several Canadian provinces. Canadians travel abroad for orthopaedic surgery, bariatric surgery, ophthalmologic surgery, stem cell injections, “Liberation therapy” for multiple sclerosis, and additional interventions. Both responding to public interest in medical travel and playing an important part in promoting the notion of a global marketplace for health services, many Canadian companies market medical travel. Methods Research began with the goal of locating all medical tourism companies based in Canada. Various strategies were used to find such businesses. During the search process it became apparent that many Canadian business promoting medical travel are not medical tourism companies. To the contrary, numerous types of businesses promote medical travel. Once businesses promoting medical travel were identified, content analysis was used to extract information from company websites. Company websites were analyzed to establish: 1 where in Canada these businesses are located; 2 the destination countries and health care facilities that they market; 3 the medical procedures they promote; 4 core marketing messages; and 5 whether businesses market air travel, hotel accommodations, and holiday tours in addition to medical procedures. Results Searches conducted from 2006 to 2011 resulted in identification of thirty-five Canadian businesses currently marketing various kinds of medical travel. The research project began with what seemed to be the straightforward goal of establishing how many medical tourism companies are based in Canada. Refinement of categories resulted in the identification of eighteen businesses fitting the category of what most researchers would identify as medical tourism
Background Despite having access to medically necessary care available through publicly funded provincial health care systems, some Canadians travel for treatment provided at international medical facilities as well as for-profit clinics found in several Canadian provinces. Canadians travel abroad for orthopaedic surgery, bariatric surgery, ophthalmologic surgery, stem cell injections, “Liberation therapy” for multiple sclerosis, and additional interventions. Both responding to public interest in medical travel and playing an important part in promoting the notion of a global marketplace for health services, many Canadian companies market medical travel. Methods Research began with the goal of locating all medical tourism companies based in Canada. Various strategies were used to find such businesses. During the search process it became apparent that many Canadian business promoting medical travel are not medical tourism companies. To the contrary, numerous types of businesses promote medical travel. Once businesses promoting medical travel were identified, content analysis was used to extract information from company websites. Company websites were analyzed to establish: 1) where in Canada these businesses are located; 2) the destination countries and health care facilities that they market; 3) the medical procedures they promote; 4) core marketing messages; and 5) whether businesses market air travel, hotel accommodations, and holiday tours in addition to medical procedures. Results Searches conducted from 2006 to 2011 resulted in identification of thirty-five Canadian businesses currently marketing various kinds of medical travel. The research project began with what seemed to be the straightforward goal of establishing how many medical tourism companies are based in Canada. Refinement of categories resulted in the identification of eighteen businesses fitting the category of what most researchers would identify as medical tourism companies. Seven other
Van Donkersgoed, J; Jewison, G; M. Mann; Cherry, B; Altwasser, B; Lower, R; Wiggins, K; Dejonge, R; Thorlakson, B; Moss, E.; C. Mills; Grogan, H
A study was conducted in 4 Canadian processing plants in 1995-96 to determine the prevalence of quality defects in Canadian cattle. One percent of the annual number of cattle processed in Canada were evaluated on the processing floor and 0.1% were graded in the cooler. Brands were observed on 37% and multiple brands on 6% of the cattle. Forty percent of the cattle had horns, 20% of which were scurs, 33% were stubs, 10% were tipped, and 37% were full length. Tag (mud and manure on the hide) wa...
The Canadian Irradiation Centre is a non-profit cooperative project between Atomic Energy of Canada Limited, Radiochemical Company and Universite du Quebec, Institut Armand-Frappier, Centre for Applied Research in Food Science. The Centre's objectives are to develop, demonstrate and promote Canada's radiation processing technology and its applications by conducting applied research; training technical, professional and scientific personnel; educating industry and government; demonstrating operational and scientific procedures; developing processing procedures and standards, and performing product and market acceptance trials. This pamphlet outlines the history of radoation technology and the services offered by the Canadian Irradiation Centre
Full Text Available Several studies have shown that wound infection (surgical site infection [ ssi ] rates fall when surgeons are provided with data on their performance. Since 1987, the authors have been performing concurrent surveillance of surgical patients and confidentially reporting surgeon-specific ssi rates to individual surgeons and their clinical directors, and providing surgeons with the mean rates of their peers. The program has been gradually refined and expanded. Data are now collected on wound infection risk and report risk adjusted rates compared with the mean for hospitals in the United States National Nosocomial Infections Surveillance (nnis data bank. Since inception through to December 1993, ssi rates have fallen 68% in clean contaminated general surgery cases (relative risk [rr] 0.36, 95% ci 0.2 to 0.6, P=0.0001, 64% in clean plastic surgery cases (rr 0.35, 95% ci 0.06 to 1.8, 72% in caesarean section cases (rr 0.23, 95% ci 0.03 to 1.96 and 42% in clean cardiovascular surgery cases (rr 0.59, 95% ci 0.34 to 1.0. In clean orthopedic surgery the ssi rate remained stable from 1987 through 1992. In 1993 a marked increase was experienced. Reasons for this are being explored. Overall there was a 32% decrease in ssi rate between the index year and 1993 or, in percentage terms, 2.8% to 1.9% (rr 0.65, 95% ci 0.51 to 0.86, P=0.002. ssi surveillance should become standard in Canadian hospitals interested in improving the quality of surgical care and reducing the clinical impact and cost associated with nosocomial infection.
Neuhaus, Susan J
The war service of Lilian Violet Cooper, the first female surgeon of the Royal Australasian College of Surgeons, is well recognized. Not so well known however, are the other pioneering female doctors who also undertook work as military surgeons during World War I. At least four of the 14 Australian female doctors that undertook overseas war service during World War I were engaged as surgeons and treated Australian, British and Allied casualties. These women operated in London, in Egypt and on the frontlines of the Macedonian campaign. While none of these other women became Fellows of the Royal Australasian College of Surgeons, their war efforts deserve recognition.
Stone, J L
nerve regeneration and nerve grafting, and after many years of devoted research, he devised successful operations for facial nerve paralysis. For this and early vascular work, he is often credited as the first English surgeon to reintroduce classical Hunterian methods of experiment into surgery. He was honored as the founder and President of The Society of British Neurological Surgeons in 1926. Perhaps best known as a general and aural surgeon, Ballance was second only to Horsley in reputation as a pioneer British neurological surgeon. Described as a painstakingly slow but delicate and meticulous operator, Ballance made a contribution to neurosurgery and temporal bone surgery that was immense.
Gómez-Sánchez, Mario; Soulé-Egea, Mauricio; Herrera-Alarcón, Valentín; Barragán-García, Rodolfo
The Syntax score has been established as a tool to determine the complexity of coronary artery disease and as a guide for decision-making among coronary artery bypass surgery and percutaneous coronary intervention. The purpose of this review is to systematically examine what the Syntax score is, and how the surgeon should integrate the information in the selection and treatment of patients. We reviewed the results of the SYNTAX Trial, the clinical practice guidelines, as well as the benefits and limitations of the score. Finally we discuss the future directions of the Syntax score.
Rackley, Sandra; Bostwick, John Michael
Though technical aspects of surgical practice are commonly emphasized, communication is the most frequent "procedure" employed by surgeons. A good patient-physician relationship enhances the quality of surgical care by improving outcomes and patient and family satisfaction. There are general principles that can enhance communication with all children and families. Employing a developmentally sensitive approach that adjusts communication style based on a child's cognitive abilities and emotional concerns can further enhance the relationship with children of different ages. These communication skills can be learned and are improved by practice and self-reflection. PMID:23870204
Full Text Available Introduced about two decades ago, computer-assisted orthopaedic surgery (CAOS has emerged as a new and independent area, due to the importance of treatment of musculoskeletal diseases in orthopaedics 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.
Bone graft is widely used within orthopaedic surgery especially in revision joint arthroplasty and spine fusion. The early implant fixation in the revision situation of loose joint prostheses is important for the long-term survival. Bone autograft has been considered as gold standard in many...... orthopaedic procedures, whereas allograft is the gold standard by replacement of extensive bone loss. However, the use of autograft is associated with donor site morbidity, especially chronic pain. In addition, the limited supply is a significant clinical challenge. Limitations in the use of allograft include...... skeletal bones. The osteoconductive properties of the composite might be improved by adding bone marrow aspirate (BMA), which can be harvested during surgery. Other alternatives to bone graft are demineralised bone matrix (DBM) and human cancellous bone (CB). DBM is prepared by acid extraction of human...
Elfar, John; Menorca, Ron Martin Garcia; Reed, Jeffrey Douglas; Stanbury, Spencer
Composite bone models are increasingly used in orthopaedic biomechanics research and surgical education-applications that traditionally relied on cadavers. Cadaver bones are suboptimal for many reasons, including issues of cost, availability, preservation, and inconsistency between specimens. Further, cadaver samples disproportionately represent the elderly, whose bone quality may not be representative of the greater orthopaedic population. The current fourth-generation composite bone models provide an accurate reproduction of the biomechanical properties of human bone when placed under bending, axial, and torsional loads. The combination of glass fiber and epoxy resin components into a single phase has enabled manufacturing by injection molding. The high level of anatomic fidelity of the cadaver-based molds and negligible shrinkage properties of the epoxy resin results in a process that allows for excellent definition of anatomic detail in the cortical wall and optimized consistency of features between models. Recent biomechanical studies of composites have validated their use as a suitable substitute for cadaver specimens. PMID:24486757
The paper reviews Canadian experience in the production of heavy water, presents a long-term supply projection, relates this projection to the anticipated long-term electrical energy demand, and highlights principal areas for further improvement that form the bulk of our research and development program on heavy water processes
The Canadian hydrogen safety program (CHSP) is a project initiative of the Codes and Standards Working Group of the Canadian transportation fuel cell alliance (CTFCA) that represents industry, academia, government, and regulators. The Program rationale, structure and contents contribute to acceptance of the products, services and systems of the Canadian Hydrogen Industry into the Canadian hydrogen stakeholder community. It facilitates trade through fair insurance policies and rates, effective and efficient regulatory approval procedures and accommodation of the interests of the general public. The Program integrates a consistent quantitative risk assessment methodology with experimental (destructive and non-destructive) failure rates and consequence-of-release data for key hydrogen components and systems into risk assessment of commercial application scenarios. Its current and past six projects include Intelligent Virtual Hydrogen Filling Station (IVHFS), Hydrogen clearance distances, comparative quantitative risk comparison of hydrogen and compressed natural gas (CNG) refuelling options; computational fluid dynamics (CFD) modeling validation, calibration and enhancement; enhancement of frequency and probability analysis, and Consequence analysis of key component failures of hydrogen systems; and fuel cell oxidant outlet hydrogen sensor project. The Program projects are tightly linked with the content of the International Energy Agency (IEA) Task 19 Hydrogen Safety. (author)
A wide ranging discussion about the factors that have influenced oil and natural gas prices, the differences of the Canadian market from international markets, the differences between eastern and western Canadian markets, and shareholders' perspectives on recent commodity price developments was presented. Developments in the OPEC countries were reviewed, noting that current OPEC production of 25 mmbbls is about 60 per cent higher than it was in 1985. It is expected that OPEC countries will continue to expand capacity to meet expected demand growth and the continuing need created by the UN embargo on Iraqi oil sales. Demand for natural gas is also likely to continue to rise especially in view of the deregulation of the electricity industry where natural gas may well become the favored fuel for incremental thermal generation capacity. Prices of both crude oil and natural gas are expected to hold owing to unusually low storage levels of both fuels. The inadequacy of infrastructure, particularly pipeline capacity as a key factor in the Canadian market was noted, along with the dynamic that will emerge in the next several years that may have potential consequences for Canadian production - namely the reversal of the Sarnia to Montreal pipeline. With regard to shareholders' expectations the main issues are (1) whether international markets reach back to the wellhead, hence the producer's positioning with respect to transportation capacity and contract portfolios, and (2) whether the proceeds from increased prices are invested in projects that are yielding more than the cost of capital. 28 figs
An emerging group of leaders in Canadian education has attracted thousands of followers. They've made Twitter an extension of their lives, delivering twenty or more tweets a day that can include, for example, links to media articles, research, new ideas from education bloggers, or to their own, or simply a personal thought. At their best,…
Small, J. M.
A survey of 67 Canadian university vice presidents and 66 deans concerning reform in recent years found that the many changes reported were modest and reactive rather than bold and proactive. Most common changes involved strategic planning, retrenchment, curriculum expansion, response to enrollment changes, administrative restructuring, and more…
Objective: To compare the pattern of adult inpatient orthopaedic injuries admitted at three Vancouver hospitals following one of the worst winter snowstorms in the region with the preceding control winter period. Methods: The surveillance study was conducted at the University of British Columbia, Vancouver, Canada, 2007 to 2010. Inpatient adult admissions for orthopaedic injuries at three hospitals were recorded, including age, gender, anatomic location of injury, type of fracture (open or closed), fixation method (internal versus external fixation), and length of acute care hospital stay. Comparisons between admissions during this weather pattern and admission during a previous winter with minimal snow were made. SPSS 19 was used for statistical analysis. Results: Of the 511 patients admitted under Orthopaedic trauma service during the significant winter snowstorms of December 2008 - January 2009, 100 (19.6%) (CI: 16.2%-23.2%) were due to ice and snow, whereas in the preceding mild winter only 18 of 415 (4.3%) (CI: 2.5%-6.8%) cases were related to snow (p<0.05). Ankle and wrist fractures were the most frequent injuries during the index snow storm period (p<0.05). At all the three institutions, 97 (96.5%) fractures were closed during the snowstorm as opposed to 17 (95%) during the control winter period. Internal fixation in 06 (89%) fractures as opposed to external fixation in 12 (11%) patients was the predominant mode of fixation across the board during both time periods. Conclusion: The study demonstrated a significantly higher inpatient orthopaedic trauma volume during the snowstorm more rigorous prospective studies need to be designed to gain further insight to solving these problems from a public health perspective. (author)
Holzer, Lukas A; Holzer, Gerold
OBJECTIVE: To give an overview of the behaviour and scientific contributions of the Journal of Bone and Joint Surgery American (JBJS-A) and British Volume (JBJS-B). METHODS: 480 original articles published in 2009 were identified through a combined comprehensive computer and manual library search. Articles were assigned to 11 orthopaedic categories and by country, type and specialty of the institution. Possible grants and citations were analysed. USA led all countries in published articles (3...
Székely, Gabor; Nolte, Lutz-P
In this note we summarize the history of computer aided surgery in orthopaedics and traumatology from the end of the nineteenth century to currently observable future trends. We concentrate on the two major components of such systems, pre-operative planning and intra-operative execution. The evolution of the necessary technological components, the numerous platforms and components offered commercially as well as their clinical use are surveyed. PMID:27377330
Full Text Available Abstract Numerous orthopaedic injuries can follow a seizure and are often diagnosed late. This is the first documented case of a missed bilateral anterior shoulder dislocation following a seizure. The possible reasons for the greater incidence of posterior dislocations are examined and why bilateral anterior dislocations following a seizure are so rare. The article discusses the reasons for the delay and highlights potential pitfalls and learning points for junior emergency department doctors.
The project deals with titanium and titanium alloys as biomaterials for implants applications, focusing on their mechanical response under dynamic stresses occurring during common human activities. In the first part, the biomaterials requirements for orthopaedic implants, the properties and the processing of titanium alloys are described. From the combined biomechanics requirements, mechanical behaviour of the materials and the bone is analysed and the additional poroelastic behaviour is adde...
Peixoto, Joaquim Jorge Gomes; Souto, A. Pedro; Flores, Paulo
The main purpose of this work is to apply new materials and new finishing to improve comfort in orthopaedic footwear associated with orthosis. This desideratum will be reached through the selection and application of advanced materials, such, breathables membranes and fabric finished with anti-fungal and anti-bacteria treatments. In this work, water vapor permeability was evaluated to determine the transport property of water vapor produced by transpiration of the skin. A new lining with brea...
Kell, M R
BACKGROUND: Acute hepatobiliary pathology is a common general surgical emergency referral. Diagnosis requires imaging of the biliary tree by ultrasonography. The accuracy and impact of surgeon-performed ultrasonography (SUS) on the diagnosis of emergent hepatobiliary pathology was examined. METHODS: A prospective study, over a 6-month period, enrolled all patients with symptoms or signs of acute hepatobiliary pathology. Patients provided informed consent and underwent both SUS and standard radiology-performed ultrasonography (RUS). SUS was performed using a 2-5-MHz broadband portable ultrasound probe by two surgeons trained in ultrasonography, and RUS using a 2-5-MHz fixed unit. SUS results were correlated with those of RUS and pathological diagnoses. RESULTS: Fifty-three consecutive patients underwent 106 ultrasonographic investigations. SUS agreed with RUS in 50 (94.3 per cent) of 53 patients. SUS accurately detected cholelithiasis in all but two cases and no patient was inaccurately diagnosed as having cholelithiasis at SUS (95.2 per cent sensitivity and 100 per cent specificity). As an overall complementary diagnostic tool SUS provided the correct diagnosis in 96.2 per cent of patients. Time to scan was significantly shorter following SUS (3.1 versus 12.0 h, P < 0.05). CONCLUSION: SUS provides a rapid and accurate diagnosis of emergency hepatobiliary pathology and may contribute to the emergency management of hepatobiliary disease.
Curtis, Jack J; McKenney-Knox, Charlotte A; Wagner-Mann, Colette C
Because of the infrequent application of cardiac assist devices for postcardiotomy heart failure, most published reports include the results of learning curves from multiple surgeons. Between October 1986 and June 2001, a single surgeon used 35 Sarns Centrifugal Pumps as ventricular assist devices in 21 patients with severe hemodynamic compromise after open heart surgery (0.88% incidence). Patients' ages ranged from 39 to 77 (mean, 59.6 years). Three patients required right ventricular assist devices, 4 left ventricular assist devices, and 14 had biventricular assist devices. For all, the indication for application was inability to wean from cardiopulmonary bypass despite multiple inotropes and intraaortic balloon pumping. All were expected to be intraoperative deaths without further mechanical assistance. Patients were assisted from 2 to 434 h (median, 48 h). Fifteen patients (71.4%) were weaned from device(s), and 11 patients (52.4%) were hospital survivors. Actuarial survival in those dismissed from the hospital was 78% at 5 years and 39% at 10 years. Patients facing certain demise after cardiac surgery can be salvaged with temporary centrifugal mechanical assist. Results are competitive with that achieved with more sophisticated devices. Hospital survivors enjoy reasonable longevity.
Albert W. Pearsall IV
Full Text Available The use of oral corticosteroid (OCS drugs is advocated because of their potent anti-inflammatory effects. They also possess many potential adverse effects. No study has assessed physician prescribing practices of OCS therapy in high school (HS or college (COL athletes. This paper reports the prescribing patterns of sports medicine physicians who used short-term OCS therapy and to describe associated complications in HS and COL athletes within a 24- month period. An internet link to a descriptive epidemiology survey was included in an e-mail to all members of the Arthroscopy Association of North America and the American Orthopaedic Society for Sports Medicine. Descriptive statistics and correlation analysis were used to examine responses. Total response rate was 32% (615/1,928. Sixty-six percent of the physicians indicated prescribing OCS to both groups of athletes, while 29% reported prescribing OCS to COL athletes and 5% to HS athletes for musculoskeletal injuries. Physicians who prescribed multiple OCS regimens to the same athlete within the same season (P = 0.01 and physicians who prescribed OCS to the skeletally immature athlete (P = 0.009 reported more complications than other physicians. Among the 412 physicians who did not prescribe OCS in the treatment of athletic induced musculoskeletal injury, 251 (61% cited a risk of developing medical complications as the primary reason for avoiding use. The reported number of medical complications was low with no cases of avascular necrosis reported for the 2-year recall period. Orthopaedic surgeons who treated athletic induced musculoskeletal injuries with a short-term course of oral corticosteroids reported that high school and college athletes benefited with few medical complications
O Mir, Marie
The demand for paediatric orthopaedic care is growing, and providing the service required is an increasingly challenging task. Physiotherapist-led triage clinics are utilised in adult orthopaedics to enable the provision of care to patients who may not require a surgical consult. The Physiotherapy Orthopaedic Triage Clinic (POTC) was established in Our Lady\\'s Children\\'s Hospital Crumlin in response to increasing demands on the paediatric orthopaedic service. The clinic is run by physiotherapists working in an advanced practice role (APP), and is the first paediatric clinic of its type and scale in the Republic of Ireland.
A primer on financing international operations by Canadian corporations was provided. Factors affecting the availability to project finance (location, political risk), the various forms of financing (debt, equity, and combinations), the main sources of government backed financing to corporations (the International Finance Corporation) (IFC), the European Bank for Reconstruction and Development (EBRD), the Asian Development Bank (ADB), the Overseas Property Insurance Corporation (OPIC), government or agency guarantees, political risk coverage, the use of offshore financial centres, and the where, when and how these various organizations operate, were reviewed. Examples of all of the above, taken from the experiences of Canadian Occidental Petroleum of Calgary in the U.S., in South America, in the Middle and Far East, and in Kazakhstan, were used as illustrations. figs
For two weeks in August, 1975 more than 140 mathematicians and other scientists gathered at the Universite de Sherbrooke. The occasion was the 15th Biennial Seminar of the Canadian Mathematical Congress, entitled Mathematics and the Life Sciences. Participants in this inter disciplinary gathering included researchers and graduate students in mathematics, seven different areas of biological science, physics, chemistry and medical science. Geographically, those present came from the United States and the United Kingdom as well as from academic departments and government agencies scattered across Canada. In choosing this particular interdisciplinary topic the programme committee had two chief objectives. These were to promote Canadian research in mathematical problems of the life sciences, and to encourage co-operation and exchanges between mathematical scientists" biologists and medical re searchers. To accomplish these objective the committee assembled a stim ulating programme of lectures and talks. Six ...
Malek, M Mike; Friedman, Melvin M; Beach, William
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 . 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.
The Petroleum History Bibliography includes a list of more than 2,000 publications that record the history of the Canadian petroleum industry. The list includes books, theses, films, audio tapes, published articles, company histories, biographies, autobiographies, fiction, poetry, humour, and an author index. It was created over a period of several years to help with projects at the Petroleum History Society. It is an ongoing piece of work, and as such, invites comments and additions.
Dala-Ali, Benan M; Lloyd, Mary Anne; Al-Abed, Yahya
Mobile technology is continuously improving and it is important that all physicians are aware of its new advances. Smartphones have the potential to improve diagnostic skills and education of a surgeon. The iPhone is a popular type of smartphone in the market. This article intends to educate surgeons about its uses, functions and medical applications. The phone is an invaluable tool for the modern day surgeon. PMID:21195331
Rodrigues, Gabriel Sunil; Khan, Sohil Ahmed
To review the status of pharmacovigilance system among surgeons and in surgical wards with recommendations. Literature search using MEDLINE, cross-reference of published data and review of World Health Organization—Pharmacovigilance transcripts. Pharmacovigilance system is still in its infancy among surgeons and in surgical wards. No major studies have been published addressing this issue, till date. Surgeons are professionals least likely to report adverse drug reactions. Moreover widespread...
Azodo, Clement C.; Ezeja, Ejike B
Objective Daily clinical activities in dental operatory expose dental surgeons to varied forms of ocular events. The purpose of the study was to determine the prevalence and pattern of ocular splashes and foreign bodies among dental surgeons in Nigeria. Methods This questionnaire-based cross-sectional of dental surgeons in Southern Nigeria was conducted between September 2010 and August 2011. The information elicited were demography, experience and type of ocular event, implicated dental proc...
Vernon H Hoeppner
Full Text Available Endemic tuberculosis (TB was almost certainly present in Canadian aboriginal people (aboriginal Canadians denotes status Indians, Inuit, nonstatus Indians and metis as reported by Statistics Canada before the Old World traders arrived. However, the social changes that resulted from contact with these traders created the conditions that converted endemic TB into epidemic TB. The incidence of TB varied inversely with the time interval from this cultural collision, which began on the east coast in the 16th century and ended in the Northern Territories in the 20th century. This relatively recent epidemic explains why the disease is more frequent in aboriginal children than in Canadian-born nonaboriginal people. Treatment plans must account for the socioeconomic conditions and cultural characteristics of the aboriginal people, especially healing models and language. Prevention includes bacillus Calmette-Guerin vaccination and chemoprophylaxis, and must account for community conditions, such as rates of suicide, which have exceeded the rate of TB. The control of TB requires a centralized program with specifically directed funding. It must include a program that works in partnership with aboriginal communities.
In contrast to modern academic surgery, in 19th century German medical care was mainly taken by non-academic barber surgeons. Only after the foundation of the German Reich (1871) the practice of surgery was made conditional on a full study of medicine. The present article follows up the moot question whether the last generation of barber surgeons succeeded in rising to academic status or if the strong tradition of surgery in barber families was brought to a complete standstill. By evaluating archival documents it can be clearly shown that the professional distance between barber surgery and academic medicine was not invincible. A considerable number of barbers and their descendents (subsequently) succeeded in studying medicine and starting a medical career. PMID:10986752
Timely and well-planned discharge improves the patient's experience, contributes to patient safety and reduces the length of hospital stays. The role of orthopaedic discharge sister was developed at James Cook University Hospital in 2007 to provide safe, timely and efficient discharge for patients from the trauma and theatre centre, and to improve patient experience and flow. This article gives an overview of the role and describes how the sister works with colleagues to plan patient discharges from pre-assessment and emergency department admission through their hospital stay until their departure. PMID:26948225
Byrne, F J
Farming is a major industry in the West of Ireland. This prospective study examined the age profile, nature and treatment of orthopaedic injuries occurring in agricultural surroundings presenting at the Orthopaedic Unit of Merlin Park Hospital, Galway.
Hiranandani, Vanmala Sunder
This paper is in response to recent calls to conceptualize and articulate Canadian perspectives and experiences in international social work, given that the Canadian standpoint has been lacking in international social work literature. This paper contends that it is imperative, first of all...
Karabdic, Ilirijana Haxhibeqiri; Veljovic, Fikret; Straus, Slavenka
Introduction: Most everyday activities, performed over a long period leads to performance degradation of skeletal muscles as well as spinal column which is reflected in the reduction of maximum force, reduction of the speed of response, reducing control of the movement etc. Although until now many mathematical models of muscles are developed, very small number takes into account the fatigue, and those models that take into account changes in the characteristics of muscles for extended activities, generally considered tiring under certain conditions. Given that the current models of muscle fatigue under arbitrary conditions of activation and load are very limited, this article presents a new model that includes scale of muscles overload. Material and Methods: There are three female cardiac surgeons working performing these surgeries in operating rooms, and their average anthropometric measures for this population is: a) Weight: 62 kg; b) Height: 166 cm. Age: 45 taken in the calculation within the CATIA software, that entity is entitled to 50% of healthy female population that is able to execute these and similar jobs. During the surgery is investigated the two most common positions: position “1” and “2”. We wish to emphasize that the experiment or surgical procedure lasted for two positions for five hours, with the position “1” lasted 0.5 hours, and position “2” lasted about 4.5 hours. The additional load arm during surgery is about 1.0 kg. Results: The analysis was done in three positions: “Operating position 1”, “Operating position 2 ‘, and each of these positions will be considered in its characteristic segments. These segments are: when the body takes the correct position, but is not yet burdened with external load, then when the surgeon receives the load and the third position when the load is lifted at the end of the position. Calculation of internal energy used on the joints is carried out in the context of software analysis of this
Macbeth, R A
The professional life of William Fulton Gillespie, third professor of surgery at the University of Alberta (1939-49) and tenth president of the Royal College of Physicians and Surgeons of Canada (1947-49), exemplifies a critical transitional period in Canadian postgraduate surgical training and in western Canadian academic surgery. This article explores the background, the training, the professional career, and the personal character of a surgical scholar and student of the humanities and arts, a man who was thrust into the professorship of surgery in a maturing western Canadian medical school following the financial restraints of the Great Depression and during the challenges faced as a result of the World War II.
van Vendeloo, S. N.; Brand, P. L. P.; Verheyen, C. C. P. M.
We aimed to determine quality of life and burnout among Dutch orthopaedic trainees following a modern orthopaedic curriculum, with strict compliance to a 48-hour working week. We also evaluated the effect of the clinical climate of learning on their emotional wellbeing. We assessed burnout, quality
van Netten, Jaap J.; Jannink, Michiel J. A.; Hijmans, Juha M.; Geertzen, Jan H. B.; Postema, Klaas
Objective: To investigate the association between patients' expectations and the actual use of custom-made orthopaedic shoes. Design: A prospective cohort study with internal comparison. Setting: Twelve orthopaedic shoe companies. Patients: During six months, consecutive patients who were provided w
Albayrak, A.; Van Veelen, M.A.; Prins, J.F.; Snijders, C.J.; De Ridder, H.; Kazemier, G.
Background: One of the main ergonomic problems during surgical procedures is the surgeon's awkward body posture, often accompanied by repetitive movements of the upper extremities, increased muscle activity, and prolonged static head and back postures. In addition, surgeons perform surgery so concen
Bogen, Moredehi Etai; Augestad, Knut Magne; Patel, Hitendra R. H.; Lindsetmo, Rolv-Ole
Laparoscopy, minimally invasive and minimal access surgery with more surgeons performing these advanced procedures. We highlight in the review several key emerging technologies such as the telementoring and virtual reality simulators, that provide a solid ground for delivering surgical education to rural area and allow young surgeons a safety net and confidence while operating on a newly learned technique.
Amirian, Ilda; Toftegård Andersen, Lærke; Rosenberg, Jacob;
BACKGROUND: Heart rate variability (HRV) has been used as a measure of stress and mental strain in surgeons. Low HRV has been associated with death and increased risk of cardiac events in the general population. The aim of this study was to clarify the effect of a 17-hour night shift on surgeons'...
THE SURGEON GENERAL’S CALL TO ACTION TO PREVENT SKIN CANCER From the Surgeon General Skin cancer is the most common type of cancer the ... be disfiguring and even deadly. Medical treatment for skin cancer is costly for individuals, families, and the nation. ...
This directory has been prepared to help potential photovoltaic (PV) customers identify Canadian-based companies who can meet their needs, and to help product manufacturers and distributors identify potential new clients and/or partners within the PV industry for new and improved technologies. To assist the reader, an information matrix is provided that identifies the product and service types offered by each firm and its primary clients served. A list of companies by province or territory is also included. The main section lists companies in alphabetical order. Information presented for each includes address, contact person, prime activity, geographic area served, languages in which services are offered, and a brief company profile
In support of the Treaty on the Non-Proliferation of Nuclear Weapons Canada provides technical support to the International Atomic Energy Agency for the development of safeguards relevant to Canadian designed and built nuclear facilities. Some details of this program are discussed, including the philosophy and development of CANDU safeguards systems; the unique equipment developed for these systems; the provision of technical experts; training programs; liaison with other technical organizations; research and development; implementation of safeguards systems at various nuclear facilities; and the anticipated future direction of the safeguards program
Chrastina, Jan; Jančálek, Radim; Hrabovský, Dušan; Novák, Zdeněk
Since 1901 Nobel Prize is awarded for exceptional achievements in physics, chemistry, literature, peace, economy (since 1968) and medicine or physiology. The first aim of the paper is to provide an overview of surgeons - winners of Nobel Prize for medicine or physiology. Although the prominent neurosurgeons were frequently nominated as Nobel Prize candidates, surprisingly no neurosurgeon received this prestigious award so far despite that the results of their research transgressed the relatively narrow limits of neurosurgical speciality.The most prominent leaders in the field of neurosurgery, such as Victor Horsley, Otfrid Foerster, Walter Dandy and Harvey Cushing are discussed from the point of their nominations. The overview of the activity of the Portuguese neurologists and Nobel Prize Winter in 1949 Egas Moniz (occasionally erroneously reported as neurosurgeon) is also provided. Although his work on brain angiography has fundamentally changed the diagnostic possibilities in neurology and neurosurgery, he was eventually awarded Nobel Prize for the introduction of the currently outdated frontal lobotomy.The fact that none of the above mentioned prominent neurosurgeons has not been recognised by Nobel Prize, may be attributed to the fact that their extensive work cannot be captured in a short summary pinpointing its groundbreaking character. PMID:27256150
Chrastina, Jan; Jančálek, Radim; Hrabovský, Dušan; Novák, Zdeněk
Since 1901 Nobel Prize is awarded for exceptional achievements in physics, chemistry, literature, peace, economy (since 1968) and medicine or physiology. The first aim of the paper is to provide an overview of surgeons - winners of Nobel Prize for medicine or physiology. Although the prominent neurosurgeons were frequently nominated as Nobel Prize candidates, surprisingly no neurosurgeon received this prestigious award so far despite that the results of their research transgressed the relatively narrow limits of neurosurgical speciality.The most prominent leaders in the field of neurosurgery, such as Victor Horsley, Otfrid Foerster, Walter Dandy and Harvey Cushing are discussed from the point of their nominations. The overview of the activity of the Portuguese neurologists and Nobel Prize Winter in 1949 Egas Moniz (occasionally erroneously reported as neurosurgeon) is also provided. Although his work on brain angiography has fundamentally changed the diagnostic possibilities in neurology and neurosurgery, he was eventually awarded Nobel Prize for the introduction of the currently outdated frontal lobotomy.The fact that none of the above mentioned prominent neurosurgeons has not been recognised by Nobel Prize, may be attributed to the fact that their extensive work cannot be captured in a short summary pinpointing its groundbreaking character.
Cashman, J P
BACKGROUND: Climate change models predict increasing frequency of extreme weather. One of the challenges hospitals face is how to make sure they have adequate staffing at various times of the year. AIMS: The aim of this study was to examine the effect of this severe inclement weather on hospital admissions, operative workload and cost in the Irish setting. We hypothesised that there is a direct relationship between cold weather and workload in a regional orthopaedic trauma unit. METHODS: Trauma orthopaedic workload in a regional trauma unit was examined over 2 months between December 2009 and January 2010. This corresponded with a period of severe inclement weather. RESULTS: We identified a direct correlation between the drop in temperature and increase in workload, with a corresponding increase in demand on resources. CONCLUSIONS: Significant cost savings could be made if these injuries were prevented. While the information contained in this study is important in the context of resource planning and staffing of hospital trauma units, it also highlights the vulnerability of the Irish population to wintery weather.
Watters, Carol L; Harvey, Carol V; Meehan, Anita J; Schoenly, Lorry
Patients who face chronic, incurable, or life-ending musculoskeletal conditions often receive inadequate care either due to a lack of caregiver awareness or inattention to maintaining the highest quality at the end of life. Palliative care focuses on the comprehensive physical, psychological, social, spiritual, and existential needs of patients with life-threatening or debilitating illness. Orthopaedic nurses and all nurses in general are challenged to incorporate palliative care principles into care planned with patients and families facing end-of-life issues. This article addresses the leadership role the National Association of Orthopaedic Nurses (NAON) has taken to develop a consensus document which endorses the Last Acts Precepts of Palliative Care and affirms the need for palliative care with patients who experience life-threatening illness. A case study is used to illustrate the opportunity a multidisciplinary team has to center care on the individual, while remaining sensitive to the holistic needs of the patient for self-determination at the end of life.
Athanasiou, K A; Agrawal, C M; Barber, F A; Burkhart, S S
Biodegradable polymers, especially those belonging to the family of polylactic acid (PLA) and polyglycolic acid (PGA), play an increasingly important role in orthopaedics. These polymers degrade by hydrolysis and enzymatic activity and have a range of mechanical and physical properties that can be engineered appropriately to suit a particular application. Their degradation characteristics depend on several parameters including their molecular structure, crystallinity, and copolymer ratio. These biomaterials are also rapidly gaining recognition in the fledging field of tissue engineering because they can be fashioned into porous scaffolds or carriers of cells, extracellular matrix components, and bioactive agents. Although their future appears to be bright, several questions regarding the biocompatibility of these materials linger and should be addressed before their wide-scale use. In the context of musculoskeletal tissue, this report provides a comprehensive review of properties and applications of biodegradable PLA/PGA polymers and their copolymers. Of special interest are orthopaedic applications, biocompatibility studies, and issues of sterilization and storage of these versatile biomaterials. Also discussed is the fact that terms such as PLA, PGA, or PLA-PGA do not denote one material, but rather a large family of materials that have a wide range of differing bioengineering properties and concomitant biological responses. An analysis of some misconceptions, problems, and potential solutions is also provided. PMID:9788368
Canada is a multicultural country which was mainly established by immigrants. Just because of that, Canadian govern⁃ment has carried out the policy of multiculturalism since1970s. However, it has encountered many problems such as policy con⁃flicts, national identity, democracy-inquiry and racial discrimination, etc. Hence the Canadian multiculturalism has been in a di⁃lemma.
Park, Moon Seok; Lee, Kyoung Min; Lee, Boram; Min, Eunki; Kim, Youhyun; Jeon, Sungchae; Huh, Young; Lee, Kisung
The O-arm system has recently been introduced and has the capability of combined two-dimensional (2-D) fluoroscopy imaging and three-dimensional computed tomography imaging. In this study, an orthopaedic surgical procedure using C-arm and O-arm systems in their 2-D fluoroscopy modes was simulated and the radiation doses to susceptible organs to which operators can be exposed were investigated. The experiments were performed in four configurations of the location of the X-ray source and detector. Shielding effects on the thyroid surface and the direct exposure delivered to the surgeon's hands were also compared. The results obtained show that the O-arm delivered higher doses to the sensitive organs of the operator in all configurations. The thyroid shield cut-off 89 % of the dose in the posteroanterior configuration of both imaging systems. Thus, the operators need to pay more attention to managing radiation exposure, especially when using the O-arm system.
Lynch, T Sean; Parker, Richard D; Patel, Ronak M; Andrish, Jack T; Spindler, Kurt P; Amendola, Annunziata; Brophy, Robert H; Dunn, Warren R; Flanigan, David C; Huston, Laura J; Jones, Morgan H; Kaeding, Christopher C; Marx, Robert G; Matava, Matthew J; McCarty, Eric C; Pedroza, Angela D; Reinke, Emily K; Wolf, Brian R; Wright, Rick W
With an estimated 200,000 anterior cruciate ligament reconstructions performed annually in the United States, there is an emphasis on determining patient-specific information to help educate patients on expected clinically relevant outcomes. The Multicenter Orthopaedic Outcomes Network consortium was created in 2002 to enroll and longitudinally follow a large population cohort of anterior cruciate ligament reconstructions. The study group has enrolled >4,400 anterior cruciate ligament reconstructions from seven institutions to establish the large level I prospective anterior cruciate ligament reconstruction outcomes cohort. The group has become more than a database with information regarding anterior cruciate ligament injuries; it has helped to establish a new benchmark for conducting multicenter, multisurgeon orthopaedic research. The changes in anterior cruciate ligament reconstruction practice resulting from the group include the use of autograft for high school, college, and competitive athletes in their primary anterior cruciate ligament reconstructions. Other modifications include treatment options for meniscus and cartilage injuries, as well as lifestyle choices made after anterior cruciate ligament reconstruction.
Full Text Available Abstract Background The aim of this study was to explore the ethical challenges in surgery from the surgeons' point of view and their experience of being in ethically difficult situations. Methods Five male and five female surgeons at a university hospital in Norway were interviewed as part of a comprehensive investigation into the narratives of nurses and physicians about being in such situations. The transcribed interview texts were subjected to a phenomenological-hermeneutic interpretation. Results No differences in ethical reasoning between male and female surgeons were found. They reasoned in both action and relational ethical perspectives. Surgeons focused on their relationships with patients and colleagues and their moral self in descriptions of the ethical challenges in their work. Dialogue and personal involvement were important in their relationships with patients. The surgeons emphasized the importance of open dialogue, professional recognition, and an inclusive and accepting environment between colleagues. Conclusion The surgeons are personally challenged by the existential realities of human life in their relationships with patients. They realized that ethical challenges are an inherent part of performing surgery and of life itself, and say that they have to learn to "live with" these challenges in a way that is confirmed both socially and by their inner moral self. This means accepting their personal and professional limitations, being uncertain, being fallible, and being humble. Living with the ethical challenges of surgery seems to contribute to the surgeons' confidence and vulnerability in their professional identity.
Learmonth Ian D
Full Text Available Abstract Background Total joint replacement (TJR of the hip or knee for osteoarthritis is among the most common elective surgical procedures. There is some inequity in provision of TJR. How decisions are made about who will have surgery may contribute to disparities in provision. The model of shared decision-making between patients and clinicians is advocated as an ideal by national bodies and guidelines. However, we do not know what happens within orthopaedic practice and whether this reflects the shared model. Our study examined how decisions are made about TJR in orthopaedic consultations. Methods The study used a qualitative research design comprising semi-structured interviews and observations. Participants were recruited from three hospital sites and provided their time free of charge. Seven clinicians involved in decision-making about TJR were approached to take part in the study, and six agreed to do so. Seventy-seven patients due to see these clinicians about TJR were approached to take part and 26 agreed to do so. The patients' outpatient appointments ('consultations' were observed and audio-recorded. Subsequent interviews with patients and clinicians examined decisions that were made at the appointments. Data were analysed using thematic analysis. Results Clinical and lifestyle factors were central components of the decision-making process. In addition, the roles that patients assigned to clinicians were key, as were communication styles. Patients saw clinicians as occupying expert roles and they deferred to clinicians' expertise. There was evidence that patients modified their behaviour within consultations to complement that of clinicians. Clinicians acknowledged the complexity of decision-making and provided descriptions of their own decision-making and communication styles. Patients and clinicians were aware of the use of clinical and lifestyle factors in decision-making and agreed in their description of clinicians' styles
Van Donkersgoed, J; Jewison, G; Mann, M; Cherry, B; Altwasser, B; Lower, R; Wiggins, K; Dejonge, R; Thorlakson, B; Moss, E; Mills, C; Grogan, H
A study was conducted in 4 Canadian processing plants in 1995-96 to determine the prevalence of quality defects in Canadian cattle. One percent of the annual number of cattle processed in Canada were evaluated on the processing floor and 0.1% were graded in the cooler. Brands were observed on 37% and multiple brands on 6% of the cattle. Forty percent of the cattle had horns, 20% of which were scurs, 33% were stubs, 10% were tipped, and 37% were full length. Tag (mud and manure on the hide) was observed on 34% of the cattle. Bruises were found on 78% of the carcasses, 81% of which were minor in severity. Fifteen percent of the bruises were located on the round, 29% on the loin, 40% on the rib, 16% on the chuck, and 0.02% on the brisket. Grubs were observed in 0.02% of the steers, and injection sites were observed in 1.3% of whole hanging carcasses. Seventy percent of the livers were passed for human food and 14% for pet food; 16% were condemned. Approximately 71% of the liver condemnations were due to liver abscesses. Four percent of the heads, 6% of the tongues, and 0.2% of whole carcasses were condemned. The pregnancy rate in female cattle was approximately 6.7%. The average hot carcass weight was 357 kg (s = 40) in steers, 325 kg (s = 41) in heifers, 305 kg (s = 53) in cows, 388 kg (s = 62) in virgin bulls and 340 kg (s = 39) in mature bulls. The average ribeye area in all cattle was 84 cm2 (s = 12); range 29 cm2 to 128 cm2. Grade fat was highly variable and averaged 9 mm (s = 4) for steers and heifers, 6 mm (s = 6) for cows, 5 mm (s = 1) for virgin bulls, and 4 mm (s = 0.5) for mature bulls. The average lean meat yield was 59.7% in cattle (s = 3.4); range 39% to 67%. One percent of the carcasses were devoid of marbling, 1% were dark cutters, and 0.05% of the steer carcasses were staggy. Six percent of the carcasses had poor conformation, 3.7% were underfinished, and 0.7% were overfinished. Yellow fat was observed in 4% of the carcasses; 10% of carcasses were
Smith, Stephanie Shintani
The surgeon-scientist offers a unique perspective as one who can arguably best comprehend clinical needs, identify areas ripe for research, and translate discoveries from bench to bedside. However, the long transition from postdoc to independent investigator can prove to be quite challenging. Surgeons have long been described as having results-oriented personalities, and so the long road to independence can be fraught with frustration at times. It requires humility in seeking scientific direction and mentorship, institutional support, and ultimately extramural funding. This reflection piece examines some hallmark steps along the pathway to independence for one otolaryngology-head and neck surgeon-scientist in her early academic career. PMID:26527611
Samsson, Karin; Larsson, Maria E H
A large proportion of patients who consult primary healthcare for musculoskeletal pain are referred for orthopaedic consultation, but only a small number of these patients are appropriate for orthopaedic intervention. Experienced physiotherapists have the appropriate knowledge to manage musculoskeletal disorders. The primary aim of this randomised study was therefore to evaluate a screening by a physiotherapist of patients referred for orthopaedic consultation compared to standard practice in primary care. Patients referred for orthopaedic consultation (n=203) were randomised to physiotherapy screening or standard practice. Selection accuracy for orthopaedic intervention and other referrals were analysed with proportion analysis. Patient views of the quality of care were analysed with Mann-Whitney U-test, waiting time with Independent t-test. There was higher selection accuracy for orthopaedic intervention in the physiotherapy screening group (p=0.002). A smaller proportion of patients in the screening group were referred back to their general practitioner (GP) (pphysiotherapy clinic (pphysiotherapy screening group (p<0.039). Waiting time was shorter in the screening group (p<0.001). A large proportion of the patients reported no hesitation to attend the clinic for future care, no difference between the groups (p<0.95). The findings in this study suggest that an experienced physiotherapist effectively can screen patients referred for orthopaedic consultation in primary healthcare.
Full Text Available Background The importance of cross-border healthcare, medical and health tourism plays a significant role in the European health policy and health management. After dentistry, orthopaedic treatments are the leading motivation for seeking care in Hungary, as patients with rheumatic and motion diseases are drawn to the thermal spas and well-established orthopaedic centres. This paper aims to gain insight into foreign patients’ perspectives on their experience of having sought medical tourism in orthopaedic care in Hungary. Methods A patient survey was conducted in 2012 on motivations for seeking treatment abroad, orthopaedic care received and overall satisfaction. In addition, health professionals’ interviews, and 17 phone interviews were conducted in 2013 with Romanian patients who had orthopaedic treatment in Hungary. Finally, medical records of foreign patients were analysed. Results The survey was completed by 115 participants – 61.1% females, mean age= 41.9, 87% Romanian origin. Most of the patients came to Hungary for orthopaedic surgeries, e.g. arthroscopy, knee/hip prosthesis or spinal surgery. 72.6% chose Hungary because of related to perceived better quality and longstanding culture of Hungarian orthopaedic care. Over 57% of patients reported being ‘very satisfied’ with care received and 41.6% ‘satisfied’. The follow-up interviews further reflected this level of satisfaction, therefore many respondents stating they have already recommended the Hungarian healthcare to others. Conclusion Based on the findings, patients from neighbouring regions are increasingly seeking orthopaedic care in Hungary. Patients having orthopaedic care are highly satisfied with the quality of care, the whole treatment process from the availability of information to discharge summaries and would consider returning for further treatments.
Recent progress in orthopaedic treatment of osteoporosis-related fractures was reviewed. In the treatment of femoral neck fractures, impacted or nondisplaced type is treated by three cannulated cancellous pins. Displaced type of femoral neck fracture is treated by bipolar prosthesis. Results of femoral neck fractures are influenced by the complications of each patients. Osteoporotic spine fractures are commonly healed within 2 or 3 months. Spinal compression with paraparesis or paraplegia is unusual complication in burst type of spine fractures. Surgical decompression, bone grafting and stabilization with instrumentation can result in some correction of deformity and neurogenic recovery. Distal radius fractures are common fractures in the eldery. Recently advances includes external fixation and plate fixation for the comminuted fractures in the distal radius. Treatments of osteoporosis-related fractures are still difficult problems to be resolved. PMID:21774371
Quinlan, Daniel J; Eriksson, Bengt I
The direct thrombin inhibitor, dabigatran, and the selective factor Xa inhibitors, rivaroxaban and apixaban, are new oral anticoagulants that are approved in many countries for prevention of venous thromboembolism in patients undergoing elective hip or knee arthroplasty. All have a rapid onset of action, a low potential for food and drug interactions and a predictable anticoagulant effect that obviates the need for routine coagulation monitoring. These agents offer a convenient alternative to conventional anticoagulant drug regimens, including parenteral low-molecular-weight heparins and fondaparinux, and oral adjusted-dose vitamin K antagonists, for the prevention of venous thromboembolism in this surgical setting. This review summarizes the pharmacology, clinical trial results, bleeding risk and practical use of these new oral anticoagulants in clinical orthopaedic practice. Potential issues to be considered when using these oral anticoagulants include renal impairment, potential drug interactions, neuraxial anaesthesia and management of bleeding. PMID:23953905
Su, Alvin W; Lin, Shuai-Chun; Larson, A Noelle
Perioperative vision loss is a rare complication of orthopaedic surgery and has been documented after spine, knee, hip, and shoulder procedures. It is associated with several ophthalmologic diagnoses, most commonly ischemic optic neuropathy. Although the pathophysiology remains unclear, current evidence suggests that systemic hemodynamic compromise and altered balance of intraocular perfusion contribute to the development of ischemic optic neuropathy. Although vision recovery has been reported, the prognosis of perioperative vision loss is poor, and no proven effective treatment is available. Perioperative vision loss is unpredictable and can occur in healthy patients. Associated risk factors include pediatric or elderly age, male sex, obesity, anemia, hypotension or hypertension, perioperative blood loss, prolonged surgical time, and prone positioning. Preventive strategies include avoiding direct pressure to the eye, elevating the head, optimizing perioperative hemodynamic status, and minimizing surgical time with staged surgical procedures as appropriate.
\\'Ready-Access\\' to CT imaging facilities in Orthopaedic Trauma Clinics is not a standard facility. This facility has been available at the regional trauma unit, in Merlin Park Hospital, Galway for the past four years. We reviewed the use of this facility over a 2-year period when 100 patients had CT scans as part of their trauma clinic assessment. The rate of CT scan per clinic was 0.6. The mean waiting time for a CT scan was 30 minutes. 20 (20%) new fractures were confirmed, 33 (33%) fractures were out-ruled, 25 (25%) fractures demonstrated additional information and 8 (8%) had additional fractures. 20 (20%) patients were discharged and 12 (12%) patients were admitted as a result of the CT scan. It adds little time and cost to CT scanning lists.
Uner, O; Yücel-Eroğlu, E
Taking the presence of an interplay between the vertical and sagittal components of craniofacial development into consideration, the beneficial therapeutic potential impacts of controlling vertical development on the correction of Class II discrepancies has been previously investigated. In the present study, a modified maxillary orthopaedic splint combined with an anterior high-pull headgear was used for early correction of the vertical and consequently sagittal dentoskeletal discrepancy as the initial stage of treatment. The aim was to evaluate its effects on the maxillary and mandibular dentoskeletal development, as well as rotational growth pattern. In order to compare with and distinguish from the uninterrupted growth changes, a control group was formed by matching each one of the control subjects to a subject in the treatment group according to certain criteria. The initial and second standardized lateral cephalograms of each subject was evaluated by means of an adopted and biologically more substantial cephalometric analysis. Evaluation of the changes induced by the splint in comparison with the uninterrupted growth changes revealed that the splint had both orthopaedic and orthodontic effects on the growth pattern of the dentoskeletal structures. There seemed to exist a relationship between the direction of total mandibular and maxillary rotations. In addition, it was believed that in order to cause a forward mandibular rotation, i.e. to change the rotational mandibular growth pattern from a backward into a forward direction, the posterior vertical maxillary development should be restrained, but anterior vertical maxillary development should be relatively more restrained or reversed and, thereby, the rotational growth pattern of the maxilla should be changed from a backward into a forward direction. Moreover, the bite block effect of the splint seemed to cause a favourable change in the condylar growth direction from a backward to an upward direction.
Full Text Available To examine the effectiveness of a "systems" approach using Lean methodology to improve surgical care, as part of a programme of studies investigating possible synergy between improvement approaches.A controlled before-after study using the orthopaedic trauma theatre of a UK Trust hospital as the active site and an elective orthopaedic theatre in the same Trust as control.All staff involved in surgical procedures in both theatres.A one-day "lean" training course delivered by an experienced specialist team was followed by support and assistance in developing a 6 month improvement project. Clinical staff selected the subjects for improvement and designed the improvements.We compared technical and non-technical team performance in theatre using WHO checklist compliance evaluation, "glitch count" and Oxford NOTECHS II in a sample of directly observed operations, and patient outcome (length of stay, complications and readmissions for all patients. We collected observational data for 3 months and clinical data for 6 months before and after the intervention period. We compared changes in measures using 2-way analysis of variance.We studied 576 cases before and 465 after intervention, observing the operation in 38 and 41 cases respectively. We found no significant changes in team performance or patient outcome measures. The intervention theatre staff focused their efforts on improving first patient arrival time, which improved by 20 minutes after intervention.This version of "lean" system improvement did not improve measured safety processes or outcomes. The study highlighted an important tension between promoting staff ownership and providing direction, which needs to be managed in "lean" projects. Space and time for staff to conduct improvement activities are important for success.
Full Text Available The article examines the influence of individual orthopaedic inserts on pressure distribution in the foot. Feet deformations, types of orthopaedic inserts, materials and pressure in the foot testing methods are discussed. Experimental computer measurements of pressure in the foot before and after the use of inserts have been done. During research, the inserts made of different kinds of materials selected according to human weight, pathology, skin sensitivity and many other reasons has been used. It has been determinated that orthopaedic inserts have a more noticeable impact on children whose feet is adjusted easier if compared with those of adults.Article in Lithuanian
Savage, P E; d'A Fearn, C B; Groom, A F; Heatley, F W
In preparation for the introduction of the specialist registrar grade the specialist advisory committee (SAC) in orthopaedics developed a six-year structured training programme leading to the award of the Certificate of Completion of Specialist Training (CCST). A team comprising the regional adviser in orthopaedics, the two regional programme directors and an associate dean of postgraduate medicine visited all the departments of orthopaedics in the South East Thames Region in order to evaluate the training opportunities they provided. This paper describes the methodology used during these visits, the lessons learned and the conclusions drawn. PMID:9496169
Boiadjiev, George; Kastelov, Rumen; Boiadjiev, Tony; Delchev, Kamen; Zagurski, Kazimir
Bone drilling manipulation often occurs in the orthopaedic surgery. By statistics, nowadays, about one million people only in Europe need such an operation every year, where bone implants are inserted. Almost always, the drilling is performed handily, which cannot avoid the subjective factor influence. The question of subjective factor reduction has its answer - automatic bone drilling. The specific features and problems of orthopaedic drilling manipulation are considered in this work. The automatic drilling is presented according the possibilities of robotized system Orthopaedic Drilling Robot (ODRO) for assuring the manipulation accuracy, precision, reliability and safety.
Eiberg, J.P.; Grantcharov, T.P.; Eriksen, J.R.;
AIM: Ultrasound has a well-established role in the diagnostic assessment of acute abdominal pain where some ultrasonically easily-accessible organs account for several diagnostic possibilities. The objective of the present study was to evaluate whether surgeons without ultrasound experience could......, specificity and kappa-agreement of the surgeon performed ultrasound examination was 1.00 (0.77-1.00), 0.96 (0.79-0.99), 0.94 (0.3-1.00) and 0.40 (0.12-0.77), 0.97 (0.83-0.99), 0.44 (0.00-0.96); respectively. Visualization of the common bile duct was poor having 73% non-diagnostic surgeon-performed ultrasound...... examinations. CONCLUSION: Surgeons in training without pre-existing ultrasound experience and only a minimum of formal ultrasound education can perform valid and reliable ultrasound examinations of the gallbladder in patients admitted with acute abdominal pain...
Kang, Sang Hee; Boo, Yoon Jung; Lee, Ji Sung; Han, Hyung Joon; Jung, Cheol Woong; Kim, Chong Suk
Surgery is a demanding and stressful field in Korea. Occupational stress can adversely affect the quality of care, decrease job satisfaction, and potentially increase medical errors. The aim of this study was to investigate the occupational stress and career satisfaction of Korean surgeons. We have conducted an electronic survey of 621 Korean surgeons for the occupational stress. Sixty-five questions were used to assess practical and personal characteristics and occupational stress using the ...
Full Text Available Physicians' emotions affect both patient care and personal well-being. Surgeons appear at particularly high risk, as evidenced by the high rate of burnout and the alarming consequences in both their personal lives and professional behavior. The aim of this qualitative study is to explore the emotional experiences of surgeons and their impact on their surgical practice.27 purposively selected liver and pancreatic surgeons from 10 teaching hospitals (23 men, 4 women participated. Inclusion took place until data saturation was reached. Data were collected through individual interviews and thematically analyzed independently by 3 researchers (a psychologist, a psychiatrist, and a surgeon. 7 themes emerged from the analysis, categorized in 3 main or superordinate themes, which described surgeons' emotional experience before, during, and after surgery. Burdensome emotions are present throughout all 3 periods (and invade life outside the hospital-surgeons' own emotions, their perception of patients' emotions, and their entwinement. The interviewees described the range of emotional situations they face (with patients, families, colleagues, the influence of the institutional framework (time pressure and fatigue, cultural pressure to satisfy the ideal image of a surgeon, as well as the emotions they feel (including especially anxiety, fear, distress, guilt, and accountability.Emotions are ubiquitous in surgeons' experience, and their exposure to stress is chronic rather than acute. Considering emotions only in terms of their relations to operative errors (as previous studies have done is limiting. Although complications are quite rare events, the concern for possible complications is an oppressive experience, regardless of whether or not they actually occur.
Van Hee, R
The author gives here some considerations about A. Vesalius through his life and his works as a surgeon. He was the father of the anatomical revolution against Galen but was also an eminent clinician and surgeon. He was immediately able to adapt his surgical practice whenever the promising methodology was identified (see Consilia). The author concludes with a critical analysis of the Chirurgia magna in septem libros digesta attributed to A. Vesalius.
Doyle Aoife; Horgan N Frances
Abstract The aim of this study was to investigate veterinary surgeons' perceptions, knowledge and use of animal physiotherapy in the Republic of Ireland. A questionnaire was developed and sent to 200 veterinary surgeons, of which 97 were returned. Results indicated that 77 (79%) of respondents were aware of animal physiotherapists. Common sources of information included veterinary colleagues, owners and professional journals, with physiotherapists themselves and undergraduate training being l...
Kinahan, James C; MacHale, Siobhan
Surgeons frequently treat the consequences of self-harm. Self-harm is a common problem and presentations to Irish hospitals are increasing. It increases the risk of suicide and is associated with long term morbidity. Appropriate management can improve the prognosis. Surgeons require a number of skills to appropriately manage patients who self-harm. In this review we outline those skills including diagnosis, communication, capacity and risk assessment.
US Fish and Wildlife Service, Department of the Interior — The mandate of the CNVC is to comprehensively classify and describe natural and semi-natural Canadian vegetation in an ecologically meaningful manner. The...
Bertges Yost, W; Eshelman, A; Raoufi, M; Abouljoud, M S
This study examines burnout in a national sample of transplant surgeons. Data analyses were conducted on a sample of 209 actively practicing transplant surgeons. Measures included the Maslach Burnout Inventory, a demographic survey, and the Surgeon Coping Inventory. Burnout was reflected in 38% of surgeons scoring high on the Emotional Exhaustion dimension, whereas 27% showed high levels of Depersonalization, and 16% had low levels of Personal Accomplishment. Several significant predictors of emotional exhaustion were identified and included questioning one's career choice, giving up activities, and perceiving oneself as having limited control over the delivery of medical services (R2= 0.43). Those who perceived themselves as having a higher ability to control delivery of medical services and who felt more appreciated by patients had lower levels of depersonalization and were less likely to question their career choice (R2= 0.16). Surgeons with high personal accomplishment experienced greater professional growth opportunities, perceived their institution as supportive, felt more appreciated by patients, and were less likely to question their career (R2= 0.24). The prioritization of goals to reflect both professional and personal values accounted for a significant amount of the variance in predicting both emotional exhaustion and personal accomplishment in separate regression equations. Recommendations to decrease burnout would include greater institutional support, increased opportunities for professional growth, and greater surgeon control over important services to facilitate efficient work. Coping strategies to moderate stress and burnout are also beneficial and should include prioritizing goals to reflect both professional and personal values. PMID:15848732
interrogate and to examine those individuals, and every gesture, every question, every maneuver they did, was jealously kept in our minds. However even at an early stage, we clearly perceived, the differences between medical branches and practitioners, and involuntarily, every one was leaning towards this or that specialty. It was during those years when 7 wonderful persons and excellent surgeons, crossed the path of my life, inspiring me to follow their steps and to embrace a surgical career. Two were classic academicians, Dr. Manuel Aguilar Bonilla and Dr. Andres Vesalio Guzman Calleja, 3 were determined, tireless and highly skilled, Dr. Longino Soto Pacheco, Dr. Claudio Orlich Carranza, y el Dr. Carlos Prada Diaz, and 2 were, although well prepared, unassuming, practical and openly friendly, Dr. Fernando Valverde Soley y el Dr. Randall Ferris Iglesias....
McHugh, S M
Surgical patients are at particular risk of healthcare-associated infection (HCAI) due to the presence of a surgical site leading to surgical site infection (SSI), and because of the need for intravascular access resulting in catheter-related bloodstream infection (CRBSI). A two-year initiative commenced with an initial audit of surgical practice; this was used to inform the development of a targeted educational initiative by surgeons specifically for surgical trainees. Parameters assessed during the initial audit and a further audit after the educational initiative were related to intra- and postoperative aspects of the prevention of SSIs, as well as care of peripheral venous catheters (PVCs) in surgical patients. The proportion of prophylactic antibiotics administered prior to incision across 360 operations increased from 30.0% to 59.1% (P<0.001). Surgical site dressings were observed in 234 patients, and a significant decrease was found in the percentage of dressings that were tampered with during the initial 48h after surgery (16.5% vs 6.2%, P=0.030). In total, 574 PVCs were assessed over the two-year period. Improvements were found in the proportion of unnecessary PVCs in situ (37.9% vs 24.4%, P<0.001), PVCs in situ for >72h (10.6% vs 3.1%, P<0.001) and PVCs covered with clean and intact dressings (87.3% vs 97.6%, P<0.001). Significant improvements in surgical practice were established for the prevention of SSI and CRBSI through a focused educational programme developed by and for surgeons. Potentially, other specific measures may also be warranted to achieve further improvements in infection prevention in surgical practice.
Bill G. X. Zhang
Full Text Available Joint replacement is a major orthopaedic procedure used to treat joint osteoarthritis. Aseptic loosening and infection are the two most significant causes of prosthetic implant failure. The ideal implant should be able to promote osteointegration, deter bacterial adhesion and minimize prosthetic infection. Recent developments in material science and cell biology have seen the development of new orthopaedic implant coatings to address these issues. Coatings consisting of bioceramics, extracellular matrix proteins, biological peptides or growth factors impart bioactivity and biocompatibility to the metallic surface of conventional orthopaedic prosthesis that promote bone ingrowth and differentiation of stem cells into osteoblasts leading to enhanced osteointegration of the implant. Furthermore, coatings such as silver, nitric oxide, antibiotics, antiseptics and antimicrobial peptides with anti-microbial properties have also been developed, which show promise in reducing bacterial adhesion and prosthetic infections. This review summarizes some of the recent developments in coatings for orthopaedic implants.
... HUMAN SERVICES Food and Drug Administration Minimum Clinically Important Difference: An Outcome Metric in Orthopaedic Device Science and Regulation; Public Workshop AGENCY: Food and Drug Administration... Technology's Translational Research Institute for Biomedical Engineering and Science ] (TRIBES). The...
Full Text Available High-resolution ultrasound has gained increasing popularity as an aid in the diagnosis of rotator cuff pathology. With the advent of portable machines, ultrasound has become accessible to clinicians. Aim: This study was conducted to evaluate the accuracy and reliability of ultrasound in diagnosing rotator cuff tears by a shoulder surgeon and comparing their ability to that of a musculoskeletal radiologist. Materials and Methods: Seventy patients undergoing shoulder arthroscopy for rotator cuff pathology underwent preoperative ultrasonography (US. All patients were of similar demographics and pathology. The surgeon used a Sonosite Micromax portable ultrasound machine with a 10-MHz high frequency linear array transducer and the radiologist used a 9-12 MHz linear array probe on a Siemens Antares machine. Arthroscopic diagnosis was the reference standard to which ultrasound findings were compared. Results: The sensitivity in detecting full thickness tears was similar for both the surgeon (92% and the radiologist (94%. The radiologist had 100% sensitivity in diagnosing partial thickness tears, compared to 85.7% for the surgeon. The specificity for the surgeon was 94% and 85% for the radiologist. Discussion: Our study shows that the surgeons are capable of diagnosing rotator cuff tears with the use of high-resolution portable ultrasound in the outpatient setting. Conclusion: Office ultrasound, by a trained clinician, is a powerful diagnostic tool in diagnosing rotator cuff tears and can be used effectively in running one-stop shoulder clinics.
Sankar, B.; Ray, P.; Rai, J.
We conducted a prospective cohort study in order to determine whether suction drain specimen cultures from orthopaedic surgery predicted an early wound infection. We included 218 consecutive clean orthopaedic operations requiring drains in one unit over a period of 1 year. The suction drain tip, drain fluid and wound discharge specimens were cultured, and the surgical wound was followed up for 3 months. There were six deep and two superficial wound infections. Wound infection was significantl...
van Hove, Ruud P.; Sierevelt, Inger N; van Royen, Barend J.; Nolte, Peter A.
Surfaces of medical implants can be enhanced with the favorable properties of titanium-nitride (TiN). In a review of English medical literature, the effects of TiN-coating on orthopaedic implant material in preclinical studies were identified and the influence of these effects on the clinical outcome of TiN-coated orthopaedic implants was explored. The TiN-coating has a positive effect on the biocompatibility and tribological properties of implant surfaces; however, there are several reports ...
Watts, Laura; Grant, David
“Each year over 25,000 people die from Venous Thromboembolism (VTE) contracted in hospital. This is more than the combined total of deaths from breast cancer, AIDS and traffic accidents”. (1) Orthopaedic patients are at particular risk of VTE. In 2011, the project team carried out an audit into compliance with national VTE assessment guidelines on all acute trauma and orthopaedic admissions during a two week period at a District General Hospital. The study demonstrated that compliance was ini...
Gandhi Rajiv; Jan Meryam; Smith Holly N; Mahomed Nizar N; Bhandari Mohit
Abstract Background After the Food and Drug Administration Modernization Act of 1997, the registration of all clinical trials became mandatory prior to publication. Our primary objective was to determine publication rates for orthopaedic trauma trials registered with ClinicalTrials.gov. We further evaluated methodological consistency between registration and publication. Methods We searched Clinical Trials.gov for all trials related to orthopaedic trauma. We excluded active trials and trials ...
Canada's energy is complex and an important resource as it fuels and funds the economy. The unique character of Canada's energy production and consumption provides strength to the country. The purpose of this booklet was to highlight Canada's energy production and consumption and to demonstrate Canada's rank globally with other major global energy players. The document also presented information on the value of Canada's energy exports, Canada's relationship with the United States, and Canada's energy-related carbon dioxide emissions. Specifically, the document discussed Canada's energy in a global context; the value of Canada's energy exports; domestic value of energy; Canada's unique energy mix; Canada's electricity mix; Canada's carbon dioxide emissions; energy strategies; and the importance of energy to Canadians. It was concluded that there are 14 federal, provincial and territorial jurisdictions managing their respective energy resources. All of these regions, with the exception of Saskatchewan have produced an energy strategy document or a climate change action plan focusing on 8 areas of action, notably awareness; benefit; efficiency; development; diversification; electricity; and emissions. refs., tabs., figs.
Bone graft is widely used within orthopaedic surgery especially in revision joint arthroplasty and spine fusion. The early implant fixation in the revision situation of loose joint prostheses is important for the long-term survival. Bone autograft has been considered as gold standard in many orthopaedic procedures, whereas allograft is the gold standard by replacement of extensive bone loss. However, the use of autograft is associated with donor site morbidity, especially chronic pain. In addition, the limited supply is a significant clinical challenge. Limitations in the use of allograft include the risk of bacterial contamination and disease transmission as well as non-union and poor bone quality. Other bone graft and substitutes have been considered as alternative in order to improve implant fixation. Hydroxyapatite and collagen type I composite (HA/Collagen) have the potential in mimicking skeletal bones. The osteoconductive properties of the composite might be improved by adding bone marrow aspirate (BMA), which can be harvested during surgery. Other alternatives to bone graft are demineralised bone matrix (DBM) and human cancellous bone (CB). DBM is prepared by acid extraction of human bone and includes bone collagen, morphogenetic proteins and growth factors. The combination of DBM with CB and with allograft might improve the healing potential of these grafts around non-cemented orthopaedic implants and thereby the implant fixation. Study I investigates the effect of HA/Collagen composite alone and in combination with BMA on the early fixation of porous coated titanium implants. In addition, the study compares also the effect of autograft with the gold standard allograft. By using a sheep model, the implants were inserted in the trabecular bone of femoral condyles. The test biomaterials were placed in a well defined peri-implant gap. After the observation period, the bone-implant specimens were harvested and evaluated mechanically by a destructive push
Full Text Available Objective: Robotic surgical systems offer better workplace in order to relieve surgeons from prolonged physical efforts and improve their surgical outcomes. However, robotic surgery could produce musculoskeletal disorders due to the prolonged sitting position of the operator, the fixed position of the console viewer and the movements of the limbs. Until today, no one study has been reported concerning the association between robotics and musculoskeletal pain. The aim of this work was verify the prevalence of musculoskeletal disorders among Italian robotic surgeons. Material and methods: Between July 2011 and April 2012 a modified Standardized Nordic Questionnaire was delivered to thirty-nine Italian robotic centres. Twentytwo surgeons (56% returned the questionnaires but only seventeen questionnaires (43.5% were evaluable. Results: Seven surgeons (41.2% reported musculoskeletal disorders, by since their first use of the robot which significantly persisted during the daily surgical activity (P < 0.001. Regarding the body parts affected, musculoskeletal disorders were mainly reported in the cervical spine (29.4% and in the upper limbs (23.5%. Six surgeons (35.3% defined the robotic console as less comfortable or neither comfortable/uncomfortable with a negative influence on their surgical procedures. Conclusions: In spite of some important limitations, our data showed musculoskeletal disorders due to posture discomfort with negative impact on daily surgical activity among robotic surgeons. These aspects could be due to the lack of ergonomic seat and to the fixed position of the console viewer which could have produced an inadequate spinal posture. The evaluation of these postural factors, in particular the development of an integrated and more ergonomic chair, could further improve the comfort feeling of the surgeon at the console and probably his surgical outcomes.
Weng, Hui-Ching; Steed, James F.; Yu, Shang-Won; Liu, Yi-Ten; Hsu, Chia-Chang; Yu, Tsan-Jung; Chen, Wency
We investigated the associations of surgeons' emotional intelligence and surgeons' empathy with patient-surgeon relationships, patient perceptions of their health, and patient satisfaction before and after surgical procedures. We used multi-source approaches to survey 50 surgeons and their 549 outpatients during initial and follow-up visits.…
Jakuscheit, Axel; Rudert, Maximilian
Wuerzburg in the centre of Germany claims to be a cradle of modern orthopaedics. Under the leadership of Johann Georg Heine (1771-1831) the first German orthopaedic hospital, the Carolinum, was established in 1816. Johann Georg Heine's legacy was continued by his son Joseph (1803-1877) and his nephew Bernhard Heine (1800-1846), before Albert Hoffa (1859-1907) put the clinical practice of orthopaedics on a strict scientific basis and further promoted a worldwide exchange of knowledge. In 1916, Albert Hoffa's successor Jakob Riedinger (1861-1917) founded the Koenig-Ludwig-Haus, which hosts the Orthopaedic Hospital and the Centre for Musculoskeletal Research of the University of Wuerzburg. On the occasion of the bicentenary and centenary anniversaries of the founding of the two orthopaedic hospitals, we provide a short view on the development of orthopaedics in Wuerzburg. PMID:27283104
Full Text Available The use of metallic implants has revolutionised the practice of orthopaedic surgery. While the safety and biocompatibility of these devices are excellent, a small percentage becomes infected. These infections are due to the formation of a biofilm that harbours bacteria encased in a complex extracellular matrix. The matrix serves as a barrier to immune surveillance as well as limiting the biocidal effects of systemic and local antibiotics. The objective of the review is to describe a novel approach to controlling implant infection using an antibiotic that is linked to titanium through a self-assembled monolayer of siloxy amines. We show that the hybrid-engineered surface is stable, biocompatible and resists colonisation by bacterial species most commonly associated with implant-related infections. Studies with rodent bone infection models suggest that the engineered titanium surface prevents bone infection. Results of a very recent investigation utilising a sheep model of infection indicate that the titanium-tethered antibiotic controls infection without compromising bone formation and remodelling. From all of these perspectives, the tethered antibiotic holds promise of providing a novel and practical approach to reducing implant-associated infections.
Total hip prosthesis (THP) is a highly successful orthopaedic device. However, its durability is generally limited to a few decades due to difficult conditions in the human body and huge demands it is subjected to. A hip prosthesis is deteriorating due to high surface pressures caused by mechanical movements of the body. The aim of this project is to improve the characteristics of hip prostheses, in order to increase their functionality and their life span. This paper presents an analysis regarding the topography and tribological parameters of femoral heads structures and of femoral heads coated with TiN. We studied the tribological properties of the surfaces of some femoral heads made of Ti alloys or coated with TiN. These femoral heads were obtained from some prostheses after revision surgery. Afterwards, we used TiN nanostructured coatings for reducing the wear process. TiN thin films were deposited using physical vapour deposition (PVD) and some scratch tests have been realized on these coatings surfaces. The study of coatings surfaces was made using atomic force microscopy (AFM) that offers the possibility to obtain nanometric 3D control of thin films. Main result of these researches is that used coatings offer the possibility to improve the system properties. (authors)
Full Text Available Introduction. The Institute for Orthopaedic Surgery 'Banjica' in Belgrade provides tertiary healthcare services on national level. After decades of constant development, a recent decline coincided with the decade of great social and governmental disturbance, the transition period after the dissociation of former Yugoslavia. Objective. In order to overcome the crisis, we used modern management methods to define problems in the institution management, and to propose appropriate strategies. Methods. A survey that included 100 employees (17.67% was carried out, followed by descriptive statistical analysis, PEST and SWOT analyses. Results The impact of political fluctuations, ageing of population, financing model, obsolete medical technology was evaluated. Various personal and interpersonal factors were assessed: the quality of medical service (3.59±0.76, mark 1-5; relations among health service participants (3.39±0.78; occupational conditions (not good-91%; human, financial and other resources; professional cooperation, stimulation; rivalry and mobbing (declared in 56%; public informing, institution image (rank 3.70±0.88 and PR activities (new to 78%. 93% declared to give maximum effort at work. Conclusion. Using these results, we defined several strategic objectives. These include strengthening scientific activities, general orientation to specific and exclusive pathological conditions and treatment methods, improvement of management transparency, introduction of quality-based stimulation of workers, support of promotional and PR activities.
Ricci, S; Ricci, O; Tucci, C E; Massoni, F; Sarra, M V; Ricci, S
Over the last decades, the increase in the global population's mean age has implied a corresponding increase in degenerative disease affecting various anatomical areas and tissues, including bones and cartilages, thus provoking a rising number of disabilities and a wider usage of drugs, mostly anti-inflammatory and cortisone. New developments in technologic and biomedical fields gave birth to new subjects, such as tissue engineering, cell therapy, gene therapy that, by and large, create a knowledge network falling under the concept of Regenerative Medicine. This science is essentially based on the usage of stem cells that can replicate and renovate themselves originating, if adequately stimulated, a number of cell types. Inter alia, in orthopaedic field a particular type of adult stem cells is used, the mesenchymal stem cells (MSCs). If combined with synthetic material produced in laboratories, the usage of these cells has provided inspiration for new study interests; today, it can be applied in various degenerative and post-traumatic pathologies, with great therapeutic benefits for the patient. Actually, many studies write about an improvement in patients' life quality. In this sense appear significant reflections on legal medicine, both in accidents and insurance, of this innovative therapeutic alternative and is hopefully an equally valid process of improvement of regulatory and case law.
Adhikari, Raju; Gunatillake, Pathiraja A; Griffiths, Ian; Tatai, Lisa; Wickramaratna, Malsha; Houshyar, Shadi; Moore, Tim; Mayadunne, Roshan T M; Field, John; McGee, Margaret; Carbone, Tania
Biodegradable polyurethanes offer advantages in the design of injectable or preformed scaffolds for tissue engineering and other medical implant applications. We have developed two-part injectable prepolymer systems (prepolymer A and B) consisting of lactic acid and glycolic acid based polyester star polyols, pentaerythritol (PE) and ethyl lysine diisocyanate (ELDI). This study reports on the formulation and properties of a series of cross linked polyurethanes specifically developed for orthopaedic applications. Prepolymer A was based on PE and ELDI. Polyester polyols (prepolymer B) were based on PE and dl-lactic acid (PEDLLA) or PE and glycolic acid (PEGA) with molecular weights 456 and 453, respectively. Several cross linked porous and non-porous polyurethanes were prepared by mixing and curing prepolymers A and B and their mechanical and thermal properties, in vitro (PBS/37 degrees C/pH 7.4) and in vivo (sheep bi-lateral) degradation evaluated. The effect of incorporating beta-tricalcium phosphate (beta-TCP, 5 microns, 10 wt.%) was also investigated. The cured polymers exhibited high compressive strength (100-190 MPa) and modulus (1600-2300 MPa). beta-TCP improved mechanical properties in PEDLLA based polyurethanes and retarded the onset of in vitro and in vivo degradation. Sheep study results demonstrated that the polymers in both injectable and precured forms did not cause any surgical difficulties or any adverse tissue response. Evidence of new bone growth and the gradual degradation of the polymers were observed with increased implant time up to 6 months. PMID:18632149
Full Text Available The aim of this study is to compare the metallic and natural fiber reinforced polymer composite bone plates used in humerus fractures. A 3D finite element model was developed to analyze the performance of both types of plates. This study proposed on fabrication of natural fiber powdered material (like Sisal (Agave sisalana, Banana (Musa sapientum and Roselle (Hibiscus sabdariffa Reinforced Polymer (NFRP composite plate material with bio epoxy resin. Instead of orthopaedics alloys such as titanium, cobalt chrome, stainless steel and zirconium, this plate material can be used for both internal and external fixation on human body for fractured bone. In this study, flexural rigidity of Sisal and banana (hybrid, Roselle and banana (hybrid and Roselle and sisal (hybrid composite at dry and wet conditions was studied. In this study the composition of the microstructure of composites specimens were studied using Electron Dispersive X-Ray Thermo detector and Scanning Electron Microscope.
Obst, Ursula; Marten, Silke-Mareike; Niessner, Christoph; Hartwig, Erich; Korsch, Michael; Walther, Winfried
The aim of this study was to compare the diversity of microbial colonization on implant material from different individuals. Eubacterial DNA was extracted, separated and sequenced from orthopaedic metallic implant material, tissues or body fluids, and skin of 4 patients as well as from identical dental cement material from 10 individuals after revision and routine removal. Additionally, the composition of the bacterial population of the dental cement and the oral swab sample from one individual after direct extraction of bacterial DNA was compared to extraction after conventional microbiological enrichment. The latter investigation proved that the commonly used cultivation technique gave different results than direct extraction of DNA, especially as regards the detection of anaerobes. Comparing the bacterial colonization of implant materials from different patients showed significant individual diversity. The common focus on a constricted pathogen spectrum may have to be expanded toward a multispecies population. Moreover, the dependence of the bacterial population on the individual host has to be integrated in discussing implant colonization and infection.
Beaussier, M; Sciard, D; Sautet, A
Postoperative pain relief is one of the cornerstones of success of orthopaedic surgery. Development of new minimally-invasive surgical procedures, as well as improvements in pharmacological and local and regional techniques should result in optimal postoperative pain control for all patients. The analgesic strategy has to be efficient, with minimal side effects, and be easy to manage at home. Multimodal analgesia allows for a reduction of opiate use and thereby its side effects. Local and regional analgesia is a major component of this multimodal strategy, associated with optimal pain relief, even upon mobilization, and it has beneficial effects on postoperative recovery. Ultrasound guidance improves the success rate of distal nerve blocks and makes distal selective blockade possible, helping to preserve the limb's motility. Besides peripheral nerve blocks, local infiltration (incisional and/or intra-articular) is also important to consider. Duration of the nerve blockade is limited after a single injection. This must be taken into consideration to avoid the recurrence of pain when the patient returns home. Continuous perineural blocks using catheters are an option that can be easily managed at home with monitoring by home-care nurses. Extended-release liposomal bupivacaine and adjuvants such as dexamethasone could significantly enhance the duration of the sensory block, thereby reducing the indications for pain pumps. Non-pharmacological approaches, such as cryotherapy, hypnosis and acupuncture should not be ignored. PMID:26803223
Full Text Available Post traumatic and post excisional full thickness tissue defects as well as exposed implants and bones after surgery are challenging to orthopedic surgeons. Management of these complex injuries become difficult if the wound closure cannot be brought primarily. A flap is a unit of tissue that may be transferred from donor to a recipient site while maintaining its blood supply. Many such type of flaps are used to cover the defects and the donor site is either closed primarily or covered by skin graft. We present our experie nce of managing post traumatic , post excisional defect at Acharya Vinoba Bhave Rural Hospital by various types of flaps such as reverse sural artery flap, gastrocnemius and anterolateral thigh flaps which have significantly reduced the morbidity and long t erm complications of the open wounds. The non - availability of expertise, experience of surgeon in the field of reconstruction and poverty are the major constraints in rural India. Our experience of three cases is discussed.
Dale, Leila Pfaeffli; LeBlanc, Allana G; Orr, Krystn; Berry, Tanya; Deshpande, Sameer; Latimer-Cheung, Amy E; O'Reilly, Norm; Rhodes, Ryan E; Tremblay, Mark S; Faulkner, Guy
The present study evaluated awareness of the Canadian Society for Exercise Physiology's 2011 Canadian Physical Activity Guidelines for Adults and assessed correlates. Reported awareness of the physical activity (PA) guidelines was 12.9% (204/1586) of the total sample surveyed. More than half (55%) self-reported meeting PA guidelines of ≥ 150 min of moderate to vigorous PA per week. Awareness of PA guidelines was significantly related to participants' level of PA (χ(2) (1) = 30.63, p < 0.001, φ = -0.14), but not to any demographic variables. PMID:27560541
Education in the knowledge, skills, and attitudes necessary for a surgeon to perform at an expert level in the operating room, and beyond, must address all potential cognitive and technical performance gaps, professionalism and personal behaviors, and effective team communication. Educational strategies should also seek to replicate the stressors and distractions that might occur during a high-risk operation or critical care event. Finally, education cannot remain fixed in an apprenticeship model of "See one, do one, teach one," whereby patients are exposed to the risk of harm inherent to any learning curve. The majority of these educational goals can be achieved with the addition of simulation-based education (SBE) as a valuable adjunct to traditional training methods. This article will review relevant principles of SBE, explore currently available simulation-based educational tools for pediatric surgeons, and finally make projections for the future of SBE and performance assessments for pediatric surgeons.
Leffler, Christopher T; Wainsztein, Ricardo D
We strove to identify the earliest cataract surgeons in Latin America. Probably by 1611, the Genovese oculist Francisco Drago was couching cataracts in Mexico City. The surgeon Melchor Vásquez de Valenzuela probably performed cataract couching in Lima by 1697. Juan Peré of France demonstrated cataract couching in Veracruz and Mexico City between 1779 and 1784. Juan Ablanedo of Spain performed couching in Veracruz in 1791. Cataract extraction might have been performed in Havana and Caracas by 1793 and in Mexico by 1797. The earliest contemporaneously documented cataract extractions in Latin America were performed in Guatemala City by Narciso Esparragosa in 1797. In addition to Esparragosa, surgeons born in the New World who established the academic teaching of cataract surgery included José Miguel Muñoz in Mexico and José María Vargas in Caracas. Although cataract surgery came quite early to Latin America, its availability was initially inconsistent and limited. PMID:27143845
Chan, James Kwok-Kwan; Jones, Sophie M; Heywood, Anthony J
Body dysmorphic disorder (BDD) is a disabling preoccupation with a slight or an imagined defect in appearance. It is recognised in some patients who present to the plastic surgeon requesting multiple cosmetic procedures. Very rarely, BDD patients may wish for amputation of a healthy limb and may even mutilate themselves deliberately in order to necessitate amputation. These patients pose a diagnostic challenge as BDD is uncommon and they are often uncooperative whilst appearing mentally sound. Furthermore, they raise difficult ethical and legal issues for the surgeon. Although there is some guidance for the management of BDD patients seeking elective amputation, there is currently none for the management of those who present in the emergency setting. Illustrated by the case of a man who, having failed to find a complicit surgeon, attempted self-amputation of the hand, we review the relevant ethical, legal and management issues with advice by the British Medical Association and General Medical Council. PMID:20392680
Ruiz de Angulo, David; Munitiz, Vicente; Ortiz, M Ángeles; Martínez de Haro, Luisa F; Frutos, M Dolores; Hernández, Antonio; Parrilla, Pascual
Communication between the bariatric surgeon and the obese patient is very important as it influences the expectations of patients with regard to surgery, aim of the surgery and the understanding of the mechanisms of failure of surgery. Furthermore, the incidence of certain psychopathology in these patients makes it necessary for the surgeon to have the ability to communicate to the patient the need for motivation and the maintenance of healthy life habits. Although the topic is subjective, in this article we review several useful recommendations to optimize communication before and after surgery. Finally, we emphasize the need to create workshops to train the bariatric surgeon in these issues that we consider so important. PMID:25912163
Bork, U; Koch, M; Büchler, M W; Weitz, J
The present day healthcare system in Germany is rapidly changing, even more so after the introduction of diagnosis-related groups. The basic requirements for every surgeon remain manual skills, a profound clinical knowledge and the ability for clinical decision-making even in difficult situations. However, these key elements of surgical education no longer fulfill the requirements for today's leaders in surgery. New requirements, consisting of administrative duties, strategic decision-making and department management are too complex to be made only intuitively. Nowadays surgeons also need a profound education in management skills and knowledge of economic mechanisms in order to run an efficient, profitable, patient-oriented surgical department. Every surgeon who aims at obtaining a leadership position should acquire the necessary knowledge and skills.
Daniel J. Kim
Full Text Available Introduction: Starting in 2008, emergency ultrasound (EUS was introduced as a core competency to the Royal College of Physicians and Surgeons of Canada (Royal College emergency medicine (EM training standards. The Royal College accredits postgraduate EM specialty training in Canada through 5-year residency programs. The objective of this study is to describe both the current experience with and the perceptions of EUS by Canadian Royal College EM senior residents. Methods: This was a web-based survey conducted from January to March 2011 of all 39 Canadian Royal College postgraduate fifth-year (PGY-5 EM residents. Main outcome measures were characteristics of EUS training and perceptions of EUS. Results: Survey response rate was 95% (37/39. EUS was part of the formal residency curriculum for 86% of respondents (32/37. Residents most commonly received training in focused assessment with sonography for trauma, intrauterine pregnancy, abdominal aortic aneurysm, cardiac, and procedural guidance. Although the most commonly provided instructional material (86% [32/37] was an ultrasound course, 73% (27/37 of residents used educational resources outside of residency training to supplement their ultrasound knowledge. Most residents (95% [35/37] made clinical decisions and patient dispositions based on their EUS interpretation without a consultative study by radiology. Residents had very favorable perceptions and opinions of EUS. Conclusion: EUS training in Royal College EM programs was prevalent and perceived favorably by residents, but there was heterogeneity in resident training and practice of EUS. This suggests variability in both the level and quality of EUS training in Canadian Royal College EM residency programs.
The Canadian Association of Petroleum Producers (CAPP) represents oil and gas companies throughout Canada; its members produce over 90% of Canada's natural gas and crude oil output. The aim of the Association is to improve the economics of the Canadian upstream petroleum sector in an environmentally and socially responsible way. The aim of this Responsible Canadian Energy report is to present the performance data of CAPP's members for the year 2009. Data, trends, and performance analyses are provided throughout the document. This analysis makes it possible to determine where progress has been made and where performance improvement is necessary. It also presents success stories and best practices so that other companies can learn from them how to improve their own performance. This paper provides useful information on the performance of the upstream petroleum industry in Canada and highlights where the focus should be for further improvement in its performance.
M. Reza Nakhaie
Full Text Available The social role of universities has been the subject of a lengthy debate as to whether those who teach in the academy are system-legitimizing conservatives or radicals helping to generate critical thinking that challenges the status quo. The aim of this paper is to evaluate political affiliations of Canadian university professors based on a national survey conducted in 2000. The study shows that Canadian professors’ political affiliation can be identified as either left or right depending on how the political orientation of political parties is conceptualized. University professors tend to vote more for the Liberal Party than other parties, and view it as centrist party. Moreover, the study highlights a complex and non-monolithic picture of the Canadian academy. University professors are not politically homogenous and party vote depends on the prestige of their university, their discipline, gender, ethnicity, marital status, generation, and agreement with liberalism.
In this report we present the design review done to date in Canada by AECL. From the Canadian point of view it covers: 1) relevant information on the Chernobyl design and the accident, both as presented by the Soviets at the Post-Accident Review Meeting (PARM) held in Vienna from August 25-29, 1986, and as deduced from publicly available Soviet documentation; and 2) details of AECL's technical review of the CANDU PHWR (Pressurized Heavy Water Reactor) against the background of the Chernobyl accident, and implications of the Chernobyl accident. Reviews of operational aspects are underway by the Canadian electrical utilities and a review by the Canadian regulatory agency (the Atomic Energy Control Board) is near completion
Eman Mohamed Mortada
Full Text Available Background and rationale of the study: Although Sharps injuries are a preventable hazard faced by medical personnel in the operating room yet it continues to be one of the hidden problems among HCP. The potential consequence of such injuries includes transmission of blood-borne pathogens with detrimental effects. Despite the advances in technology and increased awareness of medical staff, annually around 600 thousand to one million workers are affected thus considered as one of the most serious threats facing health care workers specially surgeon.Methodology: a cross sectional study of Zagazig University Hospitals surgical departments. Using a sample composed of 287 surgeons randomly chosen from different surgical departments. A questionnaire assessed in addition to personal and professional characteristics, the history of sharp injuries, types of instrument causing the injury, their post exposure prophylaxis including reporting. The results: There were total 287 surgeons participated in this study. (47% of the respondent surgeons had been exposed to at least one episode of sharp injury in the preceding 3 months and most of the exposures (68% occurred in the operation room. The injury was mainly caused during suturing (83%. The commonest devices, accused in most of the injuries were suturing needle and scalpel (74 and 59%. The majority of the surgeons (62% didn’t report the SI and it was largely explained by the majority of the sampled respondents (89% were not aware of the reporting system existing in their hospital.Conclusions: The most common reason of underreporting in our study was the lack of awareness that all injuries must be reported.Recommendations: The observed high level of under reporting reflects the need for education on prevention. Our results can guide in planning an education program for the surgeons to increase awareness about dangers of sharp injuries and help improve the reporting strategy and other potential
Krieger, Lloyd M
Periods of economic downturn place special demands on the plastic surgeon whose practice involves a large amount of cosmetic surgery. When determining strategy during difficult economic times, it is useful to understand the macroeconomic background of these downturns and to draw lessons from businesses in other service industries. Business cycles and monetary policy determine the overall environment in which plastic surgery is practiced. Plastic surgeons can take both defensive and proactive steps to maintain their profits during recessions and to prepare for the inevitable upturn. Care should also be taken when selecting pricing strategy during economic slowdowns. PMID:12360083
Presents challenges to Canadian curriculum theorists: (1) to create curriculum languages and genres that represent all of Canada; (2) to use Canadian scholars and indigenous languages to find these curriculum languages and genres; (3) to seek interpretive tools to understand what it means to be Canadian; and (4) to create curriculum theory that…
Carter, Preston L
The North Pacific Surgical Association first met in Victoria in December, 1917, in the midst of World War I, or as it was known then, the Great War. On all sides, the toll in human life was staggering. Canada alone lost more than 60,000 men in the war. Our Association now returns to Victoria as the very last survivors of that generation pass into history. We honor the great sacrifice of the Canadian Army, recall the horrific conditions they endured, and honor the doctors and nurses who attended the countless wounded through the experiences of a Canadian surgeon from Calgary, Dr. Harold McGill, who served for 3 years in the thick of action on the Western Front.
incidents. Discussion Orthopaedic surgery is a high volume specialty with major technical complexity in terms of equipment demands and staff training and familiarity. There is therefore an increased propensity for errors to occur. Wrong-site surgery still occurs in this specialty and is a potentially devastating situation for both the patient and surgeon. Despite the limitations of inclusion and reporting bias, our study highlights the need to match technical precision with patient safety. Tools such as the WHO surgical checklist can help us to achieve this.
Leite, E.S.; Uva, A.S. [Lisbon Univ., National School of Public Health/New (Portugal)
Full text of publication follows: 1. Objectives: The health care workers are exposed to ionizing radiations during their activities. In the operating rooms, the ionizing radiations are used in orthopaedic surgery and the dose depends on some factors, like the characteristics of the equipment. This study aims to: Estimate the occupational dose of ionizing radiations exposure of the orthopaedic doctors and nurses during the orthopaedic surgeries, in a Portuguese operating room; Sensitize the health care workers to use the individual dosimeter and to adopt radiation preventive measures. 2. Population and methods The study was conducted on nine Orthopaedic doctors and two nurses of an operating room of a hospital in Lisbon neighborhoods. We made a risk evaluating concerning: the radiations dose in different points, corresponding to gonads, hands and crystalline lens levels of all the professionals, during the surgeries; the average period of radiation in the orthopaedic surgeries; the number of annual orthopaedic surgeries, looking for that in the surgeries registers, to estimate the annual ionizing radiations dose of each orthopaedic doctor and nurse. 3. Results The annual doses estimated at different levels for orthopaedic doctors were the following: gonads: between 20,63 and 68,75 mGy; hands: 4,95 16,50 mGy; crystalline lens: 8,25 27,50 mGy). For the orthopaedic nurses: gonads: 130,63 151,25 mGy; hands: 31,35 36,30 mGy; crystalline lens 52,25 60,25 mGy. 4. Conclusions Although the location and positions of health care workers are not the same during the different surgeries and the equipment has an automatic control of the X ray emission, the annual ionizing radiations dose exposure for health care workers is an important one. The risk rating justifies the use of individual dosimeters for better individual dose assessment as part of an ionizing radiations prevention program. As a matter of fact preventive measures begin with a good quantitative risk assessment of
Full text of publication follows: 1. Objectives: The health care workers are exposed to ionizing radiations during their activities. In the operating rooms, the ionizing radiations are used in orthopaedic surgery and the dose depends on some factors, like the characteristics of the equipment. This study aims to: Estimate the occupational dose of ionizing radiations exposure of the orthopaedic doctors and nurses during the orthopaedic surgeries, in a Portuguese operating room; Sensitize the health care workers to use the individual dosimeter and to adopt radiation preventive measures. 2. Population and methods The study was conducted on nine Orthopaedic doctors and two nurses of an operating room of a hospital in Lisbon neighborhoods. We made a risk evaluating concerning: the radiations dose in different points, corresponding to gonads, hands and crystalline lens levels of all the professionals, during the surgeries; the average period of radiation in the orthopaedic surgeries; the number of annual orthopaedic surgeries, looking for that in the surgeries registers, to estimate the annual ionizing radiations dose of each orthopaedic doctor and nurse. 3. Results The annual doses estimated at different levels for orthopaedic doctors were the following: gonads: between 20,63 and 68,75 mGy; hands: 4,95 16,50 mGy; crystalline lens: 8,25 27,50 mGy). For the orthopaedic nurses: gonads: 130,63 151,25 mGy; hands: 31,35 36,30 mGy; crystalline lens 52,25 60,25 mGy. 4. Conclusions Although the location and positions of health care workers are not the same during the different surgeries and the equipment has an automatic control of the X ray emission, the annual ionizing radiations dose exposure for health care workers is an important one. The risk rating justifies the use of individual dosimeters for better individual dose assessment as part of an ionizing radiations prevention program. As a matter of fact preventive measures begin with a good quantitative risk assessment of
Ruso, Juan M; Sartuqui, Javier; Messina, Paula V
Bone is a biologically and structurally sophisticated multifunctional tissue. It dynamically responds to biochemical, mechanical and electrical clues by remodelling itself and accordingly the maximum strength and toughness are along the lines of the greatest applied stress. The challenge is to develop an orthopaedic biomaterial that imitates the micro- and nano-structural elements and compositions of bone to locally match the properties of the host tissue resulting in a biologically fixed implant. Looking for the ideal implant, the convergence of life and materials sciences occurs. Researchers in many different fields apply their expertise to improve implantable devices and regenerative medicine. Materials of all kinds, but especially hierarchical nano-materials, are being exploited. The application of nano-materials with hierarchical design to calcified tissue reconstructive medicine involve intricate systems including scaffolds with multifaceted shapes that provides temporary mechanical function; materials with nano-topography modifications that guarantee their integration to tissues and that possesses functionalized surfaces to transport biologic factors to stimulate tissue growth in a controlled, safe, and rapid manner. Furthermore materials that should degrade on a timeline coordinated to the time that takes the tissues regrow, are prepared. These implantable devices are multifunctional and for its construction they involve the use of precise strategically techniques together with specific material manufacturing processes that can be integrated to achieve in the design, the required multifunctionality. For such reasons, even though the idea of displacement from synthetic implants and tissue grafts to regenerative-medicine-based tissue reconstruction has been guaranteed for well over a decade, the reality has yet to emerge. In this paper, we examine the recent approaches to create enhanced bioactive materials. Their design and manufacturing procedures as well
In this podcast, Acting Surgeon General Dr. Steven Galson discusses what you can do to protect yourself from H1N1 flu. Created: 5/13/2009 by U.S. Department of Health and Human Services (HHS) and the Centers for Disease Control and Prevention (CDC). Date Released: 5/13/2009.
The development of leadership in healthcare has been seen as important in recent years, particularly at the clinical level. There have been various specific initiatives focusing on the development of leadership for doctors, nurses and other health care professions: for example, a leadership competency framework for doctors, the LEO programme and the RCN clinical leadership programme for nurses. The NHS has set up a Leadership Council to coordinate further developments. However, there has not been the same focus in dentistry, although the recent review of NHS dental services (Steele review) has proposed a need for leadership initiatives in NHS dentistry as a medium-term action. Central to this will be a need to focus on the leadership role for dental surgeons. Leadership is all the more important in dentistry, given the change of government and the policy of retrenchment, major public sector reform, the emergence of new organisations such as new commissioning consortia, possible changes to the dental contract, new ways of working, and changes to the profession such as the requirements for the revalidation of dental surgeons. The question is: which leadership theory or approach is best for dental surgeons working in primary care? This paper builds on earlier work exploring this question in relation to doctors generally, and GPs, in particular, and planned work on nurses. It will seek to address this question in relation to dental surgeons working in primary care.
Renshaw, Domeena C.
Misperceived ugliness is called body dysmorphia or dysmorphophobia, often only diagnosed after several discontented return visits to a plastic surgeon who refers the patient for counseling--rarely welcome referrals by the patient when they are convinced the problem is physical and not psychological. Careful listening and patient acceptance are…
Fergo, Charlotte; Burcharth, Jakob; Pommergaard, Hans-Christian;
surgeons in the field of general surgery, gynecology, and urology as these are potential users of 3D laparoscopy. METHODS: The study was conducted according to the STROBE guidelines for cross-sectional studies. Medical doctors from the department of general surgery, gynecology, and urology were recruited...
Christiansen, Niels Hørbye; Job, Jonas Hultmann; Klyver, Katrine;
It is shown how the procedure know as optimal brain surgeon can be used to trim and optimize artificial neural networks in nonlinear structural dynamics. Beside optimizing the neural network, and thereby minimizing computational cost in simulation, the surgery procedure can also serve as a quick...
Goldenberg, R A
This paper presents the surgical anatomy of the skull base and infratemporal fossa. The information has been derived from the author's own experience in surgical and cadaver dissection, standard anatomical references, and selected experience of other skull base surgeons. Because the lateral approach has become the utilitarian method of exposure, the intricate detailed anatomy is demonstrated from this view at five levels of dissection, so the surgeon may gain a practical understanding of the surgical relationship of critical structures. Consistent anatomical landmarks can be used by the surgeon in the location of these critical structures. The styloid process, sphenoidal spine, and middle meningeal artery identify the internal carotid artery as it enters the carotid canal. The bony or fibrous septum that divides the jugular foramen into neural and vascular compartments may be used to better identify nerves IX, X, and XI. The zygomatic root is useful for location of the middle fossa dura. The lateral pterygoid plate leads directly to the foramen ovale. The increased precision of dissection permitted by use of the microscope requires an increased level of knowledge of anatomical structures in this area. It is hoped that the information presented in this paper will assist surgeons in the meticulous and thorough removal of skull base tumors and in the preservation of neural and vascular structures that are presently being sacrificed.
Lavigne, J.-F.; Rowlands, N.; Grandmont, F. J.; Lafrenière, D.; Marois, C.; Daigle, O.; Thibault, S.; Schade, D.; Artigau, É.; Brousseau, D.; Maire, J.; Cretot-Richert, G.; Ducharme, M.-È.; Levesque, L. E.; Laurin, D.; Dupuis, J.
WFIRST-AFTA is the NASA's highest ranked astrophysics mission for the next decade that was identified in the New World, New Horizon survey. The mission scientific drivers correspond to some of the deep questions identified in the Canadian LRP2010, and are also of great interest for the Canadian scientists. Given that there is also a great interest in having an international collaboration in this mission, the Canadian Space Agency awarded two contracts to study a Canadian participation in the mission, one related to each instrument. This paper presents a summary of the technical contributions that were considered for a Canadian contribution to the coronagraph and wide field instruments.
Brcic, Jelena; Della-Rossa, Irina
Values are desirable, trans-situational goals, varying in importance, that guide behavior. Research has demonstrated that universal values may alter in importance as a result of major life events. The present study examines the effect of spaceflight and the demands of astronauts' job position as life circumstances that affect value priorities. We employed thematic content analysis for references to Schwartz's well-established value markers in narratives (media interviews, journals, and pre-flight interviews) of seven Canadian astronauts and compared the results to the values of National Aeronautics and Space Administration (NASA) and Russian Space Agency (RKA) astronauts. Space flight did alter the level of importance of Canadian astronauts' values. We found a U-shaped pattern for the values of Achievement and Tradition before, during, and after flight, and a linear decrease in the value of Stimulation. The most frequently mentioned values were Achievement, Universalism, Security, and Self-Direction. Achievement and Self Direction are also within the top 4 values of all other astronauts; however, Universalism was significantly higher among the Canadian astronauts. Within the value hierarchy of Canadian astronauts, Security was the third most frequently mentioned value, while it is in seventh place for all other astronauts. Interestingly, the most often mentioned value marker (sub-category) in this category was Patriotism. The findings have important implications in understanding multi-national crew relations during training, flight, and reintegration into society.
Doughty, Howard A.
The field of Postcolonial Studies is one of the academic fashions that has arisen in an attempt to amend or replace radical theories of social power since the alleged discrediting of Marxism. The Canadian case is more ambiguous. Postcolonialism, already an essentially contested concept, is especially conflicted where Canada is concerned. Canada…
Examines development and evolution of Canadian government information policy in response to issues of preservation of data, information industry involvement in government data development and marketing, role of Crown copyright, and public access to government information in electronic formats. Six key information policy instruments are also…
Although the Atomic Energy Control Board was established 35 years ago the basic philosophy of nuclear regulation in Canada and the underlying principles of the regulatory process remain essentially unchanged. This paper outlines the Canadian approach to nuclear regulation and explains in practical terms how the principles of regulation are applied. (author)
By December 1914, overwhelming numbers of soldiers with infected musculoskeletal wounds had filled hospitals in France and Britain. Frequently initial management had been inadequate. In 1915, patients with orthopaedic wounds were segregated for the first time when Robert Jones established an experimental orthopaedic unit in Alder Hey Hospital, Liverpool. In 1916 he opened the first of 17 orthopaedic centres in Britain to surgically treat and rehabilitate patients. Henry Gray from Aberdeen emerged as the leading authority in the management of acute musculoskeletal wounds in casualty clearing stations in France and Flanders. Gray had particular expertise in dealing with compound fractures of the femur for which he documented an 80% mortality rate in 1914-15.
Ring, Gavin; O'Mullane, John; O'Riordan, Alan; Furey, Ambrose
In utilising metal surfaces that are in constant contact with each other, metal-on-metal (MoM) surgical implants present a unique challenge, in the sense that their necessity is accompanied by the potential risk of wear particle generation, metal ion release and subsequent patient toxicity. This is especially true of orthopaedic devices that are faulty and subject to failure, where the metal surfaces undergo atypical degradation and release even more unwanted byproducts, as was highlighted by the recent recall of orthopaedic surgical implants. The aim of this review is to examine the area of metallosis arising from the wear of MoM articulations in orthopaedic devices, including how the surgical procedures and detection methods have advanced to meet growing performance and analytical needs, respectively. PMID:26794632
Sharaf, I; Saw, A; Hyzan, Y; Sivananthan, K S
The tsunami which occurred off the west coast of North Sumatra on December 26, 2004 devastated the coastal areas of North Sumatra, South-West Thailand, South-East India and Sri Lanka killing more than a quarter of a million people. The destruction was enormous with many coastal villages destroyed. The other countries affected were Malaysia, Myanmar, Maldives, Bangladesh, Somalia, Kenya, Tanzania and the Seychelles. In January 2005, volunteers went in weekly rotation to Banda Aceh in collaboration with Global Peace Mission. These were Dr Hyzan Yusof, Dr Suryasmi Duski, Dr Sharaf Ibrahim, Dr Saw Aik, Dr Kamariah Nor and Dr Nor Azlin. In Banda Aceh, the surgical procedures that we could do were limited to external fixation of open fractures and debriding infected wounds at the Indonesian Red Crescent field hospital. In February, a team comprising Dato Dr K S Sivananthan, Dr T Kumar and Dr S Vasan spent a week in Sri Lanka. In Sri Lanka, Dato Sivananthan and his team were able to perform elective orthopaedic operations in Dr Poonambalam Memorial Hospital. We appealed for national and international aid and received support from local hospitals and the orthopaedic industry. International aid bound for Banda Aceh arrived in Kuala Lumpur from the Philippine Orthopaedic Association, the Chiba Children's Hospital in Japan and the Chinese Orthopaedic Association. The COA donated 1.5 tons of orthopaedic equipments. A special handing over ceremony from the COA to the Indonesian Orthopaedic Association was held in Putrajaya in March. Malaysia Airlines flew in the donated equipment to Kuala Lumpur while the onward flight to Aceh was provided by the Royal Malaysian Air Force. In April, Dr Saw Aik and Dr Yong Su Mei joined the Tsu-Chi International Medical Association for volunteer services on Batam Island, Indonesia. The MOA acknowledges the many individuals and organizations, both governmental and non-governmental, for their contributions in the humanitarian efforts.
van Netten, Jaap J.; Hijmans, Juha M.; Jannink, Michiel J. A.; Geertzen, Jan H. B.; Postema, Klaas
Objective:To develop it short and easy to use questionnaire to measure use and usability of custom-made orthopaedic shoes, and to investigate its reproducibility. Design: Development of the questionnaire (Monitor Orthopaedic Shoes) was based on a literature search. expert interviews. 2 expert meetin
Netten, van Jaap J.; Hijmans, Juha M.; Jannink, Michiel J.A.; Geertzen, Jan H.B.; Postema, Klaas
Objective: To develop a short and easy to use questionnaire to measure use and usability of custom-made orthopaedic shoes, and to investigate its reproducibility. Design: Development of the questionnaire (Monitor Orthopaedic Shoes) was based on a literature search, expert interviews, 2 expert meetin
Orthopaedics in china originated chinese medicine and Western medicine. In the first half of twentieth century , Dr. meng chimao(Beijing),New Way Sung (Shanghai),Fang Hsienchi, and others contributed a great deal to development of modern orthopaedics in china. The orthopaedic group was organized under the auspecies of Chinese Medical Association in 1937. The chinese Medical Association Orthopaedic Society was wstablished in 1980. The main achievements of Orthopaedics in China include replantation of severed limb or fingres,toe teansplantation for thumb and fonger reconstruction, nerve teansfer for brachial plexus avulsion, resrarch and manufacturing of domestic prostheses and the techniques of artifival joint replacement, surgical treatment of severe scoliosis and classification of idiopathic scoliosis, operative tireatment of bone tumor, and basic research on giant cell tumor of bone.
Passantino, A; Di Pietro, C; Fenga, C; Passantino, M
Law No. 225/1992 established a National Service of Civil Protection, with the important role of 'safeguarding life, goods, settlements and the environment from damage deriving from natural disasters, catastrophes and calamities' (art. 1). This law arranges civil protection as a co-ordinated system of responsibilities administrated by the state, local and public authorities, the world of science, charitable organisations, the professional orders and other institutions, and the private sector (art. 6). The President of the Republic's Decree No. 66/1981 'Regulation for the application of Law No. 996/1970, containing norms for relief and assistance to populations hit by natural disasters--Civil Protection' mentions veterinary surgeons among the people that are called upon to intervene. In fact, in natural disasters the intervention of the veterinary surgeon is of great importance. The authors examine these laws and other legislation relating to the National Service of Civil Protection. PMID:15005549
Marshall, Thomas R
Half a century ago, on January 11, 1964, the U.S. Surgeon General's office released a landmark report on the health consequences of smoking. That report received massive media attention and triggered a steadily growing number of federal, state, and local restrictions on the advertising, sale, and use of cigarettes. Little is known about the report's impact on American public opinion because all the timely public opinion polls that measured the report's impact were privately commissioned by the tobacco industry and were not made publicly available. A review of these polls shows that the 1964 Surgeon General's report had a large and immediate effect on Americans' beliefs that cigarettes were a cause of lung cancer and of heart disease. However, the report had less impact on public preferences for government action or on smoking rates. PMID:25862749
The 1980s have seen a decline in markets for uranium concentrate, largely as a result of falling estimates for reactor fuel requirements and rising inventories. Spot market prices fell to $44 in September 1982, but have since risen back to $60. World production also fell in 1982 and is not expected to increase significantly before 1990. Some opportunities exist for Canadian producers with new low-cost deposits to replace high-cost producers in Canada and other countries, particularly the United States. There will be strong competition between Canadian producers as well as from Australia. Australia's reserves are somewhat larger than Canada's, although the reported ore grades tend to be lower than those of Saskatchewan
Spanager, Lene; Dieckmann, Peter; Beier-Holgersen, Randi;
-Technical Skills for Surgeons in Denmark tool to stimulate feedback conversations. Audio recordings of post-operation feedback conversations were collected. Trainees and supervisors provided questionnaire responses on the usefulness and comprehensiveness of the feedback. The feedback conversations were...... qualitatively analyzed for content and feedback style. Usefulness was investigated using a scale from 1 to 5 and written comments were qualitatively analyzed. RESULTS: Six trainees and six supervisors participated in eight feedback conversations. Eighty questionnaires (response rate 83 percent) were collected...
Ahmet Serdar Karaca
Aim: Mesh repair of inguinal hernia repairs are shown to be an effective and reliable method. In this study, a single surgeon%u2019s experience with plug-mesh method performs inguinal hernia repair have been reported. Material and Method: 587 patients with plug-mesh repair of inguinal hernia, preoperative age, body / mass index, comorbid disease were recorded in terms of form. All of the patients during the preoperative and postoperative hernia classification of information, duration of oper...
Vijay Kumar; Arun Kumar Singh; Ameer Faisal; Nandini, R.
The field of plastic surgery, while being famous for aesthetic surgery, also includes craniofacial surgery, hand surgery, burn surgery, microsurgery, reconstructive plastic surgery and paediatric plastic surgery. The magnanimous progress in these areas, though a hot topic in conferences, remains cryptic to the layman and also to generalists who are and will remain to be the most important referral source of these patients.  Hence, it becomes the duty of plastic surgeons themselves to sprea...
Zhao, Michael; Nowatzyk, Andreas G.; Lu, Thomas; Farkas, Daniel L.
We present the development of advanced neural network and 3D image processing algorithms to identify hand gestures for a novel Surgeon-Computer-Interface (SCI) in the operating room. Feature extraction methods have been identified to reliably extract unique attributes and recognize dynamic hand gestures such as "Point and Click" and "Hand Waiving" features. We show an experimental demonstration of a non-linear neural network classifier that is capable of reliably recognizing 8 complex hand gesture patterns.
Burdett, Clare; Theakston, Maureen; Dunning, Joel; Goodwin, Andrew; Kendall, Simon William Henry
For ease of use and to aid precision, left-handed instruments are invaluable to the left-handed surgeon. Although they exist, they are not available in many surgical centres. As a result, most operating theatre staff (including many left-handers) have little knowledge of their value or even application. With specific reference to cardiac surgery, this article addresses the ways in which they differ, why they are needed and what is required - with tips on use.
This paper deals with the problems of an overseas regulatory agency in licensing a Canadian-supplied nuclear plant which is referenced to a plant in Canada. Firstly, the general problems associated with the use of a reference plant are discussed. This is followed by a discussion of specific problems which arise from the licensing practices in Canada. The paper concludes with recommendations to simplify the task of demonstrating the licensability of an overseas CANDU plant
Joseph I. Daniel
Under congestion pricing, Canadian airports would annually save between $72 and $105 million. Social costs per landing and takeoff decrease about $300 at Toronto and Vancouver and $50 at Calgary and Montreal. Slot constraints fail to eliminate this airport congestion. Congestion prices are lower on average than existing weight-based prices. Current airport capacity accommodates at least five more years of traffic growth before congestion reaches current levels. Substantial welfare gains occur...
THEME: Internationalism: Worlds at Play Topics: Internationalism, Identity in Gaming and Learning to Play Abstract: How does Canada fit into the global cultural context of video games? This paper investigates the culture being reflected in video games being produced in Canada as Canada is one of the world's leading producers of video games. It examines the how Canadian culture is represented in current new media artistic output against the culture, or lack of culture, being represented in vid...
Ahmed M. S. Ibrahim, MD
Conclusions: Plastic surgeons currently use ADM in breast reconstruction for both immediate and staged procedures. Of those responding, a majority of plastic surgeons will incorporate drains and use postoperative antibiotics for more than 48 hours.
Full Text Available Abstract Introduction Although the causes of sarcoidosis are still unknown, past and current studies have provided evidence that this disease may be associated with occupational exposure to specific environmental agents. We describe a case of sarcoidosis in a dental surgeon with long exposure to inorganic dusts. To the best of our knowledge, this is the first report of this kind in the literature. Case presentation At the beginning of 2000, a 52-year-old Caucasian man, who worked as a dental surgeon, presented with shortness of breath during exercise, cough and retrosternal pain. After diagnosis of sarcoidosis, a scanning electronic microscopy with X-ray microanalysis of biopsy specimens was used in order to determine whether the disease could be traced to an occupational environmental agent. Results showed the presence of inorganic dust particles within sarcoidotic granulomas, and demonstrated that the material detected was identical to that found in a powder used by our patient for several years. Conclusions Although these results cannot be considered as definitive proof, they do however provide strong evidence that this disease may be associated with material used by dental surgeons.
Lombardi, A V; Berend, K R; Adams, J B
Previous studies of failure mechanisms leading to revision total knee replacement (TKR) performed between 1986 and 2000 determined that many failed early, with a disproportionate amount accounted for by infection and implant-associated factors including wear, loosening and instability. Since then, efforts have been made to improve implant performance and instruct surgeons in best practice. Recently our centre participated in a multi-centre evaluation of 844 revision TKRs from 2010 to 2011. The purpose was to report a detailed analysis of failure mechanisms over time and to see if failure modes have changed over the past 10 to 15 years. Aseptic loosening was the predominant mechanism of failure (31.2%), followed by instability (18.7%), infection (16.2%), polyethylene wear (10.0%), arthrofibrosis (6.9%) and malalignment (6.6%). The mean time to failure was 5.9 years (ten days to 31 years), 35.3% of all revisions occurred at less than two years, and 60.2% in the first five years. With improvements in implant and polyethylene manufacture, polyethylene wear is no longer a leading cause of failure. Early mechanisms of failure are primarily technical errors. In addition to improving implant longevity, industry and surgeons must work together to decrease these technical errors. All reports on failure of TKR contain patients with unexplained pain who not infrequently have unmet expectations. Surgeons must work to achieve realistic patient expectations pre-operatively, and therefore, improve patient satisfaction post-operatively. PMID:25381419
The fact that many famous denizens of Rijeka belong to different nationalities confirms this city's historic multicultural image. The life story of Erik Vio (1910-1966), renowned surgeon of international reputation, reflects the fate of many displaced residents of Rijeka who left to live in exile. After graduating in Rome, Vio worked as a medical doctor in Hong Kong for almost three decades. The question is weather a surgeon from Rijeka chose to live in Hong Kong because it reminded him of his hometown? The author finds the root of this thesis in Vio's novel The Pathways of Freedom (˝Irwege der Freiheit˝, Köln 1978), a particular medical-philosophic diagnosis of the contemporary civilization's spiritual state. Rare fragments dedicated to Rijeka confirm Vio's actual detachment; faced with his own identity, but also with the others' with whom he shared his living space, a surgeon from Rijeka became a true citizen of the world and at the same time a stateless person with no roots of his own. Through the projection of Hong Kong one can detect the novel's identification backbone: writer's provocation of the ideological perspective on socio-cultural relations. By engaging in the interpretation of Vio's The Pathways of Freedom the author seeks to dissect a sociological dimension of descriptions of dual identities in border space. This leads to the issue of understanding and tolerance toward the others. PMID:27598959
Full Text Available Abstract The aim of this study was to investigate veterinary surgeons' perceptions, knowledge and use of animal physiotherapy in the Republic of Ireland. A questionnaire was developed and sent to 200 veterinary surgeons, of which 97 were returned. Results indicated that 77 (79% of respondents were aware of animal physiotherapists. Common sources of information included veterinary colleagues, owners and professional journals, with physiotherapists themselves and undergraduate training being less commonly cited. Awareness of animal physiotherapy was greatest amongst those working in equine practice (χ2 = 5.7, df 1, p = 0.017; they were more knowledgeable about its techniques (t = 2.806, df 75, p = 0.006 and more likely to refer (χ2 = 48.36, df 1, p = 0.0001. Seventy-four respondents (96% thought that more research was necessary to increase the evidence base for animal physiotherapy. If this branch of physiotherapy is to develop, there needs to be increased interaction and co-operation between veterinary surgeons and chartered animal physiotherapists.
Full Text Available Aim: Hernia surgery is the second most common surgical intervention performed by general surgeons following emergent surgeries. Shouldice herniorraphy is a classical surgery which is in the high tension repair group. This technique should be known by every surgeon. Also being an alternative method, it can be a necessity in cases in which tension free methods can not be performed. In the present study we investigated the advantages, disadvantages and complications of the Shouldice herniorraphy and Lichtenstein technique with the review of the technical literature. Material and Method: We compared 75 patients who were diagnosed with inguinal hernia and treated with Lichtenstein herniorraphy with 33 patients who were treated with Shouldice herniorraphy in Samsun Bafra Public Hospital between April 2007 and May 2008. Age, sex, hernia type, anesthesia method, mean hospitalisation length, early and late post operative complications were recorded. Result: Early post operative complications were urinary retention, wound infection and hematoma. The patients under spinal anesthesia with urinary retention were treated with urinary catheterization. Superficial wound infection was treated with drainage and antibiotic threapy. Among late postoperative complications; we observed paresthesia in the thigh in one patient in the Shouldice group and relapse hernia in one patient in the Lichtenstein group. Discussion: We suggest that this surgical technique which should be known by every surgeon should be taught to new surgery attenders as an alternative technique. This technique can be an alternative method and also may be the first choice in patients in whom tension free methods can not be applicated.
Weber, Robert A; Armstrong, Elizabeth G
The purpose of this article is to introduce plastic surgeons to a theory of adult education. Most surgeons have been hired by their parent institution because of their clinical skills, and rightly so. At the same time, these same surgeons choose or are expected to be involved to varying degrees in the surgical education process with medical students, surgical residents, fellows, and allied health workers. Likewise, busy surgical residents are also expected to teach other residents and students, and yet these two groups of teachers of surgery have little or no training in the theory and practice of adult education. This article has four major sections. The first is a scenario designed to bring to mind a context and set of ideas with which the reader is already familiar. The second provides new information, Kolb's theory of adult learning and Arseneau and Rodenberg's teaching principles, and discusses their implications. The third section is designed to give the reader an opportunity to work with the new knowledge and practice possible applications, and the fourth encourages the reader to use the new knowledge in concrete ways in a real-world environment. PMID:22544100
Full Text Available Although exact statistics are not available, Indian plastic surgeons see around 7,00,000-8,00,000 burn admissions annually with around 10,00,000 cleft patients yet to be operated. In spite of this voluminous load, India does not have national health programs for the various deformities Indian plastic surgeons typically treat. As Plastic Surgeons, it is our social responsibility to treat these patients and bring ′ muskan ′ (smile in Hindi back into their lives. Project Muskan was initiated as an innovative model for targeting these patients and is probably one of its kind in the field of plastic surgery in our country. It is unique because it is a perfect collaboration of government institutions, a Non Government Organization (NGO, and cooperative sectors providing free health care at the doorstep. Identification of the patients was done with the help of the extensive milk dairy network in the state of Gujarat. Provision of transport and other facilities was done by the NGOs and quality health care provision was taken care of by the government hospital. Project Muskan started from a single village but now covers around 3000 villages and tribal areas of Gujarat. It is a system that can be easily reproducible in all hospitals and has reestablished the faith of the common man in government institutes.
This booklet is designed to explain salient aspects of the Ozone Annex, negotiated and signed recently by Canada and the United States, in a joint effort to improve air quality in North America. By significantly reducing the transboundary flows of air pollutants that cause smog, the Ozone Annex will benefit some 16 million people in central and eastern Canada and provide an example for a future round of negotiations to address concerns of the millions of Canadians and Americans who live in the border area between British Columbia and Washington State. The brochure provide summaries of the Canadian and American commitments, focusing on transportation, monitoring and reporting. The Ozone Annex complements other air quality initiatives by the Government of Canada enacted under the Environmental Protection Act, 1999. These measures include regulations to reduce sulphur content to 30 parts per million by Jan 1, 2005; proposing to restrict toxic particulate matter (PM) to less than 10 microns; establishing daily smog forecasts in the Maritimes and committing to a national program built upon existing smog advisories and forecasts in Quebec, Ontario and British Columbia; and investing in more clean air research through the newly created Canadian Foundation for Climate and Atmospheric Sciences
The Canadian Fusion Fuels Technology Project was launched in 1982 to coordinate Canada's provision of fusion fuels technology to international fusion power development programs. The project has a mandate to extend and adapt existing Canadian tritium technologies for use in international fusion power development programs. 1985-86 represents the fourth year of the first five-year term of the Canadian Fusion Fuels Technology Project (CFFTP). This reporting period coincides with an increasing trend in global fusion R and D to direct more effort towards the management of tritium. This has resulted in an increased linking of CFFTP activities and objectives with those of facilities abroad. In this way there has been a continuing achievement resulting from CFFTP efforts to have cooperative R and D and service activities with organizations abroad. All of this is aided by the cooperative international atmosphere within the fusion community. This report summarizes our past year and provides some highlights of the upcoming year 1986/87, which is the final year of the first five-year phase of the program. AECL (representing the Federal Government), the Ministry of Energy (representing Ontario) and Ontario Hydro, have given formal indication of their intent to continue with a second five-year program. Plans for the second phase will continue to emphasize tritium technology and remote handling
At the beginning of the 1930s, various factors made it necessary to transform one of the institutions which was renowned for its work regarding the social reinsertion of the disabled, that is, the Instituto de Reeducación Profesional de Inválidos del Trabajo (Institute for Occupational Retraining of Invalids of Work). The economic crisis of 1929 and the legislative reform aimed at regulating occupational accidents highlighted the failings of this institution to fulfill its objectives. After a time of uncertainty, the centre was renamed the Instituto Nacional de Reeducación de Inválidos (National Institute for Retraining of Invalids). This was done to take advantage of its work in championing the recovery of all people with disabilities.This work aims to study the role played in this process by the poliomyelitis epidemics in Spain at this time. It aims to highlight how this disease justified the need to continue the work of a group of professionals and how it helped to reorient the previous programme to re-educate the "invalids." Thus we shall see the way in which, from 1930 to 1950, a specific medical technology helped to consolidate an "individual model" of disability and how a certain cultural stereotype of those affected developed as a result. Lastly, this work discusses the way in which all this took place in the midst of a process of professional development of orthopaedic surgeons.
Separate abstracts were prepared for 15 papers from the twenty-ninth Annual Conference of the Canadian Nuclear Association. Abstracts were also prepared for the 102 papers from the tenth Annual Conference of the Canadian Nuclear Society
Amirian, Ilda; Andersen, Lærke T; Rosenberg, Jacob;
OBJECTIVE: To monitor surgeons' performance and cognition during night shifts. DESIGN: Surgeons were monitored before call and on call (17-hour shift). Psychomotor performance was assessed by laparoscopic simulation and cognition by the d2 test of attention. The surgeons performed the laparoscopic...... compared with on-call values. The d2 test of attention showed significantly improved values on call compared with before call. CONCLUSION: Sleep deprivation during a 17-hour night shift did not impair surgeons' psychomotor or cognitive performance....
Matejko, Alexander J.
abstract: the canadian federation is based on the substantial autonomy of the provinces constituting it, the welfare orientation of central bodies, the volunteer activities at the grass-root level, and the external policy open to the world. there are no any doubts about the genuinely democratic character of canadian internal politics or the commitment of canadians to the world peace. the economic prosperity of the country is secured by the mineral resources, good agriculture, and the intensiv...
McLeod Robin S
Full Text Available Abstract Background While many factors can influence the way that cancer care is delivered, including the way that evidence is packaged and disseminated, little research has evaluated how health care professionals who manage cancer patients seek and use this information to identify whether and how this could be supported. Through interviews we identified that general surgeons experience challenges in coordinating care for complex cancer patients whose management is not easily addressed by guidelines, and conducted a population-based survey of general surgeon information needs and information seeking practices to extend these findings. Methods General surgeons with privileges at acute care hospitals in Ontario, Canada were mailed a questionnaire to solicit information needs (task, importance, information seeking (source, frequency of and reasons for use, key challenges and suggested solutions. Non-responders received up to three reminder packages. Significant differences among sub-groups (age, setting were examined statistically (Kruskal Wallis, Mann Whitney, Chi Square. Standard qualitative methods were used to thematically analyze open-ended responses. Results The response rate was 44.2% (170/385 representing all 14 health regions. System resource constraints (60.4%, comorbidities (56.4% and physiologic factors (51.8% were top-ranked issues creating information needs. Local surgical colleagues (84.6%, other local colleagues (82.2% and the Internet (81.1% were top-ranked sources of information, primarily due to familiarity and speed of access. No resources were considered to be highly applicable to patient care. Challenges were related to limitations in diagnostics and staging, operative resources, and systems to support multidisciplinary care, together accounting for 76.0% of all reported issues. Findings did not differ significantly by surgeon age or setting of care. Conclusion General surgeons appear to use a wide range of information
Aye, T.; Christensen, D.; Gostick, J.; Mogharei, A.; Oskin, G. O.; Won, W.; Aida, T. [Waterloo Univ. ON (Canada)
The Canadian situation with respect to research in environmental catalysis was investigated by analyzing catalysis papers appearing in the 1999 and 2000 issues of major journals devoted to research in catalysis (Journal of Catalysis; Catalysis Today; Applied Catalysis A: General and B: Environmental). A total of 2150 papers were surveyed; of these 34 were by Canadian authors, with Canada ranking twentieth in the world in terms of research in this field. About 40 per cent of the catalysis papers were related to the environment, with nitrogen and sulphur emissions being the most important topics and energy conversion second. Hydrodesulphurization of petroleum oil, use of low sulphur coal and flue gas desulphurization are the principal processes for controlling sulfur emissions into the air, while nitrogen oxides emissions in automobiles are ccontrolled bt three-way catalysts. In power generation, selective catalytic reduction is the preferred method, although not in Canada, where installing low-NOx burners or using low nitrogen fuels such as natural gas are favored. The control of volatile organic compounds is also a serious problem. The two most promising processes for the Canadian situation are adsorption by activated carbon and catalysis using low-temperature catalysts. Water treatment of textile mill effluents, a favorite topics by Canadian authors, includes photocatalytic oxidation with titanium oxide photocatalyst, ozonation with activated carbons and a combination of photocatalysis and biological treatment. Carbon dioxide conversion was also a favoured topic by Canadian researchers; not surprising in view if the fact that Canada is the highest per capita producer of carbon dioxide emissions. Nearly two-thirds of the carbon dioxide emissions is due to the transportation and energy production sectors, therefore, any carbon dioxide mitigation strategies should be applied initially in these areas. Catalytic conversion of carbon dioxide into methanol, which then
Orri, Massimiliano; Farges, Olivier; Clavien, Pierre-Alain; Barkun, Jeffrey; Revah-Lévy, Anne
OBJECTIVES Synthesize the findings from individual qualitative studies about surgeons' account of their practice. BACKGROUND Social and contextual factors of practice influence doctors' well-being and therapeutic relationships. Little is known about surgery, but it is generally assumed that surgeons are not affected by them. METHODS We searched international publications (2000-2012) to identify relevant qualitative research exploring how surgeons talk about their practice. Meta-ethnograp...
May, Deborah C.; Turnbull, Nancy
One hundred plastic surgeons responded to a survey on opinions toward facial plastic surgery for individuals with Down's syndrome. Twenty-four of the surgeons had performed the surgery. Surgeons indicated appropriate circumstances for the surgery, consent requirements, degree of understanding expected of the patient, and degree of discomfort…
Hall, Gillian; Gregory, Julie
The management of pain is an important aspect of an orthopaedic nurse's role. The aim of this paper is to use an individual case study to demonstrate the role of an out-patient orthopaedic nurse in the identification, assessment and management of pain. This paper describes how pain was identified and managed for a patient in the orthopaedic outpatient department, highlighting that pain and its management are not isolated to the in-patient setting. The case study illustrates the importance of recognising pain and taking into account the numerous factors that can influence pain perception. The assessment of an individual patient's pain led to obtaining help from the Acute Pain Team which led to improvement in the patient's pain management and quality of life. The nursing team reflected and discussed the issues identified by this case study which led to changes in practice being introduced. This has resulted in an increased knowledge of and confidence in pain management within the nursing team and development and improvement of pain management practice within the orthopaedic out-patient department. PMID:26711709
van Netten, Jaap J.; Dijkstra, Pieter U.; Geertzen, Jan H. B.; Postema, Klaas
Background: Despite potential benefits, some patients decide not to use their custom-made orthopaedic shoes (OS). Factors are known in the domains 'usability', 'communication and service', and 'opinion of others' that influence a patient's decision to use OS. However, the interplay between these fac
Osnes-Ringen, H.; Kvamme, M. K.; Sønbø Kristiansen, Ivar;
(SD 13) years, 77% female] with inflammatory arthropathies underwent orthopaedic surgical treatment and responded to mail surveys at baseline and during follow-up (3, 6, 9, and 12 months). Questionnaires included the quality-of-life EuroQol-5D (EQ-5D) and Short Form-6D (SF-6D) utility scores. The...
van den Akker-Scheek, Inge; Zijlstra, Wiebren; Groothoff, Johan W.; van Horn, Jim R.; Bulstra, Sjoerd K.; Stevens, Martin
Objective: Validation of the program theory of the Groningen orthopaedic exit strategy (GOES), a theory-driven program aiming to improve the rehabilitation of total hip and knee arthroplasty patients after shortened hospital stay. First part of the program theory is the action theory, hypothesising
... From the Federal Register Online via the Government Publishing Office ] DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration Orthopaedic and Rehabilitation Devices Panel of the Medical Devices Advisory Committee; Notice of Meeting AGENCY: Food and Drug Administration, HHS. ACTION: Notice. This notice announces a...
... HUMAN SERVICES Food and Drug Administration Orthopaedic and Rehabilitation Devices Panel of the Medical Devices Advisory Committee: Notice of Postponement of Meeting AGENCY: Food and Drug Administration, HHS. ACTION: Notice. SUMMARY: The Food and Drug Administration (FDA) is postponing the meeting of...
... HUMAN SERVICES Food and Drug Administration Orthopaedic and Rehabilitation Devices Panel of the Medical Devices Advisory Committee; Notice of Meeting AGENCY: Food and Drug Administration, HHS. ACTION: Notice. This notice announces a forthcoming meeting of a public advisory committee of the Food and...
... HUMAN SERVICES Food and Drug Administration Orthopaedic and Rehabilitation Devices Panel of the Medical Devices Advisory Committee; Notice of Meeting AGENCY: Food and Drug Administration, HHS. ACTION: Notice. This notice announces a forthcoming meeting of a public advisory committee of the Food and...
... HUMAN SERVICES Food and Drug Administration Orthopaedic and Rehabilitation Devices Panel of the Medical Devices Advisory Committee; Notice of Meeting AGENCY: Food and Drug Administration, HHS. ACTION: Notice. This notice announces a forthcoming meeting of a public advisory committee of the Food and...
Full Text Available Bone drilling manipulation often occurs in the orthopaedic surgery. By statistics, nowadays, about one million people only in Europe need such an operation every year, where bone implants are inserted. Almost always, the drilling is performed handily, which cannot avoid the subjective factor influence. The question of subjective factor reduction has its answer - automatic bone drilling.
Meuffels, D.E.; Poldervaart, M.T.; Diercks, R.L.; Fievez, A.W.F.M.; Patt, T.W.; van der Hart, C.P.; Hammacher, E.R.; van der Meer, F.; Goedhart, E.A.; Lenssen, A.F.; Muller-Ploeger, S.B.; Pols, M.A.; Saris, D.B.F.
The Dutch Orthopaedic Association has a long tradition of development of practical clinical guidelines. Here we present the recommendations from the multidisciplinary clinical guideline working group for anterior cruciate ligament injury. The following 8 clinical questions were formulated by a steer
Neut, D; van de Belt, H; Stokroos, [No Value; van Horn, [No Value; van der Mei, HC; Busscher, HJ
In two-stage orthopaedic revision surgery, high local levels of antibiotics are achieved after removal of an infected prosthesis through temporary implantation of gentamicin-loaded beads. However, despite their antibiotic release, these beads act as a biomaterial surface to which bacteria preferenti
Markatos, Konstantinos; Tsoucalas, Gregory; Sgantzos, Markos
This manuscript represents an attempt to review orthopaedic implants and reconstructive orthopaedic surgery for lower limbs lesions or trauma mainly in the 20th century. We emphasized on the type of implants, the biomaterials and their evolution, and we also engaged in a special reference for the pioneers of orthopaedic implant surgery and the innovative designers of those implants, in such a way to understand the ways and the stages through which they evolved to their present forms, as well as the scientific principles that affected their design and progress. A correlation between the evolution of implants and several relevant disciplines (biomaterial chemists and engineers, biomechanics) that developed simultaneously with orthopaedic reconstructive joint surgery is present since the first attempts to reconstruct a damaged joint. In the future, further progress is anticipated in the use of biomaterials, more compatible towards human biology, with minimally invasive applications and a perpetually increased life span. This progress depicts a phenomenon directly related to a multilevel, multifactorial and interdisciplinary scientific and technological field with many expectations. PMID:27598960
Olson, Carl J.; And Others
This document, as a supplement to the final report of the Orthopaedic Training Study, presents a discussion of the rationale behind the implementation of a laboratory course in psychomotor skills development for medical students. Medical educators examined resident training in terms of 3 components of cognitive elements of learning: cognitive,…
Olson, Carl J.; And Others
This document, as a supplement to the final report of the Orthopaedic Training Study, contains the documents considered to be important in providing the background for the study. The materials are organized into four major areas: initial correspondence, instrumentation, special reports, and psychomotor skills. See also HE 003 275 and HE 003 276.…
Manish G Agarwal
Full Text Available Skeletal metastasis is a common cause of severe morbidity, reduction in quality of life (QOL and often early mortality. Its prevalence is rising due to a higher rate of diagnosis, better systemic treatment, longer lives with the disease and higher disease burden rate. As people with cancer live longer and with rising sensitivity of body imaging and surveillance, the incidence of pathological fracture, metastatic epidural cord compression is rising and constitutes a challenge for the orthopedic surgeon to maintain their QOL. Metastatic disease is no longer a death sentence condemning patients to "terminal care." In the era of multidisciplinary care and effective systemic targeted and nontargeted therapy, patient expectations of QOL, even during palliative end of care period is high. We lay emphasis on proving the diagnosis of metastasis by biopsy and histopathology and discuss imaging modalities to help estimate fracture risk and map disease extent. This article discusses at length the evidence and decision-making process of various modalities to treat skeletal metastasis. The modalities range from radiation including image-guided, stereotactic and whole body radiation, systemic targeted or hormonal therapy, spinal decompression with or without stabilization, extended curettage with stabilization, resection in select cases with megaprosthetic or biological reconstruction, percutaneous procedures using radio frequency ablation, cementoplasties and discusses the role of emerging modalities like high frequency ultrasound-guided ablation, cryotherapy and whole body radionuclide therapy. The focus lies on the role of multidisciplinary care, which considers complex decisions on patient centric prognosis, comorbidities, cost, feasibility and expectations in order to maximize outcomes on QOL issues.
Full Text Available Abstract Background The duty of a doctor to take care presumes the person who offers medical advice and treatment to unequivocally possess the skills and knowledge to do so. However, a sense of responsibility cannot be guaranteed in the absence of accountability, which in turn requires a comprehensive medical law system to be in place. Such a system is almost non-existent in Pakistan. Keeping the above in mind, we designed this study to assess the knowledge, attitudes and practices of surgeons regarding malpractice at a tertiary care center in Pakistan. Methods This was an observational, cross-sectional, questionnaire-based study conducted during a three month period from 31st March, 2012 to 30th June, 2012 at Civil Hospital, Karachi. Surgeons who were available during the period of our study and had been working in the hospital for at least 6 months were included. Self-administered questionnaires were distributed after seeking informed, written consent. The specialties included were general surgery, cardiothoracic surgery, neurosurgery, ophthalmology, otolaryngology, plastic surgery, pediatric surgery, orthopedic surgery, oral and maxillofacial surgery and gynecology and obstetrics. The study questionnaire comprised of four sections. The first section was concerned with the demographics of the surgeons. The second section analyzed the knowledge of the respondents regarding professional negligence and malpractice. The third section assessed the attitudes surgeons with regard to malpractice. The last section dealt with the general and specific practices and experiences of surgeons regarding malpractice. Results Of the 319 surgeons interviewed, 68.7% were oblivious of the complete definition of malpractice. Leaving foreign objects inside the patient (79.6% was the most commonly agreed upon form of malpractice, whereas failure to break news in entirety (43.9% was most frequently disagreed. In the event of a medical error, majority (67.7% were ready
Carstensen, Lena; Rose, Michael; Bentzon, Niels;
surgeons and 22 plastic surgeons; the response rate was 67%. All breast surgery units had an established cooperation with plastic surgeons. Most breast surgeons used unilateral displacement techniques; plastic surgeons also included breast reduction techniques and replacement with local flaps. Almost all......INTRODUCTION: More than 4,000 Danish women are diagnosed with operable breast cancer annually, and 70% receive breast conserving surgery. Without the use of oncoplastic surgery (OPS), 20-30% will get an unsatisfactory cosmetic result. The aim of this study was to illustrate the level...
Winship, Brenton; Grisell, Margaret; Yang, Carolyn B.; Chen, Rachel X.; Bauer, Andrea S.
Background Many patients use the Internet for health information. However, there are few guarantees to the reliability and accuracy of this information. This study examined the quality and content of Internet webpages for ten common pediatric orthopedic diagnoses. Methods We identified ten common diagnoses in pediatric orthopedics: brachial plexus injury, cerebral palsy, clubfoot, developmental dysplasia of the hip, leg length discrepancy, osteochondroma, polydactyly, scoliosis, spina bifida, and syndactyly. We used two of the most popular search engines to identify the top ten websites for each disease. We evaluated the websites utilizing both the quality-based Health On the Net Foundation criteria and our own content-based grading sheets. The custom grading sheets focused on essential information about disease summary, pathogenesis, diagnosis, treatment, and prognosis. Results Three Orthopedic surgeons graded 98 academic, commercial, non-profit and physicians’ websites for ten diseases. Academic websites scored the highest in content (mean 60.8%±15.5), while commercial websites scored the lowest (mean 46.7%±22.2). Among the diagnoses, osteochondroma websites had the highest content scores (mean 75.8%±11.8), while polydactyly websites had the lowest content scores (mean 39.3%±15.7). In contrast, websites about developmental dysplasia of the hip had the highest HON scores (65.0±11.1), while those about brachial plexus birth palsy scored the lowest (42.6%±16.9). Among the content subgroups, scores were generally higher for disease summary and diagnostics and lower for prognosis. Conclusions The Internet websites reviewed demonstrated a wide range of content and information. We found that non-profit and academic websites were the most reliable sources while commercial and, surprisingly, physician-run websites were the least reliable. We advise physicians to talk with their patients about the information they get on Internet and how it dictates their
Ball, Nicholas M.; Schade, D.; Astronomy Data Centre, Canadian
The Canadian Astronomy Data Centre (CADC) is the world's largest astronomical data center, holding over 0.5 Petabytes of information, and serving nearly 3000 astronomers worldwide. Its current data collections include BLAST, CFHT, CGPS, FUSE, Gemini, HST, JCMT, MACHO, MOST, and numerous other archives and services. It provides extensive data archiving, curation, and processing expertise, via projects such as MegaPipe, and enables substantial day-to-day collaboration between resident astronomers and computer specialists. It is a stable, powerful, persistent, and properly supported environment for the storage and processing of large volumes of data, a condition that is now absolutely vital for their science potential to be exploited by the community. Through initiatives such as the Common Archive Observation Model (CAOM), the Canadian Virtual Observatory (CVO), and the Canadian Advanced Network for Astronomical Research (CANFAR), the CADC is at the global forefront of advancing astronomical research through improved data services. The CAOM aims to provide homogeneous data access, and hence viable interoperability between a potentially unlimited number of different data collections, at many wavelengths. It is active in the definition of numerous emerging standards within the International Virtual Observatory, and several datasets are already available. The CANFAR project is an initiative to make cloud computing for storage and data-intensive processing available to the community. It does this via a Virtual Machine environment that is equivalent to managing a local desktop. Several groups are already processing science data. CADC is also at the forefront of advanced astronomical data analysis, driven by the science requirements of astronomers both locally and further afield. The emergence of 'Astroinformatics' promises to provide not only utility items like object classifications, but to directly enable new science by accessing previously undiscovered or intractable
Nayyar, Rishi; Yadav, Siddharth; Singh, Prabhjot; Dogra, Prem Nath
Introduction: It is believed that the outcomes of robotic surgery depends not only on the experience of the console surgeon but also the patient-side assistant. However, objective data supporting it is lacking. The aim of this study was to objectively determine change in operative outcomes with increasing experience of patient-side assistant. Materials and Methods: We performed a retrospective analysis of 222 urologic robotic procedures performed by two teams of surgeon-assistant and split the data into two chronological halves according to date of surgery. We considered that the assistant was inexperienced in the 1st half and had become experienced by the 2nd half, and we compared mean operative time and blood loss between these two halves of his experience. Results: We observed that with increasing experience of the assistant, the mean operative time reduced from 138.06 to 124.32 min (P = 0.001) and mean blood loss decreased from 191.93 to 187.61 ml (P = 0.57). On subset analysis, a consistent trend of reduction in the mean operative time was noted for both the assistants separately and for all surgical procedures included in the analysis. Maximum reduction was noted for pyeloplasty which was the most commonly performed surgery. The mean blood loss had a varied relation to the experience of the assistant and did not reach statistical significance in either direction. Conclusions: With increasing experience of the patient-side surgeon, the mean operative time for all robotic procedures showed a consistent trend of reduction across all types of surgery with greater reduction for commonly performed procedures. PMID:27555678
Modern English is an international language inthe world.Besides Great Britain,English is spokenas first language in 39 countries.These countries arelocated in different regions with different naturalfeatures,history development and cultural character-istics.Thus,English used in these different regionscarries its own regional character—forming Englishregional varieties.The main English regional varieties are:BritishEnglish,American English,Canadian English andSouth African English.Canada is a rich country inNorth America with its own characteristics,which of
Jalaliniya, Shahram; Pederson, Thomas
The design of general-purpose wearable computers demands particular care for how human perception, cognition, and action work and work together. The authors propose a human body-and-mind centric (egocentric as opposed to device-centric) design framework and present initial findings from deploying...... it in the design of a wearable personal assistant (WPA) for orthopedic surgeons. The result is a Google Glass-based prototype system aimed at facilitating touchless interaction with x-ray images, browsing of electronic patient records (EPR) when on the move, and synchronized ad hoc remote collaboration...
Dalager, Tina; Søgaard, Karen; Bech, Katrine Tholstrup;
, and comparative data on surgeons' physical workload with robotic-assisted laparoscopy and conventional laparoscopy. Studies only describing a single surgical modality were excluded. We applied the checklist, STrengthening the Reporting of OBservational studies in Epidemiology (STROBE), to assess the quality...... fulfilled the criteria of STROBE, with an average score of 13 (range 10-16) out of 18. DISCUSSION: Results, mainly self-reported measures, suggest that robotic-assisted laparoscopy is less strenuous compared with conventional laparoscopy. However, results are limited by the large methodological...
Santore, Matthew T; Islam, Saleem
It is a fundamental value of the surgical profession to improve care for its patients. In the last 100 years, the principles of prospective quality improvement have started to work their way into the traditional method of retrospective case review in morbidity and mortality conference. This article summarizes the history of "improvement science" and its intersection with the field of surgery. It attempts to clarify the principles and jargon that may be new or confusing to surgeons with a different vocabulary and experience. This is done to bring the significant power and resources of improvement science to the traditional efforts to improve surgical care. PMID:26653158
Improvised explosive devices have created a new class of casualties that presents a unique surgical challenge for oral and maxillofacial surgeons. The injury pattern and severity are different from those seen in conventional trauma patients. Because of battlefield circumstances, patients are sometimes delayed significantly in their transport to a trauma center, and they frequently arrive at a trauma center with hypotension, hypothermia, and acidosis. Definitive care is delayed while the hemodynamic status and life-threatening injuries are stabilized. Hospital triage protocols must be well established in advance to prepare a timely response to the mass casualty event. Proper resource use is an ever-evolving challenge for hospital staff during these times.
Full Text Available In the article, the problem of Canadian lifelong education development has been studied. The main objectives of the article are defined as theoretical analysis of scientific and pedagogical literature which highlights different aspects of the research problem; periods of lifelong education development; and determination of lifelong learning role and importance in modern Canadian society.
Laye, Adele M.; Mykota, David B.
Exposure to physical violence is an unfortunate reality for many Canadian youth as it is associated with numerous negative psychosocial effects. The study aims to assist in understanding resilience in rural Canadian youth exposed to physical violence. This is accomplished by identifying the importance of protective factors, as measured by the…
Pink, G H; Knotts, U A; Parrish, L G; Shields, C A
The Canadian Hospital Executive Simulation System (CHESS) is a computer-based management decision-making game designed specifically for Canadian hospital managers. The paper begins with an introduction on the development of business and health services industry-specific simulation games. An overview of CHESS is provided, along with a description of its development and a discussion of its educational benefits. PMID:10109530
Full Text Available This paper sums up the applications of Statistical model such as ARIMA family timeseries models in Canadian lynx data time series analysis and introduces the method of datamining combined with Statistical knowledge to analysis Canadian lynx data series.
This paper presents a detailed description of calcaneal fractures, which are underestimated and neglected despite their relatively high frequency. In association with significant anatomic destruction of the calcaneus they lead to unsatisfactory results of fracture treatment. Radiographic features of a healthy calcaneal bone together with pathomechanism and radiographic attributes of most common fracture types are presented. The prognostic role of the posterior talo-calcaneal joint and extraarticular anatomy of the calcaneus are emphasized. Special attention is directed to the methods of calcaneal imaging, especially the most valuable in the authors opinion - lateral radiographic view and computed tomography. Other commonly used views: axial, antero-posterior or Broden, are also described, with explanation why they are rarely recommended. The widely used standard classification system for calcaneal fractures introduced by Sanders, based on computed tomography is presented. Correct x-ray imaging is the basis for further diagnostic workup and treatment, giving also valuable prognostic information. The orthopedic surgeon, who undertakes the difficult task of treating the broken calcaneus receives thorough information about bone damage, which helps to realize the consequences of injury and of possible negligence. According to the authors experience, problems discussed in this paper are rarely fully appreciated by radiologists and orthopedic surgeons resulting in, often, catastrophic consequences. (author)
Errani, C., E-mail: firstname.lastname@example.org [Department of Orthopaedic Oncology, Istituto Ortopedico Rizzoli, Bologna (Italy); Kreshak, J., E-mail: email@example.com [Department of Orthopaedic Oncology, Istituto Ortopedico Rizzoli, Bologna (Italy); Department of Pathology, Istituto Ortopedico Rizzoli, Bologna (Italy); Ruggieri, P., E-mail: firstname.lastname@example.org [Department of Orthopaedic Oncology, Istituto Ortopedico Rizzoli, Bologna (Italy); Alberghini, M., E-mail: email@example.com [Department of Pathology, Istituto Ortopedico Rizzoli, Bologna (Italy); Picci, P., E-mail: firstname.lastname@example.org [Department of Pathology, Istituto Ortopedico Rizzoli, Bologna (Italy); Department of Research, Istituto Ortopedico Rizzoli, Bologna (Italy); Vanel, D., E-mail: email@example.com [Department of Pathology, Istituto Ortopedico Rizzoli, Bologna (Italy); Department of Research, Istituto Ortopedico Rizzoli, Bologna (Italy)
The appropriate diagnosis and treatment of bone tumors requires close collaboration between different medical specialists. Imaging plays a key role throughout the process. Radiographic detection of a bone tumor is usually not challenging. Accurate diagnosis is often possible from physical examination, history, and standard radiographs. The location of the lesion in the bone and the skeleton, its size and margins, the presence and type of periosteal reaction, and any mineralization all help determine diagnosis. Other imaging modalities contribute to the formation of a diagnosis but are more critical for staging, evaluation of response to treatment, surgical planning, and follow-up.When necessary, biopsy is often radioguided, and should be performed in consultation with the surgeon performing the definitive operative procedure. CT is optimal for characterization of the bone involvement and for evaluation of pulmonary metastases. MRI is highly accurate in determining the intraosseous extent of tumor and for assessing soft tissue, joint, and vascular involvement. FDG-PET imaging is becoming increasingly useful for the staging of tumors, assessing response to neoadjuvant treatment, and detecting relapses.Refinement of these and other imaging modalities and the development of new technologies such as image fusion for computer-navigated bone tumor surgery will help surgeons produce a detailed and reliable preoperative plan, especially in challenging sites such as the pelvis and spine.
Akinfenwa T Atanda
Full Text Available Background: In the changing world of clinicopathologic practice where surgeons and pathologists are faced with increasing therapeutic demands, precise demands of each group from the other have often been reduced to blames and counter-blames. This study is thus aimed at auditing the current practice of specimen handling as a means of highlighting areas where mutual best practice is required. Materials and Methods: A total of 200 specimens and 100 separate request cards received over the 3 months were audited for: Use of fixative, adequacy of fixative used, types of specimen containers and appropriate labeling of containers. The request cards were audited for: Documentation of patients′ hospital numbers, ages, histories of disease, sites of biopsy, examination findings, investigations done, provisional diagnosis and concordance of clinical diagnosis with histopathological diagnosis. Results: About 20% of specimens were unfixed, 23.5% had inadequate fixative, 16.5% were in inappropriate containers and 32.5% were incompletely labeled respectively. In 25%, 50% and 53% of forms the age, clinical history and examination findings respectively were not documented. Provisional diagnosis was in concordance with eventual histological diagnosis in 69% of cases. Conclusion: To ensure the quality of histopathological diagnosis with minimal turnaround time, the surgeon plays a vital role by ensuring adequate and prompt fixation of tissue biopsies, put in the right container and accompanied by well labeled request cards.
John Finney (1863–1942) was born near Natchez, Mississippi. After receiving his medical degree from Harvard, he interned at Massachusetts General Hospital and then went to Baltimore to become one of the first interns at the new Johns Hopkins Hospital. He met William Osler the day the hospital opened and became a lifelong admirer of “the Chief.” Finney specialized in gastrointestinal surgery and was recognized for his expertise in the field. Osler recommended Finney to a physician colleague, writing, “You could not be in better hands…. Finney has been most successful and his judgment is so good.” Finney served for 33 years under William Halsted at Hopkins. After Halsted's death, Finney was offered the chair of surgery at Johns Hopkins but declined. He was a founder and first president of the American College of Surgeons. He also served as president of the American Surgical Association and the Society of Clinical Surgery. Finney became chief surgical consultant for the Allied Expeditionary Forces in World War I. He was decorated by the United States, France, and Belgium. Finney was a master surgeon and a role model for generations of students and physicians. PMID:26722185
Stone, Marvin J
John Finney (1863-1942) was born near Natchez, Mississippi. After receiving his medical degree from Harvard, he interned at Massachusetts General Hospital and then went to Baltimore to become one of the first interns at the new Johns Hopkins Hospital. He met William Osler the day the hospital opened and became a lifelong admirer of "the Chief." Finney specialized in gastrointestinal surgery and was recognized for his expertise in the field. Osler recommended Finney to a physician colleague, writing, "You could not be in better hands…. Finney has been most successful and his judgment is so good." Finney served for 33 years under William Halsted at Hopkins. After Halsted's death, Finney was offered the chair of surgery at Johns Hopkins but declined. He was a founder and first president of the American College of Surgeons. He also served as president of the American Surgical Association and the Society of Clinical Surgery. Finney became chief surgical consultant for the Allied Expeditionary Forces in World War I. He was decorated by the United States, France, and Belgium. Finney was a master surgeon and a role model for generations of students and physicians. PMID:26722185
Pribitkin, E D; Boger, G
Herbal medicine (phytomedicine) uses remedies possessing significant pharmacological activity and, consequently, potential adverse effects and drug interactions. The explosion in sales of herbal therapies has brought many products to the marketplace that do not conform to the standards of safety and efficacy that physicians and patients expect. Unfortunately, few surgeons question patients regarding their use of herbal medicines, and 70% of patients do not reveal their use of herbal medicines to their physicians and pharmacists. All surgeons should question patients about the use of the following common herbal remedies, which may increase the risk of bleeding during surgical procedures: feverfew, garlic, ginger, ginkgo, and Asian ginseng. Physicians should exercise caution in prescribing retinoids or advising skin resurfacing in patients using St John's wort, which poses a risk of photosensitivity reaction. Several herbal medicines, such as aloe vera gel, contain pharmacologically active ingredients that may aid in wound healing. Practitioners who wish to recommend herbal medicines to patients should counsel them that products labeled as supplements have not been evaluated by the US Food and Drug Administration and that no guarantee of product quality can be made. PMID:11368667
The application of minimally invasive techniques in treating orthopaedic trauma includes two aspects: on the one hand, minimally invasive technique is an effective means of damage control orthopaedics in the treatment of patients with serious multiple traumatic injuries, aiming to reduce surgical morbidity, improve postoperative care and rehabilitation; on the other hand, minimally invasive technique is widely used in the treatment of fractures around the joints, pelvic and acetabular fractures, spine fracture, with advantages of minor operation injury,smaller incision ,less muscle rupture ,lower bone blood supply damage, better local hematoma protection, rapid fracture recovery. Minimally invasive technique is not a concept that it possesses lower operational risk, more easy operation procedure, and smaller incision. The surgeon should grasp the concept and operation indications, learn and improve the surgical methods.%创伤骨科中微创技术的应用包括两方面的内容,一方面,在严重多发伤病人的骨折治疗中,微创外科技术可被作为损害控制骨科的有效手段,以降低早期确定性手术治疗的死亡率,创伤越严重,越应该受益于该技术;另一方面,微创技术广泛应用于关节周围骨折、骨盆和髋臼骨折、脊柱骨折等,以更小的创伤达到与传统骨折治疗相同或更佳的疗效,病人受益于更小的切口,更少的肌肉损伤,更低的骨血供破坏,更好的骨折端血肿保护,骨折愈合加速,病人恢复加快.关于创伤骨科微创技术,仍然有很多需要研究学习之处,也对创伤骨科医师提出了更高的要求.微创并不意味着手术危险性的降低和操作更容易,也不能简单理解为"小切口",应正确理解其理念,掌握手术适应证,学习和改善手术方法.
Samsson, Karin S.; Bernhardsson, Susanne; Larsson, Maria E. H.
Background Physiotherapist-led orthopaedic triage, where physiotherapists diagnose and determine management plans, aims to enhance effectiveness and provide the best care. However, scientific evidence for the effectiveness of this model of care remains limited, and there are few studies reporting on patients’ perceptions of the care provided. The purpose of this study was to evaluate patients’ perceived quality of care in a physiotherapist-led orthopaedic triage in primary care, compared with...
O’Connor, Bonnie; Pollner, Fran; Fugh-Berman, Adriane
Background Industry payments to surgeons have received public attention, but little is known about the relationships between surgeons and medical device representatives. Medical device representatives ("device reps") have become an integral part of operating room personnel. The effect of their presence on patient care deserves discussion. Study Design We conducted a qualitative, ethnographic study to explore relationships between surgeons and medical device representatives, and characterize industry involvement in the training of surgeons. We used group and individual open-ended interviews to gain insight into the beliefs, values, and perspectives of surgeons and device reps. We conducted two focus groups, one with ear, nose, and throat surgeons, and one with hospital-based attending orthopedic surgeons. We also conducted individual interviews with three former or current medical device representatives, a director of a surgical residency program at an academic medical center, and a medical assistant for a multi-physician orthopedic practice. Results While surgeons view themselves as indisputably in charge, device reps work hard to make themselves unobtrusively indispensable in order to establish and maintain influence, and to imbue the products they provide with personalized services that foster a surgeon's loyalty to the reps and their companies. Surgeons view industry-funded training opportunities as a necessary service. Device reps and some surgeons believe that reps benefit patient care, by increasing efficiency and mitigating deficiencies among operating room personnel (including the surgeons themselves). Conclusions Our study raises ethical questions about the reliance of surgeons on device reps and device companies for education and surgical assistance and practical concerns regarding existing levels of competence among OR personnel. PMID:27486992
Naseem, Haris; Wall, Alun P; Sangster, Marshall; Paton, Robin W
Rickets is a potentially treatable disease of the bone that is most commonly due to deficiency of vitamin D and is increasing in incidence in developed countries. Risk factors include dietary factors, the practice of covering up and darker skin pigmentation. This small retrospective case study set out to examine all cases of rickets presenting to the Paediatric Orthopaedic clinic over a 15-month period. Rickets presented in a bimodal fashion in the 6 cases identified: in males and females aged 3 or less and female adolescents aged 10 and above. This is in keeping with what is known regarding the rapid phases of growth during development. Five cases were from ethnic minority groups. Both female adolescents presented with genu valgum. Rickets can present primarily to Orthopaedic clinics with vague musculoskeletal symptoms. We recommend that biochemical screening be performed on patients from ethnic minorities who may be 'at risk'.
Buck, Thomas Croft; Brandstrup, Lene; Brandslund, Ivan;
OBJECTIVE: To assess the effects and cost effects of introducing clinical pharmacists on hospital wards. METHODS: Comparative prospective study on four orthopaedic surgical wards in two hospitals. The primary effect variables were 10 target areas widely considered to be indicators of good...... sub-optimal prescriptions were changed, 43% resulted in cost reductions. The reductions achieved could cover 47% of the costs of clinical pharmacy service. CONCLUSION: Clinical pharmacy services offered to four orthopaedic surgical wards resulted in reduction of sub-optimal prescriptions. Every time...... the pharmacist screened seven patients one sub-optimal prescription was found and adjusted. The reduction in medicine costs due to adjusted sub-optimal prescriptions could not cover the whole cost of clinical pharmacy service....
Sikimić, L B; Blagojević, Z B; Radojević, B B; Mancić, N Z; Djurić, M; Jovanović, Z D
Postoperative saving of drainage blood presents postoperative autologous transfusion and that means group of action of collection patients blood and its late reinfision. The conditions of orthopaedic surgery join with arthroplasty of coxae and knee are connected with signicifant loss of blood (800-1200 ml). With the aim of reducing the need for use of heterologous blood and elimination of potentional risks because of her application, we investigate the possibility of application the system of posteoperative saving of drainage blood in the study group of 48 patients in relation of control group of 25 patients. Postoperative blood saving has been derived after the first 4-8 hours, after the and of surgical operation. In the study group only 4 patients (8%) need additional heterologous transfusions. Postoperative blood saving and its reinfusion have not significant effect at hemostasis and sistem of coagulation. During six months postoperative, no patients in the study group have not any complication after orthopaedic surgery. PMID:17688045
Ruud P. van Hove
Full Text Available Surfaces of medical implants can be enhanced with the favorable properties of titanium-nitride (TiN. In a review of English medical literature, the effects of TiN-coating on orthopaedic implant material in preclinical studies were identified and the influence of these effects on the clinical outcome of TiN-coated orthopaedic implants was explored. The TiN-coating has a positive effect on the biocompatibility and tribological properties of implant surfaces; however, there are several reports of third body wear due to delamination, increased ultrahigh molecular weight polyethylene wear, and cohesive failure of the TiN-coating. This might be due to the coating process. The TiN-coating process should be optimized and standardized for titanium alloy articulating surfaces. The clinical benefit of TiN-coating of CoCrMo knee implant surfaces should be further investigated.
Full Text Available The aim of this study was to find out the possibility to predict the compression properties of orthopaedic knits by inlay-yarn properties. For this purpose, six groups of elastic double covered threads with different raw material were investigated. It was established that in area of low elongation, the covering threads practically don't have significant influence on tensile force values. Also results demonstrate that by increasing the number of tested threads, the elongation value has a higher impact on tensile force. The influence of linear density of elastic PU core on tensile force increases by increasing elongation value of threads. When influence of inlay-yarn linear density and number of threads on tensile force is determined it is possible to predict influence of inlay-yarn properties on compression properties of knitted orthopaedic supports. DOI: http://dx.doi.org/10.5755/j01.ms.20.3.4048
Fernández, Luis G
Traditionally, the surgical approach to managing abdominal injuries was to assess the extent of trauma, repair any damage and close the abdomen in one definitive procedure rather than leave the abdomen open. With advances in medicine, damage control surgery using temporary abdominal closure methods is being used to manage the open abdomen (OA) when closure is not possible. Although OA management is often observed in traumatic injuries, the extension of damage control surgery concepts, in conjunction with OA, for the management of the septic patient requires that the general surgeon who is faced with these challenges has a comprehensive knowledge of this complex subject. The purpose of this article is to provide guidance to the acute care and general surgeon on the use of OA negative pressure therapy (OA-NPT; ABTHERA™ Open Abdomen Negative Pressure Therapy System, KCI, an ACELITY Company, San Antonio, TX) for OA management. A literature review of published evidence, clinical recommendations on managing the OA and a case study demonstrating OA management using OA-NPT have been included. PMID:27547961
Rishiram Poudel; Venkatesan Sampath Kumar; Ashok Kumar; Shah Alam Khan
Background: Factors influencing publication of manuscripts in reputed journals have never been studied to the best of our knowledge. This study was conducted to evaluate the trend in publication within the Indian Journal of Orthopaedics (IJO). Materials and Methods: A cross-sectional study was conducted by accessing the online database of the IJO. All the issues available online were included. Published articles were classified into one of the following thirteen categories: (i) Basic Scie...
Arun Vashisht; Avinash Rastogi
Background: Myths in the field of medicine regarding the treatment of health problems are frequently observed, which may not only retard the recovery but often be harmful for the patients. We were baffled to see lot of patients under the influence of certain myths about treatment of their orthopaedic ailments. The aim of this observational, prospective study was to dispel the misconceptions and to create awareness in the society about the bad effects of these myths. Methods: 1285 patients...
Evans, Jonathan; Saxby, Clair; Armstrong, Alexander
A Trust level audit demonstrated that the trauma and orthopaedic department did not reach its own standards in adhering to Trust antibiotic prescribing guidelines. Junior doctors are the main prescribers of antibiotics during inpatient stays. Local policy states that for all inpatients on antibiotics, the start date, duration, and indication for antibiotics must be documented on the drug card. Each patient drug card was reviewed by the department pharmacist and it was recorded whether the doc...
Tai, Siu-king, Rosetti; 戴筱荊
Constipation is a multifactorial digestive disorder highly prevailing among the hospitalized elderly Orthopaedic patients. Unlike Western countries, laxative therapy is used to be the first line remedy for constipation in many hospitals of Hong Kong although fiber-rich diet has been proven by numerous studies as the best alternative with low cost and less complications. This dissertation is a translational nursing research which aims at formulating a programme of using fiber-rich food pro...
Karlakki, S.; Brem, M.; Giannini, S.; Khanduja, V.; Stannard, J; R. Martin
Objectives The period of post-operative treatment before surgical wounds are completely closed remains a key window, during which one can apply new technologies that can minimise complications. One such technology is the use of negative pressure wound therapy to manage and accelerate healing of the closed incisional wound (incisional NPWT). Methods We undertook a literature review of this emerging indication to identify evidence within orthopaedic surgery and other surgical disciplines. Liter...
Albert, K; Schledjewski, R; Harbaugh, M; Bleser, S; Jamison, R; Friedrich, K
Carbon fiber/PEEK polymer (C/PEEK) composite materials are being developed for use as orthopaedic implant materials. Wear is an issue of increasing importance in orthopaedic implants; particulate debris generated by the wearing of biomaterials may be a causal factor leading to osteolysis and implant loosening. Therefore, numerical and experimental studies were completed to characterize the wear of C/PEEK composite materials in comparison to current orthopaedic implant materials. Finite element analyses (FEA) of a composite material hip stem implanted in a femur and loaded at 890 N determined that peak contact stresses will occur at the proximal-medial and distal regions of the implant. These contact stresses were found to be below 1.0 MPa over most of the implant surface; however the peak stress in the proximal-medial region was 1.8 MPa and higher still at the distal portion of the stem. In vivo forces result in contact stress values up to 9.0 MPa. The composite implant exhibited 10-40% lower contact stresses in the distal region compared to a titanium-alloy implant of identical design. Composite material wear samples were slid against porous hydroxylapatite (HA) to simulate the stem/bone interface. An identical series of experiments was run for comparison to a current orthopaedic implant material--Ti6A14V titanium alloy. Two domains of motion were studied; a composite ring-on-HA disc large amplitude sliding wear test; and a composite pin-on-HA disc small amplitude fretting regimen. Nominal contact pressures during testing were 1.4 MPa and 7.6 MPa for sliding and fretting tests, respectively. Fretting and sliding abrasive wear tests resulted in the composite material exhibiting a lower wear rate than the titanium-alloy. The magnitude of the difference was greatly dependent on the contact pressures, sliding amplitudes, and counterface material properties.
Schilling, Lisa; Forst, Raimund; Forst, Jürgen; Fujak, Albert
Background Myotonic Dystrophy Type 1 (DM1) is the most common form of hereditary myopathy presenting in adults. This autosomal-dominant systemic disorder is caused by a CTG repeat, demonstrating various symptoms. A mild, classic and congenital form can be distinguished. Often the quality of life is reduced by orthopaedic problems, such as muscle weakness, contractures, foot or spinal deformities, which limit patients’ mobility. The aim of our study was to gather information about the o...
Lampe, Renée; Mitternacht, Jürgen; Schrödl, Silvia; Gerdesmeyer, Ludger; Natrath, Michaela; Gradinger, Reiner
In our gait laboratory, the gait pattern of 18 youths with neurogenic foot deformities as a result of spina bifida or cerebral palsy was examined. The influence of technical orthopaedic devices for the foot and ankle on kinematics and kinetics of the gait and especially of the knee joint were analyzed. Kinematic data were derived from 3D-video analysis, kinetic data from force plates and pressure distribution plates. Muscle activities were measured with eight-channel EMG. The data were examined to see if there were differences when using the technical devices. All patients had already been supported externally with the different devices like orthopaedic shoes, insoles, Nancy Hilton orthoses and orthoses for the lower leg extremity. The devices restricted to the foot and the ankle joint improved the feeling of gait stability of the patients. In this investigation, the different supports had various but little effects on the kinematics and kinetics of the knee joint, depending on the type of orthoses used and the kind of handicap of the youths. Because of the great expenditure, the data obtained in this study were taken from a small number of patients. Therefore, they are individual findings and are of restricted general significance.
Full text: Canada operates a publicly funded health care system in which 70% of health care costs are paid by some level of government. Radiotherapy, indeed most cancer management, falls within the publicly funded realm of Canada's health care system. National legislation (the Canada Health Act) guarantees access to cancer services for all Canadians. However, the financial responsibility for these services is borne by the provinces. Most Canadian provinces manage the cancer management problem through central cancer agencies. In the past few decades, these provincial cancer agencies have formed the Canadian Association of Provincial Cancer Agencies (CAPCA). This association has adopted a broad mandate for cancer management in Canada (see www.capca.ca). Included in this mandate is the adoption of standards and guidelines for all aspects of cancer control. The complexity of radiation therapy has long underscored the need for cooperation at the international and national levels in defining programmes and standards. In recent decades formal quality assurance programme recommendations have emerged in the United States, Europe and Great Britain. When defining quality assurance programs, Canadian radiation treatment centres have referenced U.S. and other program standards since they have been available. Recently, under the leadership of the Canadian Association of Provincial Cancer Agencies (CAPCA), Canadian national quality assurance program recommendations are emerging. A CAPCA sponsored project to harmonize Canadian quality assurance processes has resulted in a draft document entitled 'Standards for Quality Assurance at Canadian Radiation Treatment Centres'. This document provides recommendations for the broad framework of radiation therapy quality assurance programs. In addition, detailed work is currently underway regarding equipment quality control procedures. This paper explores the historical and political landscape in which the quality assurance problem has
Greer, Andrew I M; Lim, Teoh S; Brydone, Alistair S; Gadegaard, Nikolaj
Sol-gel processing is an attractive method for large-scale surface coating due to its facile and inexpensive preparation, even with the inclusion of precision nanotopographies. These are desirable traits for metal orthopaedic prostheses where ceramic coatings are known to be osteoinductive and the effects may be amplified through nanotexturing. However there are a few concerns associated with the application of sol-gel technology to orthopaedics. Primarily, the annealing stage required to transform the sol-gel into a ceramic may compromise the physical integrity of the underlying metal. Secondly, loose particles on medical implants can be carcinogenic and cause inflammation so the coating needs to be strongly bonded to the implant. These concerns are addressed in this paper. Titanium, the dominant material for orthopaedics at present, is examined before and after sol-gel processing for changes in hardness and flexural modulus. Wear resistance, bending and pull tests are also performed to evaluate the ceramic coating. The findings suggest that sol-gel coatings will be compatible with titanium implants for an optimum temperature of 500 °C.
Cox, P J; Clarke, N M
The patterns, management and outcome of non-fatal orthopaedic injury in childhood was audited over a 1 year period in Southampton. A computer-based audit (1 September 1993 to 31 August 1994) was conducted of all children aged under 15 years who were admitted to the orthopaedic unit after accidental injury. Management was audited by studying the primary conservative and operative treatment methods employed. Treatment outcome was evaluated in terms of need for secondary operative treatment, salvage internal fixation, length of hospital stay and unplanned readmission. In all, 398 children, representing 50/10,000 of the local paediatric population, were admitted with a traumatic injury. There was a significant (P internal fixation procedures were performed as 'salvage' after failure of conservative treatment, entailing either reoperation during the initial admission or a further unplanned readmission. 3 A prolonged inpatient stay for patients with femoral fractures owing to a wide variation in treatment method. The outcome of non-fatal orthopaedic injury can be improved through the selective use of primary internal fixation of distal radial and humeral fractures and the close adherence to a management algorithm in femoral fractures. There may be a role for more specialised supervision of primary treatment of these particular fractures. PMID:9422873
Anderson, Julie; Perry, Heather R
This article offers a comparative analysis of the evolution of orthopaedics and rehabilitation within German and British military medicine during the Great War. In it, we reveal how the field of orthopaedics became integral to military medicine by tracing the evolution of the discipline and its practitioners in each nation during the war. In doing so, however, we document not only when and why both medical specialists and military officials realized that maintaining their respective national fighting forces depended upon the efficient rehabilitation of wounded soldiers, but also how these rehabilitative practices and goals reflected the particularities of the military context, civilian society and social structure of each nation. Thus, while our comparison reveals a number of similarities in the orthopaedic developments within each nation as a response to the Great War, we also reveal significant national differences in war-time medical goals, rehabilitation treatments and soldierly 'medical experiences'. Moreover, as we demonstrate, a social and cultural re-conceptualization of the disabled body accompanied the medical advancements developed for him; however, this re-conceptualization was not the same in each nation. Thus, what our article reveals is that although the guns of August fell silent in 1918, the war's medical experiences lingered long thereafter shaping the future of disability medicine in both nations.
Full Text Available Magnesium (Mg-based biodegradable materials are promising candidates for the new generation of implantable medical devices, particularly cardiovascular stents and orthopaedic implants. Mg-based cardiovascular stents represent the most innovative stent technology to date. However, these products still do not fully meet clinical requirements with regards to fast degradation rates, late restenosis, and thrombosis. Thus various surface coatings have been introduced to protect Mg-based stents from rapid corrosion and to improve biocompatibility. Similarly, different coatings have been used for orthopaedic implants, e.g., plates and pins for bone fracture fixation or as an interference screw for tendon-bone or ligament-bone insertion, to improve biocompatibility and corrosion resistance. Metal coatings, nanoporous inorganic coatings and permanent polymers have been proved to enhance corrosion resistance; however, inflammation and foreign body reactions have also been reported. By contrast, biodegradable polymers are more biocompatible in general and are favoured over permanent materials. Drugs are also loaded with biodegradable polymers to improve their performance. The key similarities and differences in coatings for Mg-based stents and orthopaedic implants are summarized.
Nayak, Soumyaranjan; Bhushan, Bharat; Jayaganthan, R; Gopinath, P; Agarwal, R D; Lahiri, Debrupa
Magnesium is presently attracting a lot of interest as a replacement to clinically used orthopaedic implant materials, due to its ability to solve the stress shielding problems, biodegradability and osteocompatibility. However, the strength of Mg is still lower than the requirement and it becomes worse after it starts degrading fast, while being exposed in living body environment. This research explores the effectiveness of 'grain refinement through deformation', as a tool to modify the strength (while keeping elastic modulus unaffected) of Mg based alloys in orthopaedic application. Hot rolled Mg-3wt% Zn alloy (MZ3) has been investigated for its potential in orthopaedic implant. Microstructure, mechanical properties, bio-corrosion properties and biocompatibility of the rolled samples are probed into. Grain size gets refined significantly with increasing amount of deformation. The alloy experiences a marked improvement in hardness, yield strength, ultimate tensile strength, strain and toughness with finer grain size. An increment in accelerated corrosion rate is noted with decreasing grain size, which is correlated to the increased grain boundary area and mechano-chemical dissolution. However, immersion test in simulated body fluid (SBF) reveals reduction in corrosion rate after third day of immersion. This was possible owing to precipitation of protective hydroxyapatite (HA) layer, formed out of the interaction of SBF and the alloy. More nucleation sites at the grain boundary for fine grained samples help in forming more HA and thus reduce the corrosion rate. Human osteosarcoma cells show less viability and adhesion on grain refined alloy. PMID:26745721
The aim of this study was to define a correlation between the incidence of orthopaedic injuries and the skeletal maturity, radiologically assessed, in a group of 23 standardbred horses. Starting at 18 months of age, radiograms of calcaneus and distal radial physis were taken at two months intervals, until X-ray evidence of closure. All the physis were blindly graded as: C: open physis; B-: initial evidence of central closure; B: partially closed physis; B+: full closure of the central portion of the physis; A: closed physis. Based on this classification, the horses were grouped as I (immature subject - C, B- and B), or M (mature subject - B+ and A). Orthopaedic injuries were classified as major lesion, if causing prolonged or definitive interruption of training, or minor, if causing brief or no interruption of training. Estimation of injury incidence in the different groups was calculated using the chi-square test (significance level P0.01). The average ages of physis closure (mean +- SD) were 24.1 +- 2.6 months (range 19-28), for the calcaneal physis, and 28.2 +- 2 months (range 26-33), for the distal radial physis, without significant differences between colts and fillies. In our study, according to a previous report, no correlation between X-ray skeletal maturity and incidence of orthopaedic injuries was demonstrated
Carstensen, Lena Felicia; Rose, Michael; Bentzon, Niels;
surgeons and 22 plastic surgeons; the response rate was 67%. All breast surgery units had an established cooperation with plastic surgeons. Most breast surgeons used unilateral displacement techniques; plastic surgeons also included breast reduction techniques and replacement with local flaps. Almost all......INTRODUCTION: More than 4,000 Danish women are diagnosed with operable breast cancer annually, and 70% receive breast conserving surgery. Without the use of oncoplastic surgery (OPS), 20-30% will get an unsatisfactory cosmetic result. The aim of this study was to illustrate the level...... of implementation of OPS in Denmark. METHODS: An electronic questionnaire was sent to breast and plastic surgeons performing breast cancer treatment. The questionnaire included demographics, education, experience with operative procedures and opinions on OPS. RESULTS: The questionnaire was sent to 50 breast...
Groves, Richard R
The Canadian Forces Dental Services utilizes a dental classification system to identify those military members dentally fit for an overseas deployment where dental resources may be limited. Although the Canadian Forces Dental Services dental classification system is based on NATO standards, it differs slightly from the dental classification systems of other NATO country dental services. Data collected by dental teams on overseas deployments indicate a low rate of emergency dental visits by Canadian Forces members who were screened as dentally fit to deploy. PMID:18277717
Johnson, Mike; Davidson, Jim; Mortensen, Paul
In a relatively new development over just the past few years, shale formations are being targeted for natural gas production. Based on initial results, there may be significant potential for shale gas in various regions of Canada, not only in traditional areas of conventional production but also non-traditional areas. However, there is much uncertainty because most Canadian shale gas production is currently in experimental or early developmental stages. Thus, its full potential will not be known for some time. If exploitation proves to be successful, Canadian shale gas may partially offset projected long-term declines in Canadian conventional natural gas production.
An overview of the various tritium research and operational activities in Canada is presented. These activities encompass tritium processing and recovery, tritium interactions with materials, and tritium health and safety. Many of these on-going activities form a sound basis for the tritium use and handling aspects of the ITER project. Tritium management within the CANDU heavy water reactor, associated detritiation facilities, research and development facilities, and commercial industry and improving the understanding of tritium behaviour in humans and the environment remain the focus of a long-standing Canadian interest in tritium. While there have been changes in the application of this knowledge and experience over time, the operating experience and the supporting research and development continue to provide for improved plant and facility operations, an improved understanding of tritium safety issues, and improved products and tools that facilitate tritium management. (author)
Full Text Available This paper will discuss the existence of a Canadian Political Business Cycle (PBC during the period 1946-1989. Logit analysis was used to determine if changes in the unemployment rate, growth of real GNE and the rate of inflation are significantly different in the period before an election than during the rest of the electoral term. It was found that the rate of growth in the unemployment rate declines and the rate of growth of real GNP increases in the four quarters before an election. The behavior of these variables reverses in the period after an election. These findings are consistent with a political business cycle. Policy variables, under a majority government, also behave in a manner associated with a PBC, with the government stimulating the economy approximately two years into its term so that good economic news will occur before it has to call an election. Minority governments tend to simulate the economy immediately after taking office.
<正>On March 30, "The Chinese Feelings Across the Pacific-The Century Exhibition of the Old Photos Treasured by the Canadians" was open in the Lu Xun Museum in Beijing. The exhibition lasted for one week. At the exhibition some old photos taken in the early 20th century were on display, showing James G. Endicott, envoy of world peace, together with Mao Zedong and Zhou Enlai; the family of O. L. Kilborn, one of the founders of West China Union University, together with Chinese women with bound feet: O. L. Kilborn treating the wounded soldiers during the Revolution of 1911; Leslie Earl Willmott in Chinese tunic suit and his wife reluctant to bid farewell to China, as well as photos of Ashley Woodward Lindesay, founder of China’s modern
Hemmings, R.L. [Canatom NPM (Canada)
An overview of the various tritium research and operational activities in Canada is presented. These activities encompass tritium processing and recovery, tritium interactions with materials, and tritium health and safety. Many of these on-going activities form a sound basis for the tritium use and handling aspects of the ITER project. Tritium management within the CANDU heavy water reactor, associated detritiation facilities, research and development facilities, and commercial industry and improving the understanding of tritium behaviour in humans and the environment remain the focus of a long-standing Canadian interest in tritium. While there have been changes in the application of this knowledge and experience over time, the operating experience and the supporting research and development continue to provide for improved plant and facility operations, an improved understanding of tritium safety issues, and improved products and tools that facilitate tritium management. (author)
Greenhagen, Robert M; Johnson, Adam R; Bevilacqua, Nicholas J
Tobacco cigarette smoking causes many negative effects on the body, and it is the leading preventable cause of death in the United States. These negative effects are a concern for the foot and ankle surgeon, as smoking can increase the risk of diabetes and peripheral artery disease and delay healing of surgical incisions and ulcerations of the lower extremities. Tobacco cigarette smoking can also increase the risk of avascular necrosis and delayed union and nonunions of fractures and osteotomies. Smoking cessation is an important component in the overall treatment of conditions affecting the foot and ankle. Smoking cessation can be a difficult goal to achieve, but proper education and support can help patients reach this goal. PMID:20400436
K. B. Ashok
Full Text Available Echinococcus granulosus causes a zoonotic infection called Cystic Echinococcosis (CE. Surgeons meet with hydatid cysts of the liver and lungs with reasonable frequency. However hydatid cyst may appear in other parts of the body too.A 30 yrs old lady presented with a smooth slow-growing subcutaneous nodule on the anteromedial side of the right thigh with no detectable primary site in the liver or lung. The case subsequently diagnosed as hydatid cyst of muscle and radical surgery was done under coverage of anihelminthic drug.The common practice in this type of case is to do FNAC taking the lesion to be a soft tissue neoplasm. The aim of this case presentation is to make aware of the fact that in a case of diffuse non-tender swelling with history of gradual increase in size hydatid cyst also has to be considered in the differential diagnosis.
Belda Lozano, Ricardo; Ferrer Márquez, Manuel; García Torrecillas, Juan Manuel; Alvarez García, Antonio; Reina Duarte, Angel
Numerous articles and opinions have been published in the last few years on how the Internet is changing clinical practice. In this article we focus on describing 2 aspects that we believe are fundamental in the web 2.0 and Medicine-Surgery inter-relationship: a) web 2.0 conceptualisation and its differences with other pre-existing tools, and b) a description of some of the tools that from a medical-surgical view could be of major interest to the professionals, the patients, and interaction between both. The time has arrived to board train 2.0, where the channels of communication between the professionals, and between them and the patients, are improving disease situations daily, to improve learning through contact with other physicians and surgeons, at the same time providing an excellent resource for maintaining health and to know the disease and its treatment.
Koch, Horst; Dabernig, Jörg; Allert, Sixtus; Puchinger, Markus; Scharnagl, Erwin
To obtain information on the use of the Internet, 3,139 survey forms were sent out to plastic surgeons throughout the world. More than 90% of the 565 respondents have access to the Internet and 85.5% use electronic mail for professional matters. They use the World Wide Web to search the literature, to read scientific articles, and to obtain information on congresses. A substantial proportion of the contributors have a positive attitude toward virtual congresses on the Internet and most would welcome a newsgroup dedicated to plastic surgery. Perceived apprehensions include secure transmission of sensitive data, slow data transmission, and the lack of structure and of an authority to control the contents of the Internet. Virtual congresses and a newsgroup on plastic surgery seem to be worthwhile future goals. Some problems pointed out in this survey have already been solved, at least partially, and possible solutions for the rest are discussed. PMID:12439012
Abdul Rahim Shaik
Full Text Available Aim: To describe the work-related musculoskeletal disorders among on-job dental surgeons. Objectives: To identify the musculoskeletal disorders in terms of perception of pain and stiffness experienced by the dental surgeons due to the rigors of dental work, to determine the prevailing working environment with particular reference to dental work station in relation to musculoskeletal disorders, and to find the association between pain and stiffness experienced by the dental surgeons and the selected socio-demographic variables. Materials and Methods: The study was conducted on 30 graduated dental surgeons having a work experience of 1 year or more, post graduates and faculty members of various specialties at Yenepoya Dental College Hospital, Mangalore. The subjects were selected randomly from the hospital and they were given closed-ended questionnaire to find out perception of pain and stiffness experienced in the past 6 months. The observation of the working environment was done by walk-through observational survey. Results: The study showed that 6.6% dental surgeons always experienced shoulder pain, while 83.3% dental surgeons sometimes experienced back pain and 70% sometimes experienced neck pain. Majority of the dental surgeons (73.3% experienced stiffness in the back and 23.3% experienced severe pain in their neck. It was observed that the number of patients attended per day by the dental surgeons had a significant association (P = 0.024 with the pain they experienced in their hip/thigh region. The frequency of pain experienced by the dental surgeons in the hip/thigh and knee joints also showed a significant association (P = 0.037 with the height of the dental surgeons. Conclusion: The study revealed that various socio-demographic variables contributed to the musculoskeletal disorders experienced by the dental surgeons. However, the number of patients attended per day by the dental surgeons vis-à-vis pain experienced in the back, wrist, and
Tsoucalas, Gregory; Karamanou, Marianna; Piagkou, Maria; Skandalakis, Panagiotis; Androutsos, George
Jean Falcon, an Aragon native, became a famous surgeon at the Faculty of Montpellier. He was a Royal physician, wealthy enough to live a luxurious life and treat influential patients. His lectures were legendary, and his works gave him fame among the surgeons' class. Of all his manuscripts stands the "Guidon", which became an anatomical surgeons' handbook, worthy of reference from the scientific community for centuries.
Whiteley, M. S.; Smith, J J; Galland, R. B.
Subfascial endoscopic perforator vein surgery (SEPS) has recently caused considerable interest among British surgeons. There are no data indicating which, if any, patients benefit from SEPS. A series of 47 British surgeons, identified as having taken up SEPS, were sent a questionnaire asking about their current practice; 26 were returned completed (55% response rate). Of those surgeons replying, 22 (85%) had performed their first SEPS procedure within the previous 21 months, 18 (69%) within t...
Geddes, Jennian F
Louisa Garrett Anderson, daughter of Britain's first woman doctor, has been largely forgotten today despite the fact that her contribution to the women's movement was as great as that of her mother. Recognized by her contemporaries as an important figure in the suffrage campaign, Anderson chose to lend her support through high-profile action, being one of the few women doctors in her generation who risked their professional as well as their personal reputation in the fight for women's rights by becoming a suffragette - in her case, even going so far as to spend a month in prison for breaking a window on a demonstration. On the outbreak of war, with only the clinical experience she had gained as outpatient surgeon in a women's hospital, Anderson established a series of women-run military hospitals where she was a Chief Surgeon. The most successful was the Endell Street Military Hospital in London, funded by the Royal Army Medical Corps and the only army hospital ever to be run and staffed entirely by women. Believing that a doctor had an obligation to take a lead in public affairs, Anderson continued campaigning for women's issues in the unlikely setting of Endell Street, ensuring that their activities remained in the public eye through constant press coverage. Anderson's achievement was that her work played no small part in expunging the stigma of the militant years in the eyes of the public and - more importantly - was largely instrumental in putting women doctors on equal terms with their male colleagues. PMID:18952990
Polk, J. D.; Schmid, Josef; Hurst, Victor, IV; Doerr, Harold K.; Doerr, Harold K.
Introduction: The cohort of NASA flight surgeons (FS) is a very accomplished group with varied clinical backgrounds; however, the NASA Flight Surgeon Office has identified that the extremely demanding schedule of this cohort prevents many of these physicians from practicing clinical medicine on a regular basis. In an effort to improve clinical competency, the NASA FS Office has dedicated one day a week for the FS to receive clinical training. Each week, an FS is assigned to one of five clinical settings, one being medical patient simulation. The Medical Operations Support Team (MOST) was tasked to develop curricula using medical patient simulation that would meet the clinical and operational needs of the NASA FS Office. Methods: The MOST met with the Lead FS and Training Lead FS to identify those core competencies most important to the FS cohort. The MOST presented core competency standards from the American Colleges of Emergency Medicine and Internal Medicine as a basis for developing the training. Results: The MOST identified those clinical areas that could be best demonstrated and taught using medical patient simulation, in particular, using high fidelity human patient simulators. Curricula are currently being developed and additional classes will be implemented to instruct the FS cohort. The curricula will incorporate several environments for instruction, including lab-based and simulated microgravity-based environments. Discussion: The response from the NASA FS cohort to the initial introductory class has been positive. As a result of this effort, the MOST has identified three types of training to meet the clinical needs of the FS Office; clinical core competency training, individual clinical refresher training, and just-in-time training (specific for post-ISS Expedition landings). The MOST is continuing to work with the FS Office to augment the clinical training for the FS cohort, including the integration of Web-based learning.
Full Text Available Background: This study described the current conditions of work of paediatric surgeons in Francophone sub-Saharan Africa (FSSA and set the debate at the level of the humanist thinking in medicine. Patients and Methods: This was a multicentre study from 1 st May to 30 th October 2008. The African Society of paediatric surgeons′ directory was used to identify paediatric surgeons in the Francophone′s countries in Sub Saharan Africa. The parameters studied were number of surgeons per country, means of training, working conditions, remunerations, needs for continuous training and the research. Results: A total of 41 paediatric surgeons (68.33% responded. The average number of paediatric surgeons per country was 5. The means of training included government scholarships among 7 paediatric surgeons (17.07%, scholarship from a non-governmental organisations in 14 (34.15% and self-sponsorships in 20 (48.78%. The average salary was 450 Euros (€ (range: 120-1 400 Euros. Most of the paediatric surgeons (68.29% had internet services for continuous update courses and research. Thirty six paediatric surgeons (87.80% had no subscription to specialised scientific journals. Conclusion: The paediatric surgeon in FSSA faces many problems related to his working and living conditions that may have a negative impact on their competences.
I.C.J.M. Eyssen; M.P.M. Steultjens; T.A.M. Oud; E.M. Bolt; A. Maasdam; J. Dekker
This study evaluated the responsiveness of the Canadian Occupational Performance Measure (COPM), an individualized, client-centered outcome measure for the identification and evaluation of self-perceived occupational performance problems. We recruited 152 consecutive patients with various diagnoses,
Dobni, Dawn; Dobni, Brooke
Using Porter's five-forces model (potential entrants, suppliers, buyers, rivalry, substitutes) to analyze competition in Canadian university business schools, the authors conclude that schools are becoming increasingly vulnerable to competitive pressures and that strategic reorientation is necessary. (SK)
Boyd, Amanda D; Jardine, Cynthia G; Driedger, S Michelle
A Canadian case of bovine spongiform encephalopathy (BSE) or "mad cow disease" was confirmed in May, 2003. An in-depth content analysis of newspaper articles was conducted to understand the portrayal of BSE and variant Creutzfeldt-Jakob disease (vCJD) in the Canadian media. Articles in the "first 10 days" following the initial discovery of a cow with BSE in Canada on May 20, 2003, were examined based on the premise that these initial stories provide the major frames that dominate news media reporting of the same issue over time and multiple occurrences. Subsequent confirmed Canadian cases were similarly analyzed to determine if coverage changed in these later media articles. The results include a prominence of economic articles, de-emphasis of health aspects, and anchoring the Canadian outbreak to that of Britain's crisis. The variation in media representations between those in Canada and those documented in Britain are explored in this study. PMID:19697246
A federal government environmental assessment review of the disposal concept developed under the Canadian Nuclear Fuel Waste Management Program is currently underway. The Canadian concept is, simply stated, the placement of used fuel (or fuel waste) in long-lived containers at a depth between 500 m and 1000 m in plutonic rock of the Canadian Shield. Atomic Energy of Canada Limited submitted an Environmental Impact Statement in 1994 and the public hearing aspect of the concept review is in its final phase. A unique aspect of the Canadian situation is that government has stipulated that site selection can not commence until the concept has been approved. Hence, the safety and acceptability of the concept is being reviewed in the context of a generic site. Some comments and lessons learned to date related to the review process are discussed. (author)
Trakman, Leon E.
Academically, Canadian education is at the crossroads between formalism and functionalism, with the latter prevailing in recent years. There now arises a demand for a more integrated approach, linking legal theory with legal practice. (MSE)
A survey conducted by Decima Research in April 1989 showed that 50% of Canadians were somewhat or strongly in favour of nuclear energy, the percentage varying from 37% in British Columbia to 65% in Ontario. A majority (56%) questioned the nuclear industry's ability to handle its waste safely, but 45% believed that it was working hard to solve the problem. It was evident that an advertising campaign by the Canadian Nuclear Association had an effect
Canadian national identity is closely related to antiAmericanism and for Canadians,comparing with America has become the main way to identify themselves.So some scholars argue that Canada lacks a real national identity and this is the main reason of its anti-American tradition.However,the author remarks Canada has its national identity.In this paper,the author will present three reasons to support her view.
Canadian national identity is closely related to anti-Americanism and for Canadians,comparing with America has become the main way to identify themselves.So some scholars argue that Canada lacks a real national identity and this is the main reason of its anti-American tradition.However,the author remarks Canada has its national identity.In this paper,the author will present three reasons to support her view.
Grand'Maison, P.; Lescop, J; Brailovsky, C. A.
The use of structured clinical examinations to improve the evaluation of medical students and graduates has become significantly more common in the past 25 years. Many Canadian medical educators have contributed to the development of this technique. The Canadian experience is reviewed from the introduction of simulated-standardized patients and objective-structured clinical examinations to more recent developments and the use of such examinations for licensure and certification.
Ketovuori, Mikko Mr.
This article is about a multidisciplinary R&D project in which a Canadian Learning Through The Arts (LTTA) program was imported to Finland in 2003–2004. Cultural differences in arts education in Finland and Canada are discussed. While Finland has a national school curriculum with all the arts included. Canada relies more on partnerships to ensure arts education for children in the schools. Despite the fact that Canadian learning methods appeared to be quite similar to the ones Finnish teacher...
Human Resources and Social Development Canada, 2008
In 2007, Human Resources and Social Development Canada commissioned Environics Research Group Limited to conduct a public opinion survey on labour market issues among 3,000 adult Canadians. The objective of the public opinion survey was to better understand the perceptions of Canadians regarding labour market challenges and opportunities in order…
... announcing the availability of Compliance Policy Guide Sec. 335.700, Surgeons' Gloves and Patient Examination.... Background FDA is announcing the availability of a guidance document entitled ``Compliance Policy Guide Sec... HUMAN SERVICES Food and Drug Administration 21 CFR Part 800 Compliance Policy Guide: Surgeons'...
... for Surgeon General's (SG) Youth Video Contest AGENCY: Centers for Disease Control and Prevention (CDC... Department of Health and Human Services (HHS) announces the launch of the Surgeon General's (SG) Youth Video... contest has been designed to engage youth and young adults in developing original videos in...
M.P. Schijven; R.K. Reznick; O.T.J. ten Cate; T.P. Grantcharov; G. Regehr; L. Satterthwaite; A.S. Thijssen; H.M. Macrae
Background: Although the objective in European Union and North American surgical residency programmes is similar - to train competent surgeons - residents' working hours are different. It was hypothesized that practice-ready surgeons with more working hours would perform significantly better than th
The directory is intended to help potential PV customers identify Canadian-based companies who can meet their needs, and to help product manufacturers and distributors identify potential new clients and/or partners within the PV industry for new and improved technologies leading to greater end-use customer satisfaction. The principal feature of the directory is an information matrix that identifies the product and service types offered by each firm and the primary clients served. There is also a list of companies by province and territory, followed by an alphabetical listing of all companies, with detailed information including, mailing address, contact person, prime activity, geographic area served, languages in which services are provided, and a brief company profile. Additional information provided by the companies themselves, dealing with items such as number of systems sold, the total installed capacity, etc., is included in an 'experience matrix' for each firm. Sources of additional information on photovoltaic systems are included in a list at the end of the directory
McFee, John E.; Das, Yogadhish; Faust, Anthony A.
Defence R&D Canada (DRDC), an agency within the Department of National Defence, has been conducting research and development (R&D) on the detection of landmines for countermine operations and of unexploded ordnance (UXO) for range clearance since 1975. The Canadian Centre for Mine Action Technologies (CCMAT), located at DRDC Suffield, was formed in 1998 to carry out R&D related to humanitarian demining. The lead group responsible for formulating and executing both countermine and humanitarian R&D programs in detection is the Threat Detection Group at DRDC Suffield. This paper describes R&D for both programs under the major headings of remote minefield detection, close-in scanning detection, confirmation detection and teleoperated systems. Among DRDC's achievements in landmine and UXO detection R&D are pioneering work in electromagnetic and magnetic identification and classification; the first military-fielded multisensor, teleoperated vehicle-mounted landmine detection system; pioneering use of confirmation detectors for multisensor landmine detection systems; the first fielded thermal neutron activation landmine confirmation sensor; the first detection of landmines using a real-time hyperspectral imager; electrical impedance imaging detection of landmines and UXO and a unique neutron backscatter landmine imager.
Badia, Josep M; Nve, Esther; Jimeno, Jaime; Guirao, Xavier; Figueras, Joan; Arias-Díaz, Javier
There is a wide variability in the management of acute cholecystitis. A survey among the members of the Spanish Association of Surgeons (AEC) analyzed the preferences of Spanish surgeons for its surgical management. The majority of the 771 responders didn't declare any subspecialty (41.6%), 21% were HPB surgeons, followed by colorectal and upper-GI specialities. Early cholecystectomy during the first admission is the preferred method of management of 92.3% of surgeons, but only 42.7% succeed in adopting this practice. The most frequent reasons for changing their preferred practice were: Patients not fit for surgery (43.6%) and lack of availability of emergency operating room (35.2%). A total of 88.9% perform surgery laparoscopically. The majority of AEC surgeons advise index admission cholecystectomy for acute cholecystitis, although only half of them succeed in its actual implementation. There is room for improvement in the management of acute cholecystitis in Spanish hospitals.
Ottenhof, Anne; IJpma, Frank A; van Gulik, Thomas M
In the 17th and 18th centuries the entrance to the guild chamber of the Amsterdam Guild of Surgeons was located in the right corner-tower of the Waag on the Nieuwmarkt in Amsterdam. The surgeons entered their guild chamber through this door for guild meetings or to take surgical exams. The entrance also gave access to the anatomy theatre, the 'Theatrum Anatomicum', where anatomical dissections - anatomy lessons - took place. There was a bust of Hippocrates in the facade above the door, and the inscription 'Theatrum Anatomicum'. The series of 'anatomy lessons' reminds us of the famous paintings that were commissioned by the Surgeons' Guild. At the beginning of the 17th century, a skeleton was painted on the door in the gateway, and this marked the entrance to the Surgeons' Guild for almost 200 years. We examined, from a historical perspective, how the gateway to the guild chamber of the Amsterdam Guild of Surgeons was transformed over time. PMID:27122076
Li, Ye; Ohya, Jun; Chiba, Toshio; Xu, Rong; Yamashita, Hiromasa
Because of the shortage of nurses in the world, the realization of a robotic nurse that can support surgeries autonomously is very important. More specifically, the robotic nurse should be able to autonomously recognize different situations of surgeries so that the robotic nurse can pass necessary surgical tools to the medical doctors in a timely manner. This paper proposes and explores methods that can classify suture and tying actions during suture operations from the video sequence that observes the surgery scene that includes the surgeon's hands. First, the proposed method uses skin pixel detection and foreground extraction to detect the hand area. Then, interest points are randomly chosen from the hand area so that their 3D SIFT descriptors are computed. A word vocabulary is built by applying hierarchical K-means to these descriptors, and the words' frequency histogram, which corresponds to the feature space, is computed. Finally, to classify the actions, either SVM (Support Vector Machine), Nearest Neighbor rule (NN) for the feature space or a method that combines "sliding window" with NN is performed. We collect 53 suture videos and 53 tying videos to build the training set and to test the proposed method experimentally. It turns out that the NN gives higher than 90% accuracies, which are better recognition than SVM. Negative actions, which are different from either suture or tying action, are recognized with quite good accuracies, while "Sliding window" did not show significant improvements for suture and tying and cannot recognize negative actions.
Broer, P Niclas; Jenny, Hillary E; Ng-Kamstra, Joshua S; Juran, Sabrina
In September 2015, the international community came together to agree on the 2030 Agenda for Sustainable Development, a plan of action for people, the planet, and prosperity. Ambitious and far-reaching as they are, they are built on three keystones: the elimination of extreme poverty, fighting climate change, and a commitment to fighting injustice and inequality. Critical to the achievement of the Agenda is the global realization of access to safe, affordable surgical and anesthesia care when needed. The landmark report by the Lancet Commission on Global Surgery estimated that between 28 and 32 percent of the global burden of disease is amenable to surgical treatment. However, as many as five billion people lack access to safe, timely, and affordable surgical care, a burden felt most severely in low- and middle-income countries (LMICs). Surgery, and specifically plastic surgery, should be incorporated into the international development and humanitarian agenda. As a community of care providers dedicated to the restoration of the form and function of the human body, plastics surgeons have a collective opportunity to contribute to global development, making the world more equitable and helping to reduce extreme poverty. As surgical disease comprises a significant burden of disease and surgery can be delivered in a cost-effective manner, surgery must be considered a public health priority. PMID:27579265
Cole, Jana; Isik, Frank
The Human Genome Project was launched in 1989 in an effort to sequence the entire span of human DNA. Although coding sequences are important in identifying mutations, the static order of DNA does not explain how a cell or organism may respond to normal and abnormal biological processes. By examining the mRNA content of a cell, researchers can determine which genes are being activated in response to a stimulus. Traditional methods in molecular biology generally work on a "one gene: one experiment" basis, which means that the throughput is very limited and the "whole picture" of gene function is hard to obtain. To study each of the 60,000 to 80,000 genes in the human genome under each biological circumstance is not practical. Recently, microarrays (also known as gene or DNA chips) have emerged; these allow for the simultaneous determination of expression for thousands of genes and analysis of genome-wide mRNA expression. The purpose of this article is twofold: first, to provide the clinical plastic surgeon with a working knowledge and understanding of the fields of genomics, microarrays, and bioinformatics and second, to present a case to illustrate how these technologies can be applied in the study of wound healing.
Full Text Available Aim: To report the results of the early discharge of children after hypospadias repair with an indwelling catheter. Materials and Methods: To facilitate early the discharge of children after hypospadias repair, the author adopted the technique of draining the indwelling urinary catheter into diapers in children undergoing this operation. Home catheter care was taught to the mother; the dressings and catheters were subsequently managed in the outpatient clinic. Results: Over a 2-year period, 43 children were managed by this technique and were sent home within 24-48 h after the operation with an indwelling catheter. Minor problems requiring outpatient visits to the surgeon occurred in nine (20% children after discharge from the hospital. All the nine children were successfully managed as outpatients and no child required rehospitalisation. The catheter remained in position for 5 days in all the children. The overall results were satisfactory with an acceptable (7% fistula rate. Conclusions: It is possible to reduce the duration of the hospital stay of children after hypospadias repair without compromising on the final results.
Levin, P.E.; Schoen, R.W. Jr.; Browner, B.D.
During interlocking intramedullary nailing of twenty-five femoral and five tibial fractures, the primary surgeon wore both a universal film badge on the collar of the lead apron and a thermoluminescent dosimeter ring on the dominant hand to quantify the radiation that he or she received. When distal interlocking was performed, the first ring was removed and a second ring was used so that a separate recording could be made for this portion of the procedure. At the conclusion of the study, all of the recorded doses of radiation were averaged. The average amount of radiation to the head and neck during the entire procedure was 7.0 millirems of deep exposure and 8.0 millirems of shallow exposure. The average dose of radiation to the dominant hand during insertion of the intramedullary nail and the proximal interlocking screw was 13.0 millirems, while the average amount during insertion of the distal interlocking nail was 12.0 millirems. Both of these averages are well within the government guidelines for allowable exposure to radiation during one-quarter (three months) of a year. Precautions that are to be observed during this procedure are recommended.
Khera, G; Wild, J R L; Fitzgerald, J E F
The Association of Surgeons in Training (ASiT) is a professional body and registered charity working to promote excellence in surgical training for the benefit of junior doctors and patients alike. With a membership of over 2000 surgical trainees from all ten surgical specialities, the association provides support at both regional and national levels throughout the United Kingdom and Republic of Ireland. Originally founded in 1976, ASiT is independent of the National Health Service (NHS), Surgical Royal Colleges, and speciality associations. The 2012 Annual Conference in Cardiff City Hall brought together nearly 700 delegates for an educational weekend programme with expert guest speakers. Clinical updates were complimented by debates on current training in surgery, and the weekend included 6 pre-conference courses covering a diverse range of topics including laparoscopic skills, surgical drawing and a masterclass in journal club. A record number of 1168 abstract submissions were received and those successful competed for 18 awards representing £3500 in trainee prizes and bursaries. As the only national surgical trainee meeting for all specialities, ASiT continues to grow and we look forward to an even larger and more successful conference next year.
Bhardwaj, Amit; Nagandla, Kavitha
Low back pain is a common musculoskeletal symptom in pregnancy that can present as lumbar pain or pelvic girdle pain, with significant physical and psychosocial implications. Pelvic girdle pain is more prevalent and results in greater disability than lumbar pain. It is possible to distinguish between these two conditions from a detailed history based on the site of the pain, its intensity, disability and pain provocation tests. Management of low back pain in pregnancy is conservative, with physical exercise for lumbar pain and minimising activities that exacerbate pain, analgesics and bed rest for pelvic girdle pain, as well as avoiding abduction beyond the pain-free zone in labour. There is evidence that stabilising exercises in patients with pelvic girdle pain postpartum have a beneficial effect. Other treatment modalities that have been shown to be safe and effective include pelvic belts, transcutaneous electrical nerve stimulation, spinal manipulative therapy, acupuncture and complementary therapy with yoga. Other orthopaedic complications in pregnancy such as carpal tunnel syndrome, pubic symphysis rupture, transient osteoporosis and osteonecrosis are usually self-limiting with a satisfactory outcome. However, a lack of awareness and failure to recognise these complications can result in long-term morbidity. Knowledge of the preoperative diagnostic investigations, surgical approaches and intraoperative positioning of the mother to avoid gravid uterus compression is vital in orthopaedic emergencies such as lumbar disc herniation, cauda equina syndrome, fractures and acute compartment syndrome of the lower limb to ensure a safe maternal and fetal outcome and to prevent serious disability. Pregnancy is not contraindicated in women with pre-existing orthopaedic complications such as kyphoscoliosis and total hip arthroplasty as there is no evidence to suggest increased maternal or fetal risks. PMID:24904047
Bertin Dibi Kouame
Full Text Available Background: Postoperative complications are related to the surgical procedures, of failures of initial bladder closure and influence the urological, aesthetical and orthopaedic outcomes. Materials and Methods: We reviewed four patients who underwent complex bladder exstrophy-epispadias repair over a period of 14 years. The outcomes of treatment were assessed using, aesthetic, urological and orthopaedic examination data. Orthopaedic complications were explored by a radiography of the pelvis. Results: Out of four patients who underwent bladder exstrophy surgical management, aesthetic, functional outcomes and complications in the short and long follow-up were achieved in three patients. The first patient is a male and had a good penis aspect. He has a normal erection during micturition with a good jet miction. He has a moderate urinary incontinence, which requires diaper. In the erection, his penis-measures 4 cm long and 3 cm as circumference. The second patient was a female. She had an unsightly appearance of the female external genitalia with bipartite clitoris. Urinary continence could not be assessed; she did not have the age of cleanness yet. The third patient had a significant urinary leakage due to the failure of the epispadias repair. He has a limp, a pelvic obliquity, varus and internal rotation of the femoral head. He has an inequality of limbs length. Pelvis radiograph shows the right osteotomy through the ilium bone, the left osteotomy through the hip joint at the acetabular roof. Conclusion: When, the epispadias repair is performed contemporary to initial bladder closure, its success is decisive for urinary continence. In the female, surgical revision is required after the initial bladder closure for an aesthetic appearance to the external genitalia. Innominate osteotomy must be performed with brilliancy amplifier to avoid osteotomy through to the hip joint to prevent inequality in leg length.
Frame, Mark; Leach, William
3D printing is an emerging technology that is primarily used for aiding the design and prototyping of implants. As this technology has evolved it has now become possible to produce functional and definitive implants manufactured using a 3D printing process. This process, however, previously required a large financial investment in complex machinery and professionals skilled in 3D product design. Our pilot study's aim was to design and create a 3D printed custom orthopaedic implant using only freely available consumer hardware and software. PMID:24574013
YAN Shi-ju; CHEN Xiao-jun; WANG Cheng-tao; SU Ying-ying; XIA Qing
Camera calibration is the key technique in a C-arm based orthopaedic surgical navigation system. The extraction of marker location information is a necessary step in the calibration process. Ideal marker images should possess uniform background and contain marker shadow only, but in fact marker images always possess nonuniform background and are contaminated by noise and unwanted anatomic information, making the extraction very difficult. A target-orientated marker shadow extraction method was proposed. With this method a proper threshold for marker image binarization can be determined.
Full Text Available Abstract Background To determine factors predicting the duration of time away from work following acute orthopaedic non life threatening trauma Methods Prospective cohort study conducted at four hospitals in Victoria, Australia. The cohort comprised 168 patients aged 18-64 years who were working prior to the injury and sustained a range of acute unintentional orthopaedic injuries resulting in hospitalization. Baseline data was obtained by survey and medical record review. Multivariate Cox proportional hazards regression analysis was used to examine the association between potential predictors and the duration of time away from work during the six month study. The study achieved 89% follow-up. Results Of the 168 participants recruited to the study, 68% returned to work during the six month study. Multivariate Cox proportional hazards regression analysis identified that blue collar work, negative pain attitudes with respect to work, high initial pain intensity, injury severity, older age, initial need for surgery, the presence of co-morbid health conditions at study entry and an orthopaedic injury to more than one region were associated with extended duration away from work following the injury. Participants in receipt of compensation who reported high social functioning at two weeks were 2.58 times more likely to have returned to work than similar participants reporting low social functioning. When only those who had returned to work were considered, the participant reported reason for return to work " to fill the day" was a significant predictor of earlier RTW [RR 2.41 (95% C.I 1.35-4.30] whereas "financial security" and "because they felt able to" did not achieve significance. Conclusions Many injury-related and psycho social factors affect the duration of time away from work following orthopaedic injury. Some of these are potentially modifiable and may be amenable to intervention. Further consideration of the reasons provided by participants
E.B Dolan; Haugh, M. G.; Tallon, D.; Casey, C.; McNamara, L. M.
Severe heat-shock to bone cells caused during orthopaedic procedures can result in thermal damage, leading to cell death and initiating bone resorption. By contrast, mild heat-shock has been proposed to induce bone regeneration. In this study, bone cells are exposed to heat-shock for short durations occurring during surgical cutting. Cellular viability, necrosis and apoptosis are investigated immediately after heat-shock and following recovery of 12, 24 h and 4 days, in osteocyte-like MLO-Y4 ...
Canadians' health and their social and economic well-being are fundamentally linked to the quality of their environment. Recognizing this, in 2004 the Government of Canada committed to establishing national indicators of freshwater quality, air quality and greenhouse gas emissions. The goal of these new indicators is to provide Canadians with more regular and reliable information on the state of their environment and how it is linked with human activity. Canadians need clearly defined environmental indicators - measuring sticks that can track the results that have been achieved through the efforts of governments, industries and individuals to protect and improve the environment. Environment Canada, Statistics Canada and Health Canada are working together to further develop and communicate these indicators. Reflecting the joint responsibility for environmental management in Canada, this effort has benefited from the cooperation and input of the provinces and territories. The indicators are: air quality; greenhouse gas emissions; and, freshwater quality. Air quality tracks Canadians' exposure to ground-level ozone - a key component of smog. The indicator measures one of the most common, harmful air pollutants to which people are exposed. The use of the seasonal average of ozone concentrations reflects the potential for long-term health effects. Greenhouse gas emissions tracks the annual releases of the six greenhouse gases that are the major contributors to climate change. The indicator comes directly from the greenhouse gas inventory report prepared by Environment Canada for the United Nations Framework Convention on Climate Change (UNFCCC) and the Kyoto Protocol. The data are widely used to report on progress toward Canada's Kyoto target for reduced emissions. Freshwater quality reports the status of surface water quality at selected monitoring sites across the country. For this first report, the focus of the indicator is on the protection of aquatic life, such as
Edmundson, S P
Methicillin-resistant Staphylococcus aureus (MRSA) infections are associated with increased mortality, costs and length of stay compared to non-MRSA infections. This observational 4-year study analyses the impact of screening and treating orthopaedic healthcare workers for MRSA colonisation. A total of 1,011 swabs were taken from 566 healthcare workers. Positive healthcare workers were treated with topical mupirocin to both anterior nares. The prevalence of MRSA colonisation on initial testing was 4.77%. The rate of positive MRSA colonisation of those tested on more than one occasion fell from 5.88% to 2.71% (p = 0.055) on subsequent screening. All healthcare workers receiving treatment were successfully cleared of colonisation; however, some required more than one course of treatment. These results show that there could be a role for screening and treating orthopaedic staff for MRSA colonisation as part of a strategy to reduce the prevalence of MRSA infections in orthopaedic units.
Lauber, Wilfred R.; Bertrand, Jean M.
For the past three years, during a period of high sun spot numbers, propagation measurements were made on the reception of VLF signals in the Canadian Arctic. Between Aug. and Dec. 1989, the received signal strengths were measured on the Canadian Coast Guard icebreaker, John A. MacDonald in the Eastern Canadian Arctic. Between Jul. 1991 and Jun. 1992, the received signal strengths were measured at Nanisivik, Baffin Island. The purposes of this work were to check the accuracy and estimate variances of the Naval Ocean Systems Center's (NOSC) Long Wave Propagation Capability (LWPC) predictions in the Canadian Arctic and to gather ionospheric storm data. In addition, the NOSC data taken at Fort Smith and our data at Nanisivik were used to test the newly developed Longwave Noise Prediction (LNP) program and the CCIR noise predictions, at 21.4 and 24.0 kHz. The results of the work presented and discussed in this paper show that in general the LWPC predicts accurate values of received signal strength in the Canadian Arctic with standard deviations of 1 to 2 dB over several months. Ionospheric storms can gauge the received signal strengths to decrease some 10 dB for a period of several hours or days. However, the effects of these storms are highly dependent on the propagation path. Finally the new LNP atmospheric noise model predicts lower values of noise in the Arctic than the CCIR model and our limited measurements tend to support these lower values.
LR Henry, LB Helou, NP Solomon, A Chang, SK Libutti, A Stojadinovic
Full Text Available Background: Heterogeneity of surgical care exists among surgeons regarding the conduct of thyroidectomy and parathyroidectomy.Aim: To identify the current patterns of technical conduct of operation amongst surgeons performing thyroidectomy or parathyroidectomy.Methods: A survey was designed and beta-tested on five surgical oncologists for face validity and usability. The final version of this survey was constructed and disseminated using the professional version of the internet-based survey mechanism Survey Monkey and consisted of two eligibility questions and 22 questions regarding thyroidectomy/parathyroidectomy treatment patterns. The survey was disseminated electronically to American Association of Endocrine Surgeons (AAES and American College of Surgeons (ACS members. Survey results were collected, tabulated and analyzed. Responses among groups were compared using two sample T- tests. Significant responses were subsequently analyzed in generalized linear models to ascertain if significance remained with control of covariates.Results: Of 420 initial web survey visits, 236 (56.2% surveys were completed. The majority of respondents reported being 'fellowship trained', experienced and 'high-volume' surgeons. The most common fellowship trainings were endocrine (46%, oncology (22%, head & neck (13%, or combinations of the three fellowships (14%. Most surgeons reported that they dissect the course of the recurrent laryngeal nerve (RLN without using neuromonitoring. Nearly a third of respondents reported routinely using the Harmonic scalpel during the conduct of the operations. Significant differences emerged regarding operative technique according to residency training type, fellowship training, surgeon volume, and practice setting, but only those associated with residency training type and annual surgeon surgical volume remained significant within generalized linear models.Conclusion: Most surgeons who responded to this survey do not routinely
Full Text Available Since the 1970s, the appointment of trial judges in Canada has generally involved an arms-length committee of professionals, although the structure of these committees and their role in the process has varied from province to province, as well as evolving over time. Yet these “new” structures and “new” processes did not prevent a major judicial appointment scandal in the province of Quebec in 2010, culminating in the formation of the Bastarache Committee to recommend changes. This paper summarizes the forty-year history of Canadian judicial appointment committees, identifies the major challenges that face those committees, and suggests the basic values toward which reforms to the appointment process might be directed. Depuis les années 1970, la nomination des juges de première instance au Canada a généralement mis à contribution un comité de professionnels indépendants, bien que la structure de ce comité et son rôle dans le processus de nomination aient varié d’une province à l’autre et évolué avec le temps. Ces « nouvelles » structures et « nouveaux » processus n’ont certes pas empêché l’éclatement du scandale sur la nomination des juges au Québec en 2010. Ce scandale a donné lieu à la formation de la Commission Bastarache qui avait notamment le mandat de recommander des changements. La présent document résume les quarante ans d’histoire des comités canadiens de nomination des juges, recense les principaux défis que ces comités doivent relever, et propose les valeurs fondamentales qui devraient inspirer les réformes du processus de nomination.
Ahmet Serdar Karaca
Full Text Available Aim: Mesh repair of inguinal hernia repairs are shown to be an effective and reliable method. In this study, a single surgeon%u2019s experience with plug-mesh method performs inguinal hernia repair have been reported. Material and Method: 587 patients with plug-mesh repair of inguinal hernia, preoperative age, body / mass index, comorbid disease were recorded in terms of form. All of the patients during the preoperative and postoperative hernia classification of information, duration of operation, antibiotics, perioperative complications, and later, the early and late postoperative complications, infection, recurrence rates and return to normal daily activity, verbal pain scales in terms of time and postoperative pain were evaluated. Added to this form of long-term pain ones. The presence of wound infection was assessed by the presence of purulent discharge from the incision. Visual analog scale pain status of the patients was measured. Results: 587 patients underwent repair of primary inguinal hernia mesh plug. One of the patients, 439 (74% of them have adapted follow-ups. Patients%u2019 ages ranged from 18-86. Was calculated as the mean of 47±18:07. Follow-up period of the patients was found to be a minimum of 3 months, maximum 55 months. Found an average of 28.2±13.4 months. Mean duration of surgery was 35.07±4.00 min (min:22mn-max:52mn, respectively. When complication rates of patients with recurrence in 2 patients (0.5%, hematoma development (1.4% in 6 patients, the development of infection in 11 patients (2.5% and long-term groin pain in 4 patients (0.9% appeared. Discussion: In our experience, the plug-mesh repair of primary inguinal hernia repair safe, effective low recurrence and complication rates can be used.
Bazin, J-E; Attias, A; Baghdadi, H; Baumann, A; Bizouarn, P; Claudot, F; Eon, B; Fieux, F; Frot, C; Guibet Lafaye, C; Muzard, O; Nicolas-Robin, A; Orjubin, V; Otero-Lopez, M; Pelluchon, C; Pereira, J; Roussin, F; Vigué, B; Beydon, L
In the perioperative period, several potential conflicts between anaesthetists/intensive care specialists and surgeons may exist. They are detrimental to the quality of patient care and to the well-being of the teams. They are a source of medical errors and contribute to burn-out. Patients can become the victims of such conflicts, which deserve ethical reflection. Their resolution through analysis and shared solutions is necessary. This article seeks to analyse these conflicts, taking into account their specificities and constraints. In order to understand this context, it is important to consider the specificities of each group involved and the records of such situations. Several factors can prevent these conflicts, first and foremost the patients themselves and the quality of the care that is provided. Medical deontology aims mainly at preventing and resolving these conflicts. Generally speaking, the quality approach which is increasingly applied in health care institutions (involving declarations of adverse events, morbidity/mortality reviews, benchmarking, analysis and improvement of practices, etc.) also contributes to the prevention and resolution of disagreements. The teaching of communication techniques that begins with the initial training, the evaluation of team behaviours (through simulation training for example), the respect of others' constraints, particularly when it comes to learning, as well as transparency regarding conflicts of interests, are all additional elements of conflict prevention. Lastly, conflicts may at times be caused by deviant behaviours, which must be met with a clear and uncompromising collective and institutional approach. This article concludes by offering a standardised approach for conflict resolution. PMID:24821342
Full Text Available Abstract Background The aim of this study was to describe the kinds of ethical dilemmas surgeons face during practice. Methods Five male and five female surgeons at a University hospital in Norway were interviewed as part of a comprehensive investigation into the narratives of physicians and nurses about ethically difficult situations in surgical units. The transcribed interview texts were subjected to a phenomenological-hermeneutic interpretation. Results No gender differences were found in the kinds of ethical dilemmas identified among male and female surgeons. The main finding was that surgeons experienced ethical dilemmas in deciding the right treatment in different situations. The dilemmas included starting or withholding treatment, continuing or withdrawing treatment, overtreatment, respecting the patients and meeting patients' expectations. The main focus in the narratives was on ethical dilemmas concerning the patients' well-being, treatment and care. The surgeons narrated about whether they should act according to their own convictions or according to the opinions of principal colleagues or colleagues from other departments. Handling incompetent colleagues was also seen as an ethical dilemma. Prioritization of limited resources and following social laws and regulations represented ethical dilemmas when they contradicted what the surgeons considered was in the patients' best interests. Conclusion The surgeons seemed confident in their professional role although the many ethical dilemmas they experienced in trying to meet the expectations of patients, colleagues and society also made them professionally and personally vulnerable.
Coyne, L. A.; Latham, S. M.; Williams, N. J.; Dawson, S.; Donald, I. J.; Pearson, R. B.; Smith, R. F.; Pinchbeck, G. L.
Objectives The use of antimicrobials in food-producing animals has been linked with the emergence of antimicrobial resistance in bacterial populations, with consequences for animal and public health. This study explored the underpinning drivers, motivators and reasoning behind prescribing decisions made by veterinary surgeons working in the UK pig industry. Methods A qualitative interview study was conducted with 21 veterinary surgeons purposively selected from all UK pig veterinary surgeons. Thematic analysis was used to analyse transcripts. Results Ensuring optimum pig health and welfare was described as a driver for antimicrobial use by many veterinary surgeons and was considered a professional and moral obligation. Veterinary surgeons also exhibited a strong sense of social responsibility over the need to ensure that antimicrobial use was responsible. A close relationship between management practices, health and economics was evident, with improvements in management commonly identified as being potential routes to reduce antimicrobial usage; however, these were not always considered economically viable. The relationship with clients was identified as being a source of professional stress for practitioners due to pressure from farmers requesting antimicrobial prescriptions, and concern over poor compliance of antimicrobial administration by some farmers. Conclusions The drivers behind prescribing decisions by veterinary surgeons were complex and diverse. A combination of education, improving communication between veterinary surgeons and farmers, and changes in regulations, in farm management and in consumer/retailer demands may all be needed to ensure that antimicrobial prescribing is optimal and to achieve significant reductions in use. PMID:27516473
The Canadian Petroleum Products Institute (CPPI) was created in 1989 as a nonprofit association of Canadian refiners and marketers of petroleum products. In 1991, the Atlantic Petroleum Association, the Quebec Petroleum Association, the Ontario Petroleum Association, the Canada West Petroleum Association, and the Petroleum Association for Conservation of the Canadian Environment (PACE) were integrated into the CPPI. The objective of the CPPI is to serve and represent the refining and marketing sectors of the petroleum industry with respect to environment, health and safety, and business issues. An industry overview is provided, as well as highlights of environmental achievements and challenges, and economics and operations for the year. Lists of CPPI publications, standing committees, and officers are also included. 9 figs
Webb, Tracy; Di Francesco, James; Matthews, Brenda; Murray, Norm; Scott, Douglas; Wilson, Christine
We survey the present landscape in submillimetre astronomy for Canada and describe a plan for continued engagement in observational facilities to ~2020. Building on Canada's decadal Long Range Plan process, we emphasize that continued involvement in a large, single-dish facility is crucial given Canada's substantial investment in ALMA and numerous PI-led submillimetre experiments. In particular, we recommend: i) an extension of Canadian participation in the JCMT until at least the unique JCMT Legacy Survey program is able to realize the full scientific potential provided by the world-leading SCUBA-2 instrument; and ii) involvement of the entire Canadian community in CCAT, with a large enough share in the partnership for Canadian astronomers to participate at all levels of the facility. We further recommend continued participation in ALMA development, involvement in many focused PI-led submillimetre experiments, and partnership in SPICA.
Mauffrey, C; Herbert, B; Young, H; Wilson, M L; Hake, M; Stahel, P F
The development of post-traumatic infection is potentially a limb threatening condition. The orthopaedic trauma literature lags behind the research performed by our arthroplasty colleagues on the topic of implant-related infections. Surgical site infections in the setting of a recent ORIF are notoriously hard to eradicate due to biofilm formation around the implant. This bacteria-friendly, dynamic, living pluri-organism structure has the ability to morph and adapt to virtually any environment with the aim to maintain the causative organism alive. The challenges are twofold: establishing an accurate diagnosis with speciation/sensitivity and eradicating the infection. Multiple strategies have been researched to improve diagnostic accuracy, to prevent biofilm formation on orthopaedic implants, to mobilize/detach or weaken the biofilm or to target specifically bacteria embedded in the biofilm. The purpose of our paper is to review the patho-physiology of this mysterious pluri-cellular structure and to summarize some of the most pertinent research performed to improve diagnostic and treatment strategies in biofilm-related infections. PMID:27262848
Dillon, J P
Since the opening of a temporary ice-rink in our hospital\\'s catchment area, we have observed an increase in patients requiring in-patient treatment for orthopaedic intervention. The authors performed a prospective analysis of all patients admitted to our unit over a one-month period. Epidemiological data, wearing of protective gear and skater experience were collected. Fracture type, treatment required, average length of hospital stay and number of days missed from work was also recorded. Ice-skating injuries accounted for 7.7% of our total admissions over the study period. There was a significant variation noted in the types of fracture sustained ranging from comminuted fractures of the radial head to spiral fractures of the tibia. The average length of hospital stay was 2.6 days and average time missed from work was 6.1 weeks. This paper highlights the potential serious injuries that can occur in ice-skating and their impact on admissions to our orthopaedic unit.
Xu, T; Pruitt, L
A detailed investigation of the tribological behaviour of vacuum arc diamond-like carbon coated Ti-6Al-4V against a medical grade ultra-high molecular weight polyethylene is conducted in this work in order to investigate the potential use of diamond-like carbon coatings for orthopaedic appplications. Lubricated and non-lubricated wear experiments are performed using a standard pin-on-disc wear tester. The coefficient of friction is monitored continuously during testing and wear rate calculations are performed using surface profilometry measurements of worn disc surfaces. Sliding wear tests show the existence of two distinct friction and wear regimes distinguished by physically different mechanisms. In the first stages of wear, adhesion and abrasion are the dominant mechanisms of wear while fatigue processes are activated later in the tests. The effects of diamond-like carbon coating structure, surface roughness and lubrication on tribological behaviour are presented. Optimal process-structure-property design for vacuum arc plasma deposition is utilized in order to obtain strong adhesion to the titanium alloy substrate. Diamond-like carbon coatings significantly improve the friction and wear performance of the orthopaedic bearing pair and show exceptional promise for biomedical applications. PMID:15347929
Drago, Lorenzo; Agrappi, Serse; Bortolin, Monica; Toscano, Marco; Romanò, Carlo Luca; De Vecchi, Elena
Over the years, various techniques have been proposed for the quantitative evaluation of microbial biofilms. Spectrophotometry after crystal violet staining is a widespread method for biofilm evaluation, but several data indicate that it does not guarantee a good specificity, although it is rather easy to use and cost saving. Confocal laser microscopy is one of the most sensitive and specific tools to study biofilms, and it is largely used for research. However, in some cases, no quantitative measurement of the matrix thickness or of the amount of embedded microorganisms has been performed, due to limitation in availability of dedicated software. For this reason, we have developed a protocol to evaluate the microbial biofilm formed on sandblasted titanium used for orthopaedic implants, that allows measurement of biomass volume and the amount of included cells. Results indicate good reproducibility in terms of measurement of biomass and microbial cells. Moreover, this protocol has proved to be applicable for evaluation of the efficacy of different anti-biofilm treatments used in the orthopaedic setting. Summing up, the protocol here described is a valid and inexpensive method for the study of microbial biofilm on prosthetic implant materials. PMID:26927075
Fracture liaison services (FLS) aim to provide cost-effective targeting of secondary fracture prevention. It is proposed that a dedicated FLS be available in any hospital to which a patient presents with a fracture. An existing orthopaedic clinic nurse was retrained to deliver a FLS. Proformas were used so that different nurses could assume the fracture liaison nurse (FLN) role, as required. Screening consisted of fracture risk estimation, phlebotomy and DXA scanning. 124 (11%) of all patients attending the orthopaedic fracture clinic were reviewed in the FLS. Upper limb fractures accounted for the majority of fragility fractures screened n=69 (55.6%). Two-thirds of patients (n=69) had reduced bone mineral density (BMD). An evidence based approach to both non-pharmacological and pharmacotherapy was used and most patients (76.6%) receiving pharmacotherapy received an oral bisphosphonate (n=46). The FLS has proven to be an effective way of delivering secondary prevention for osteoporotic fracture in a non-regional fracture clinic, without increasing staff costs.
Full Text Available Background: Myths in the field of medicine regarding the treatment of health problems are frequently observed, which may not only retard the recovery but often be harmful for the patients. We were baffled to see lot of patients under the influence of certain myths about treatment of their orthopaedic ailments. The aim of this observational, prospective study was to dispel the misconceptions and to create awareness in the society about the bad effects of these myths. Methods: 1285 patients aged 20-55 years, suffering from fractures, neck pain, backache, osteoarthritis knee, myofascial trigger points, episacroiliac lipomas etc. and being under the influence of one or the other myth about the treatment of their ailments, were included in this study. Results: All Patients were counseled and made to realize the harmful effects of their false beliefs regarding treatment of their orthopaedic ailments. Every patient was treated as necessitated for the ailment. All patients were found satisfied at the end of treatment, and were happy after dispelling their myths. Conclusions: Misconceptions do not have any scientific basis rather these are rooted in the society due to high rate of illiteracy and lack of health education. Being a part and parcel of the health care system, it becomes our duty to create awareness among patients about the harmful effects of the prevailing false beliefs by imparting proper health care advice and treatment to relieve the sufferings of our patients. [Int J Res Med Sci 2016; 4(6.000: 2197-2201
Clem, William C; Chowdhury, Shafiul; Catledge, Shane A; Weimer, Jeffrey J; Shaikh, Faheem M; Hennessy, Kristin M; Konovalov, Valery V; Hill, Michael R; Waterfeld, Alfred; Bellis, Susan L; Vohra, Yogesh K
Ultra-smooth nanostructured diamond (USND) can be applied to greatly increase the wear resistance of orthopaedic implants over conventional designs. Herein we describe surface modification techniques and cytocompatibility studies performed on this new material. We report that hydrogen (H)-terminated USND surfaces supported robust mesenchymal stem cell (MSC) adhesion and survival, while oxygen- (O) and fluorine (F)-terminated surfaces resisted cell adhesion, indicating that USND can be modified to either promote or prevent cell/biomaterial interactions. Given the favorable cell response to H-terminated USND, this material was further compared with two commonly used biocompatible metals, titanium alloy (Ti-6Al-4V) and cobalt chrome (CoCrMo). MSC adhesion and proliferation were significantly improved on USND compared with CoCrMo, although cell adhesion was greatest on Ti-6Al-4V. Comparable amounts of the pro-adhesive protein, fibronectin, were deposited from serum on the three substrates. Finally, MSCs were induced to undergo osteoblastic differentiation on the three materials, and deposition of a mineralized matrix was quantified. Similar amounts of mineral were deposited onto USND and CoCrMo, whereas mineral deposition was slightly higher on Ti-6Al-4V. When coupled with recently published wear studies, these in vitro results suggest that USND has the potential to reduce debris particle release from orthopaedic implants without compromising osseointegration. PMID:18490051
Downes, Jessica; Rauk, Philip N; Vanheest, Ann E
Pregnant or lactating staff working in the orthopaedic operating room may be at risk of occupational exposure to several hazards, including blood-borne pathogens, anesthetic gases, methylmethacrylate, physical stress, and radiation. Because the use of proper personal protective equipment is mandatory, the risk of contamination with blood-borne pathogens such as hepatitis B, hepatitis C, and HIV is low. Moreover, effective postexposure prophylactic regimens are available for hepatitis B and HIV. In the 1960s, concerns were raised about occupational exposure to harmful chemicals in the operating room such as anesthetic gases and methylmethacrylate. Guidelines on safe levels of exposure to these chemicals and the use of personal protective equipment have helped to minimize the risks to pregnant or lactating staff. Short periods of moderate physical activity are beneficial for pregnant women, but prolonged strenuous activity can lead to increased pregnancy complications. The risk of prenatal radiation exposure during orthopaedic procedures is of concern, as well. However, proper lead protection and contamination control can minimize the risk of occupational exposure to radiation. PMID:24788448
Full Text Available BACKGROUND: Given the high levels of stress in anesthesiologists and also their close working liaison with surgeons, it may be worthwhile to compare the personality profiles of these two groups of professionals. AIM: To compare the personality profiles of surgeons and anesthesiologists, using a well-standardized and validated instrument. SETTINGS AND DESIGN: Survey (cross-sectional on surgeons and anesthesiologists working in several medical institutes in India. MATERIAL & METHODS: The self-report Temperament and Character Inventory, 125-item version (TCI-125 was mailed out to an incidental sample of surgeons and anesthesiologists working in medical institutes in India. Of the 200 questionnaires sent (100 to anesthesiologists and surgeons each, 93 completed responses were returned (46 anesthesiologists, 47 surgeons; return rate 46.5%. STATISTICAL ANALYSIS: Student′s unpaired ′t′ test; P<0.05 was considered statistically significant. RESULTS: The mean scores of anesthesiologists vis-a-vis surgeons on the various temperament dimensions were Novelty seeking: 8.6 vs. 9.2; Harm avoidance: 7.3 vs. 8.1; Reward dependence: 8.1 vs. 8.0; and Persistence: 3.0 vs. 3.1, respectively. Similar scores for the character dimensions were Self-directedness: 16.9 vs. 15.9; Cooperativeness: 17.5 vs. 16.5; and Self-transcendence: 7.0 vs. 6.7, respectively. There was no significant difference between the surgeons and anesthesiologists on any of the temperament and character variables of personality chosen for the study. CONCLUSION: Personality measures did not differ significantly between surgeons and anesthesiologists in this preliminary investigation. If replicated on a larger and more representative sample, the findings have clinical relevance to improve the working relationship between these two groups of closely working professionals.
Full Text Available A survey of Canadian research libraries was conducted to determine the extent of funding support for open access publications in these institutions. Results indicate that there is substantial support for open access publishing, and a diversity of approaches is being used to fund open access resources. The reasons for funding support along with policy and promotional issues are explored. The broader implications of funding open access are discussed in the context of a changing scholarly publishing landscape. This paper will be especially relevant to Canadian academic libraries that are exploring options for funding open access publications.
Lawless, Jerald F
Commissioned by the Statistical Society of Canada (SSC), Statistics in Action: A Canadian Outlook helps both general readers and users of statistics better appreciate the scope and importance of statistics. It presents the ways in which statistics is used while highlighting key contributions that Canadian statisticians are making to science, technology, business, government, and other areas. The book emphasizes the role and impact of computing in statistical modeling and analysis, including the issues involved with the huge amounts of data being generated by automated processes.The first two c
Di Matteo, Berardo; Tarabella, Vittorio; Filardo, Giuseppe; Viganò, Anna; Tomba, Patrizia; Marcacci, Maurilio
All the medical knowledge of all time in one book, the universal and perfect manual for the Renaissance surgeon, and the man who wrote it. This paper depicts the life and works of Giovanni Andrea della Croce, a 16th Century physician and surgeon, who, endowed with true spirit of Renaissance humanism, wanted to teach and share all his medical knowledge through his opus magnum, titled "Universal Surgery Complete with All the Relevant Parts for the Optimum Surgeon". An extraordinary book which truly represents a defining moment and a founding stone for traumatology, written by a lesser known historical personality, but nonetheless the Renaissance Master of Traumatology.
Post, Sylvia; Staunton, Ted, Ed.
One of a series of teaching units designed to introduce secondary school students to the Canadian economy, this handbook contains activities on the economic status and roles of Canadian women. The first of 4 sections presents a profile of male and female occupations. Section 2 contains statistics on females in the Canadian labor force. Section 3,…
Canadian Film will be a new course in the Communications Studies department at the University of Missouri at Kansas City particularly designed for non-Canadian Midwestern US students. It will not only introduce students to the richness and significance of Canadian film as both art and entertainment (which is virtually unrecognized around here),…
The transport of contaminants to the Canadian Arctic by air and in water and their concentration through the marine food web has lead to enhanced levels of contaminants in several foods of Canadian northern inhabitants. Artificial radionuclides in the marine water can be used to determine water circulation and to trace contaminant transport through the Canadian Archipelago
This paper provides an up-to-date career and demographic profile of Canadian research university librarians by comparing newly derived data from the 8Rs Study: The "Future of Human Resources in Canadian Libraries", with corresponding information from the author's 2006 survey: "The Scholarship of Canadian Research University Librarians", and other…
Full Text Available Ayurveda is described as science of life and it was recalled by Brahma as mentioned in Ayurvedic treatises. Brahma transmitted his noble knowledge to Prajapati or Daksha, later Daksha passed his legacy to Ashwins and Indra received knowledge from Aswins. As per Sushruta opinion, Indra taught Ayurveda to Dhanvantari, the surgeon of gods embodied as king Divodasa of Banaras (Kashiraja. Divodasa then transmitted medical knowledge with special reference to surgery to the wise men like Sushruta and others who approached him as pupils, out of sympathy for the suffering humanity and also in order to prolong their own life. This school of thoughts is known as Dhanvantara-Sampradaya i.e. the school of surgery. All the fellows of Sushruta and Sushruta himself composed texts on the base of the perceptions of the teacher Divodasa Dhanvantari. Sushruta composed ‘Sushruta-Samhita’ which is fully available till now and is considered the best book for Sharira. Nagarjuna redacted the Sushruta-Samhita and possibly added Uttaratantra in 5th century A.D. In 10th century Chandrata, son of Tisata did the Pathashuddhi and renewed the Sushruta-Samhita on the basis of commentary done by Jejjata.In due course of time, many commentaries in Sanskrit, Hindi and English were written which show the growing acceptance and utility of the text. Charaka-Samhita, Sushruta-Samhita and Samhitas of Vagbhata are considered as Brihat-trayee i.e. three main treatises. In Kshemakutuhala text, it is well versed that a Vaidya who has listened many more text books but not listened the Sushruta-Samhita is devoid of actual benefits and if studied many other books but not the Charaka-Samhita gets defame or criticism among Vaidyas who have studied both the Samhitas. Vagbhata says that if the texts written by seers and sages get recognition in society then except Charaka-Samhita and Sushruta-Samhita why Bhela-Samhita etc. are not studied. All these references prove the gravity of Charaka
María Rita Rodríguez-Luna
Conclusion: Despite the low incidence of colonic complication and lethal colonic necrosis associated with the CER clinical use, the general surgeon needs a high index of suspicion when dealing with patients treated with CER and abdominal pain.
Klein, M.; Andersen, L.P.H.; Gögenür, Ismayil;
Purpose: There have been no studies examining the effect of optimized ergonomic and technical environment on the psychological and physiological stress of the surgeon. The aim of this study was to examine whether optimized ergonomics and technical aids within a modern operating room (OR) affect...... psychological and physiological stress in experienced laparoscopic surgeons. Methods: This was a prospective case-controlled study including 10 experienced surgeons. Surgery was performed in 2 different ORs: a standard room and a modern room (OR1-suite, Karl Storz). The surgeons filled out questionnaires...... concerning physical and psychological wellbeing before and after surgery and had their heart rate variability registered during surgery. Results: Preoperative to postoperative physical strain and pain measurements revealed a systematical difference with 14 of 15 parameters favoring the modern OR. Two...
Briet, Justine M.; Mourits, Marian J. E.; Kenkhuis, Monique J. A.; van der Zee, Ate G. J.; de Bock, Geertruida H.; Arts, Henriette J. G.
Study Objective: To investigate the feasibility of safely implementing a total laparoscopic hysterectomy (LH) in established gynecologists' practices with on-site coaching and monitoring of the learning curve by an experienced visiting surgeon. Design: Multicenter prospective feasibility and impleme
Williams, Katherine; Schneider, Brandon; Lajos, Paul; Marin, Michael; Faries, Peter
The increase in prevalence of certain cardiovascular risk factors increases susceptibility to vascular disease, which may create demand for surgical intervention. In our study, data collected by the American Association of Medical Colleges Physician Specialty Databook of 2012, the United States Census Bureau, and other nationwide organizations were referenced to calculate future changes in vascular surgeon supply and prevalence of people at risk for vascular disease. In 2010, there were 2853 active vascular surgeons. By 2040, the workforce is expected to linearly rise to 3573. There will be an exponential rise in people with cardiovascular risk factors. Adding to concern, in 2030, an estimated 3333 vascular surgeons will be available for 180,000,000 people with at least one risk factor for peripheral arterial disease. The paucity of properly trained surgeons entering the workforce needs to be addressed before this shortage becomes a larger burden on healthcare providers and governmental spending. PMID:26199290
DeJong, Melissa Joy
In the late 1990s, human security was promoted as a new idea to guide the formation of Canadian foreign policy in the post-Cold War era. However, a review of the ideas which have influenced foreign policymaking in Canada since the end of the Second World War demonstrates that human security is rooted in internationalism, the dominant Canadian foreign policy tendency. Internationalism prescribes that cooperation, multilateralism, responsibility, international law and a consideration of the v...
Czoli, Christine D; Leatherdale, Scott T; Rynard, Vicki
Introduction Although cigarette use among Canadian youth has decreased significantly in recent years, alternative forms of tobacco use are becoming increasingly popular. Surveillance of youth tobacco use can help inform prevention programs by monitoring trends in risk behaviors. We examined the prevalence of bidi and hookah use and factors associated with their use among Canadian youth by using data from the 2010–2011 Youth Smoking Survey (YSS). Methods We analyzed YSS data from 28,416 studen...
Konst, Emmy Maria
This thesis describes an investigation into the effects of infant orthopaedics (IO) on speech and language development in children with unilateral cleft lip and palate (UCLP). The study was performed within the framework of the three-centre prospective randomised clinical trial 'Dutchcleft'. Two gro
Jannink, MJA; de Vries, J; Stewart, RE; Groothoff, JW; Lankhorst, GJ
Objective: To develop a self-report questionnaire for patients with degenerative disorders of the foot to evaluate the usability of their orthopaedic shoes, and to assess the reproducibility and responsiveness of the instrument. Design: Development of the Questionnaire for Usability Evaluation of or
Jannink, Michiel J.A.; Vries, de Jaap; Stewart, Roy E.; Groothoff, Johan W.; Lankhorst, Gustaaf J.
Objective: To develop a self-report questionnaire for patients with degenerative disorders of the foot to evaluate the usability of their orthopaedic shoes, and to assess the reproducibility and responsiveness of the instrument. Design: Development of the Questionnaire for Usability Evaluation of or
Lohmander, Anette; Lillvik, Malin; Friede, Hans
The purpose of study was to investigate the impact of pre-surgical Infant Orthopaedics (IO) on consonant production at 18 months of age in children with Unilateral Cleft Lip and Palate (UCLP) and to compare the consonant production to that of age-matched children without clefts. The first ten children in a consecutive series of 20 with UCLP…
textabstractAn outbreak of methicillin-resistant Staphylococcus aureus (MRSA) occurred in two adjacent orthopaedic wards following the admission of a known carrier. The outbreak was not contained by ward closure or by standard infection control measures. Eventually several nasal carriers were identi
Because of the huge volume of capital required to construct a modern electric power generating station, investment decisions have to be made with as complete an understanding of the consequences of the decision as possible. This understanding must be provided by the evaluation of future situations. A key consideration in an evaluation is the financial component. This paper attempts to use an econometric method to forecast the construction costs escalation of a standard Canadian nuclear generating station (NGS). A brief review of the history of Canadian nuclear electric power is provided. The major components of the construction costs of a Canadian NGS are studied and summarized. A database is built and indexes are prepared. Based on these indexes, an econometric forecasting model is constructed using an apparently new econometric methodology of forecasting modelling. Forecasts for a period of 40 years are generated and applications (such as alternative scenario forecasts and range forecasts) to uncertainty assessment and/or decision-making are demonstrated. The indexes, the model, and the forecasts and their applications, to the best of the author's knowledge, are the first for Canadian NGS constructions. (author)
Richardson Katya L
Full Text Available Abstract The disproportionate effects of the 2009 H1N1 pandemic on many Canadian Aboriginal communities have drawn attention to the vulnerability of these communities in terms of health outcomes in the face of emerging and reemerging infectious diseases. Exploring the particular challenges facing these communities is essential to improving public health planning. In alignment with the objectives of the Pandemic Influenza Outbreak Research Modelling (Pan-InfORM team, a Canadian public health workshop was held at the Centre for Disease Modelling (CDM to: (i evaluate post-pandemic research findings; (ii identify existing gaps in knowledge that have yet to be addressed through ongoing research and collaborative activities; and (iii build upon existing partnerships within the research community to forge new collaborative links with Aboriginal health organizations. The workshop achieved its objectives in identifying main research findings and emerging information post pandemic, and highlighting key challenges that pose significant impediments to the health protection and promotion of Canadian Aboriginal populations. The health challenges faced by Canadian indigenous populations are unique and complex, and can only be addressed through active engagement with affected communities. The academic research community will need to develop a new interdisciplinary framework, building upon concepts from ‘Communities of Practice’, to ensure that the research priorities are identified and targeted, and the outcomes are translated into the context of community health to improve policy and practice.
Samuel, T. John
Examines the characteristics of landed immigrants (permanent settlers) from Asia, and explores their settlement, adaptation, and integration experience in Canada. It suggests that access to Canadian land does not always translate into equal opportunity in the economy and society, but notes that Canada may be more successful at assimilating Asian…