Sample records for canadian orthopedic surgeons

  1. A Bariatric Surgery Primer for Orthopedic Surgeons. (United States)

    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.

  2. Chinese Orthopedic Surgeons' Practice Regarding Postoperative Thromboembolic Prophylaxis after Major Orthopedic Surgery

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    Zhi-jian Sun; Gui-xing Qiu; Xi-sheng Weng; Yu Zhao; Jin Jin


    Objective To assess Chinese surgeon practice of thromboprophylaxis following major orthopedic surgery.Methods A questionnaire survey was conducted amongst Chinese orthopedic surgeons.A total of 293 surgeons were surveyed concerning five key aspects of thromboembolic prophylaxis after major orthopedic surgery at the proseminar of Chinese guidelines for prevention of venous thromboembolism (VTE) after major orthopedic surgery in January of 2009.Results Totally,208 surgeons (71.0%) responded,successfully completing the questionnaire.Of them,57.6% respondents selected combined basic,mechanical,and pharmacologic methods for thromboprophylaxis; 51.0% respondents prefer starting prophylaxis 12-24 hours after surgery; 60.3% surgeons would use chemoprophylaxis for 7-10 days; 47.6% respondents prefer VTE prevention based on patients'special conditions and needs upon discharge."Safety" was the most repeated and emphasized factor during VTE prophylaxis.Conclusions Multimodal thromboprophylaxis is frequently used after major orthopedic surgery.Half surgeons prefer to start chemoprophylaxis 12-24 hours after surgery.Thromboprophylaxis regimen varies for discharged patients.

  3. Improving surgeon utilization in an orthopedic department using simulation modeling

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    Simwita YW


    Full Text Available Yusta W Simwita, Berit I Helgheim Department of Logistics, Molde University College, Molde, Norway Purpose: Worldwide more than two billion people lack appropriate access to surgical services due to mismatch between existing human resource and patient demands. Improving utilization of existing workforce capacity can reduce the existing gap between surgical demand and available workforce capacity. In this paper, the authors use discrete event simulation to explore the care process at an orthopedic department. Our main focus is improving utilization of surgeons while minimizing patient wait time.Methods: The authors collaborated with orthopedic department personnel to map the current operations of orthopedic care process in order to identify factors that influence poor surgeons utilization and high patient waiting time. The authors used an observational approach to collect data. The developed model was validated by comparing the simulation output with the actual patient data that were collected from the studied orthopedic care process. The authors developed a proposal scenario to show how to improve surgeon utilization.Results: The simulation results showed that if ancillary services could be performed before the start of clinic examination services, the orthopedic care process could be highly improved. That is, improved surgeon utilization and reduced patient waiting time. Simulation results demonstrate that with improved surgeon utilizations, up to 55% increase of future demand can be accommodated without patients reaching current waiting time at this clinic, thus, improving patient access to health care services.Conclusion: This study shows how simulation modeling can be used to improve health care processes. This study was limited to a single care process; however the findings can be applied to improve other orthopedic care process with similar operational characteristics. Keywords: waiting time, patient, health care process

  4. Therapists, Trainers, and Acupuncturists: Focused Review for the Orthopedic Surgeon. (United States)

    Domes, Christopher M; Kruger, Cori L


    Effective treatment of orthopedic injuries requires a multidisciplinary team, including physical and occupational therapists, athletic trainers, massage therapists, and acupuncturists. Orthopedic surgeons commonly encounter these practitioners but may not be familiar with the training, credentialing, and most importantly, the appropriate use of members of this team. There are general similarities in practice locations as well as types of symptoms addressed by the providers discussed, which include the treatment of physical pain, evaluation and treatment of physical impairment, and some facilitation of adaptation to the limitations caused by injuries. Across the 5 types of providers discussed there are widely varying training and licensing requirements, specializations, and continuing education requirements to maintain licensure. This article provides a focused review of these members of the multidisciplinary team and highlights the current American Academy of Orthopaedic Surgeons recommendations for the use of occupational and physical therapists for orthopedic conditions, including hip fractures, total hip arthroplasty, and anterior cruciate ligament reconstruction.

  5. Online reviews of orthopedic surgeons: an emerging trend. (United States)

    Frost, Chelsea; Mesfin, Addisu


    Various websites are dedicated to rating physicians. The goals of this study were to: (1) evaluate the prevalence of orthopedic surgeon ratings on physician rating websites in the United States and (2) evaluate factors that may affect ratings, such as sex, practice sector (academic or private), years of practice, and geographic location. A total of 557 orthopedic surgeons selected from the 30 most populated US cities were enrolled. The study period was June 1 to July 31, 2013. Practice type (academic vs private), sex, geographic location, and years since completion of training were evaluated. For each orthopedic surgeon, numeric ratings from 7 physician rating websites were collected. The ratings were standardized on a scale of 0 to 100. Written reviews were also collected and categorized as positive or negative. Of the 557 orthopedic surgeons, 525 (94.3%) were rated at least once on 1 of the physician rating websites. The average rating was 71.4. The study included 39 female physicians (7.4%) and 486 male physicians (92.6%). There were 204 (38.9%) physicians in academic practice and 321 (61.1%) in private practice. The greatest number of physicians, 281 (50.4%), practiced in the South and Southeast, whereas 276 (49.6%) practiced in the West, Midwest, and Northeast. Those in academic practice had significantly higher ratings (74.4 vs 71.1; P<.007). No significant difference based on sex (72.5 male physicians vs 70.2 female physicians; P=.17) or geographic location (P=.11) were noted. Most comments (64.6%) were positive or extremely positive. Physicians who were in practice for 6 to 10 years had significantly higher ratings (76.9, P<.01) than those in practice for 0 to 5 years (70.5) or for 21 or more years (70.7).

  6. [What do orthopedic surgeons need to know from radiologists?]. (United States)

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


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

  7. Publication Productivity of Early-Career Orthopedic Trauma Surgeons. (United States)

    Hake, Mark E; Lee, John J; Goulet, James A


    The goals of this study were to: (1) define the publication productivity of early-career orthopedic trauma surgeons over time; (2) compare the early-career publication productivity of recent orthopedic trauma fellowship graduates vs their more senior colleagues; and (3) determine the proportion of fellowship graduates who meet the Orthopaedic Trauma Association (OTA) publication criteria for active membership early in their careers. Orthopedic trauma fellowship graduates from 1982 to 2007 were analyzed. A literature search was performed for each fellow's publications for the 6-year period beginning the year of fellowship graduation. Publication productivity was compared between early and recent groups of graduates, 1987 to 1991 and 2003 to 2007, respectively. Fulfillment of OTA publication criteria was determined. Seventy-nine percent of graduates contributed to 1 or more publications. The recent group produced more total publications per graduate (4.06 vs 3.29, P=.01) and more coauthor publications (2.60 vs 2.04, P=.019) than the early group. The number of first-author publications did not differ between groups (1.46 vs 1.25, P=.26). A greater percentage of the recent group met current OTA publication criteria compared with the early group (51% vs 35%, P=.04). The findings showed that recent orthopedic trauma graduates had increased publication productivity compared with their more senior colleagues, although a proportion had not qualified for active OTA membership 6 years into their career. Overall, these data are encouraging and suggest that young orthopedic trauma surgeons remain committed to sustaining a high level of academic excellence.

  8. Canadian cardiac surgeons' perspectives on biomedical innovation. (United States)

    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.

  9. Qualitative evaluation of a form for standardized information exchange between orthopedic surgeons and occupational physicians

    NARCIS (Netherlands)

    E. Faber (Elske); A. Burdorf (Alex); A.L. van Staa (AnneLoes); H.S. Miedema (Harald); J.A.N. Verhaar (Jan)


    textabstractBACKGROUND: Both occupational physicians and orthopedic surgeons can be involved in the management of work relevant musculoskeletal disorders. These physicians hardly communicate with each other and this might lead to different advice to the patient. Therefore, we evaluated a standardize

  10. Advocacy--answering old mail. Canadian Association of General Surgeons. (United States)

    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.

  11. Orthopedic Resident Anatomy Review Course: A Collaboration between Anatomists and Orthopedic Surgeons (United States)

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


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

  12. Traumatic elbow injuries: what the orthopedic surgeon wants to know. (United States)

    Sheehan, Scott E; Dyer, George S; Sodickson, Aaron D; Patel, Ketankumar I; Khurana, Bharti


    Traumatic elbow injuries are commonly encountered in the emergency department setting, but their complexity and clinical significance often go unrecognized at the initial evaluation. Initial imaging in patients with elbow trauma should not only help identify major injuries that require immediate intervention but also allow detection of other, often more subtle injuries that may lead to instability or poor functional outcomes if appropriate treatment is delayed. Awareness and detection of these injuries may be improved by a better-developed and more intuitive understanding of the mechanisms that underlie the most common injury patterns. Ideally, such understanding should prompt appropriate early use of advanced imaging techniques. Traumatic elbow injuries should be described in the radiology report within the context of their clinical significance and their implications for management, information that is often best captured by the injury grading and classification systems used by the orthopedic surgery community. This article reviews the relevant anatomy and functional stability of the elbow and discusses common traumatic elbow injury patterns, including elbow dislocations as well as fractures of the distal humerus, radial head and neck, coronoid process, and olecranon. Less commonly encountered injury constellations that are clinically significant are also described. Injury patterns are explained in the context of the responsible force mechanism by using three-dimensional modeling and animation, with emphasis on the functional impact of associated secondary bone and soft-tissue injuries. The utility of cross-sectional imaging modalities such as computed tomography and magnetic resonance imaging in the acute care setting is discussed, and specific imaging guidelines are provided. Supplemental material available at

  13. Bilateral simultaneous anterior cruciate ligament injury: a case report and national survey of orthopedic surgeon management preference

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    Ehsan Saadat


    Full Text Available Unilateral anterior cruciate ligament (ACL tear is a common injury seen by sports medicine orthopedic surgeons. However, a bilateral simultaneous ACL injury is extremely rare and has been reported only three times in the literature. We present a young female skier with simultaneous bilateral ACL tears that were managed with staged ACL reconstruction. We then conducted a nationwide survey (United States to determine the prevalence of simultaneous bilateral ACL tear and preferred management strategies by sports medicine orthopedic surgeons. Sports medicine fellowship directors were contacted and asked to send an 8-item survey to colleagues (sports medicine fellowship trained surgeons asking about overall number of ACL reconstructions performed, number of bilateral simultaneous ACL injuries seen and optimal management strategies of such an injury. Out of 43 responses, only 22 (51.2% surgeons had seen a bilateral simultaneous ACL injury. Of these, 16 (76.2% preferred staged reconstruction. Graft choice was mixed between autograft and allograft, but a large majority preferred either patellar tendon autograft (58% or hamstring autograft (41% were the most common choice. Staged reconstruction is the treatment of choice by surgeons surveyed in our study.

  14. Evaluation of the orthopedic residency training program in Saudi Arabia and comparison with a selected Canadian residency program

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    Al-Ahaideb A


    Full Text Available Abdulaziz Al-Ahaideb,1 Hamza M Alrabai,1 Osama A Alrehaili,1 Abdulaziz N Aljurayyan,1 Ranyah M Alsaif,2 Nizar Algarni,1 Hazem M Al-Khawashki,1 Abdulrahman D Algarni1 1Department of Orthopedics, 2Department of Physiotherapy, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia Objective: The primary aim of the present study was to assess the quality of the Saudi Orthopedic Residency Program. Methodology: As a comparator, a cross-sectional survey involving 76 Saudi residents from different training centers in Saudi Arabia namely; Riyadh, Jeddah, Medina, Abha, and Dammam and 15 Canadian. Results: The results showed that Canadian residents read more peer-reviewed, scholarly articles compared with Saudi residents (P=0.002. The primary surgical role for residents was to hold retractors during surgery. The survey respondents strongly supported the ability to recommend removal of incompetent trainers. Saudi trainees were more apprehensive of examinations than Canadian trainees (P<0.0001. Most residents preferred studying multiple-choice questions before examinations. Saudi and Canadian participants considered their programs to be overcrowded. Unlike Canadian participants, Saudi trainees reported an inadequate level of training (P<0.0001. Conclusion: Educational resources should be readily accessible and a mentorship system monitoring residents' progress should be developed. The role of the resident must be clearly defined and resident feedback should not be ignored. Given the importance of mastering basic orthopedic operative skills for residents, meaningful remedial action should be taken with incompetent trainers. Keywords: evaluation, medical education, orthopedic board, residency program, training

  15. Canadian Cardiovascular Society/Canadian Society of Cardiac Surgeons/Canadian Society for Vascular Surgery Joint Position Statement on Open and Endovascular Surgery for Thoracic Aortic Disease. (United States)

    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.

  16. Comparison of characteristics and therapeutic efficacy in rheumatoid arthritis patients treated by rheumatologists and those treated by orthopedic surgeons under a team medicine approach at the same institute. (United States)

    Momohara, Shigeki; Inoue, Eisuke; Ikari, Katsunori; Yano, Koichiro; Tokita, Asami; Honjo, Yurino; Sakuma, Yu; Hiroshima, Ryo; Iwamoto, Takuji; Seto, Yohei; Tanaka, Eiichi; Taniguchi, Atsuo; Yamanaka, Hisashi


    The treatment of rheumatoid arthritis (RA) has improved dramatically with the advent of the latest generation of disease-modifying antirheumatic drugs. Despite these advances, in some patients inflammation is not diminished sufficiently to prevent irreversible musculoskeletal damage, thereby necessitating surgical intervention to reduce pain and improve function. For RA treatment, Japanese orthopedic surgeons also prescribe medication. In this study, we examined whether this Japanese system is effective for RA treatment. We analyzed the clinical condition of RA patients treated by rheumatologists and those treated by orthopedists in a linked registry study using information from a large observational cohort of RA patients followed every half year from 2000 to 2010 (the IORRA cohort). Two groups of patients were compared: patients treated by rheumatologists (rheumatologic group) and patients treated by orthopedists (orthopedic group). The results revealed that patients in the orthopedic group were older, more likely to be female, and had a longer disease duration than patients in the rheumatologic group. The proportion of patients with a history of joint surgery was also much higher in the orthopedic group than in the rheumatologic group. The average scores on the Japanese version of the Health Assessment Questionnaire, and the remission ratio determined using a Boolean-based definition gradually increased from 2000 until 2010, and these findings were consistently better in the rheumatologic group than in the orthopedic group. These data suggest that patients treated primarily by orthopedists are more likely to have long-standing RA compared to patients treated by rheumatologists. Therefore, it is critical for rheumatologists and orthopedists to complement each other medically in the treatment of RA patients.

  17. Como o especialista em ortopedia e traumatologia avalia o atendimento ao trauma ortopédico no Brasil How do orthopedic surgeons rate the orthopedic trauma care in Brazil

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    Jorge Santos Silva


    Society database containing more than 7000 records. A structured query has been applied and the interview lasted around 25 minutes. RESULTS: 97% of interviewees dedicate part of his/her time to orthopedic trauma. 87% of all interviewees dedicate his/her time to more than one sub-specialty. The majority of orthopedic trauma patients comes from government insurance system (43%, while 41% of patients come from private insurance. 61% of all interviewees think that the quality of public health system could be rated as unsatisfactory. Northeast of Brazil is the place where the majority of patients are from public health system and where we have highest rates of dissatisfaction (85% related to available infrastructure for orthopedic trauma care. Half of all interviewed individuals have problems for getting private insurance authorization previously to a surgery. CONCLUSIONS: Orthopedic trauma is a specialty practiced by the vast majority of orthopedic surgeons in our country. Neither the infrastructure nor the salaries satisfy the majority or orthopedic surgeons dedicated to trauma care.

  18. Personal dosimetry TLD 100 in orthopedic surgeons exposed to ionizing radiation in Bogota - Colombia; Dosimetria personal TLD 110 en medicos ortopedistas expuestos a radiacion ionizante en Bogota - Colombia

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    Sierra C, B. Y.; Jimenez, Y. [Universidad Nacional de Colombia, Departamento de Fisica, Grupo de Fisica Medica, Carrera 45 No. 26-85, Bogota (Colombia); Plazas, M. C. [Hospital Universitario Fundacion Santa Fe de Bogota, Instituto de Oncologia Carlos Ardila Lulle, Calle 119, No. 7-90, 220246 Bogota (Colombia); Eslava S, J. [Universidad Nacional de Colombia, Instituto de Investigaciones Clinicas, Grupo Equidad en Salud, Carrera 45 No. 26-85, Bogota (Colombia); Groot R, H., E-mail: [Universidad de los Andes, Laboratorio de Genetica Humana, Carrera 1 No. 18A -12, Bogota (Colombia)


    Orthopedic surgeons should be considered as professionals occupationally exposed to ionizing radiation, for using C arc (fluoroscope) an equipment of X type radiation emission, during surgical procedures for imaging generation. Some health institutes, use of C arc under uncontrolled circumstances, such a lack of dosimetry control, incomplete or absence of personnel protective elements and protective measures, which in turn, lead to a high exposition to the personnel. Materials and methods. Study of double match cohort by age and gender, was conducted, in four health institutions of second and third level of attention in Bogota city. Personal dosimetry measurements with TLD-100 dosimetry crystals in both cohorts and environmental dosimetry in each of operation rooms used for orthopedic procedures, were carry out during six months of follow up. Dosimetry crystals were read in a Harshaw 4500 - Bicron equipment, in the Medical Physics Laboratory of National University of Colombia. Results. Dosimetry measurements are compatibles with those of occupationally exposed personnel 3.44 mSv/6 m CI 95% (1.66-3.99), even does not overpass ICRP recommendations, are higher as were expect at the beginning of the study. The median of effective accumulative dose in thorax is 3,4 mSv CI 95% (1,66-3,99), higher in comparison with neck value 2,7 mSv CI 95% (1,73-3,80) and hand dosimetry 1,42 mSv CI 95% (0,96-2,34). Conclusions: Orthopedic surgeons should be considered occupational exposed to ionizing radiation, who has to accomplish to the radiological protection measures, dosimetric follow up and maintenance of the used X ray equipment. It was confirm throughout this study that dosimetry shows higher levels as expected at the beginning of the study, compatible with occupationally exposed personnel. (Author)

  19. How many orthopedic surgeons does it take to write a research article? 50 years of authorship proliferation in and internationalization of the orthopedic surgery literature. (United States)

    Rahman, Luthfur; Muirhead-Allwood, Sarah K


    Publications are considered to indicate academic achievement and can lead to various rewards, including job opportunities and research funding. Recent years have seen a rising trend in the number of articles published, multiple authorship, and internationalization of the biomedical literature. The goal of this study was to analyze the trends in authorship over the past 50 years to determine whether the orthopedic literature parallels trends seen in other areas of the biomedical literature. We performed an observational study with analysis of the number of authors and geographic origin of articles published in the Journal of Bone and Joint Surgery British Volume (JBJS) and Clinical Orthopaedics and Related Research (CORR). We analyzed 2776 articles (CORR, n=1809; JBJS, n=967) published between 1958 and 2008 at 10-year intervals. There has been a significant increase in the mean number of authors per article from 1.638 to 4.08 (P<.0001) and 1.633 to 4.540 (P<.0001) for CORR and JBJS, respectively between 1958 and 2008. There has been a significant increase in the international contribution to both journals (P<.0001). The number of countries contributing to articles increased from 5 to 39 and from 17 to 33 for CORR and JBJS, respectively. These findings are similar to other areas of the biomedical literature. The reasons for this proliferation are multifactorial, including multicenter trials and inappropriate authorship. Guidelines for authorship and preparation of manuscripts from the International Committee of Medical Journal Editors or from individual journals are widely available, and every effort should be made to adhere to them to prevent inappropriate authorship proliferation in the future.

  20. Evaluation of equivalent and effective dose by KAP for patient and orthopedic surgeon in vertebral compression fracture surgery (United States)

    Santos, Felipe A.; Galeano, Diego C.; Santos, William S.; Silva, Ademir X.; Souza, Susana O.; Carvalho Júnior, Albérico B.


    Clinical scenarios were virtually modeled to estimate both the equivalent and effective doses normalized by KAP (Kerma Area Product) to vertebra compression fracture surgery in patient and surgeon. This surgery is known as kyphoplasty and involves the use of X-ray equipment, the C-arm, which provides real-time images to assist the surgeon in conducting instruments inserted into the patient and in the delivery of surgical cement into the fractured vertebra. The radiation transport code used was MCNPX (Monte Carlo N-Particle eXtended) and a pair of UFHADM (University of Florida Hybrid ADult Male) virtual phantoms. The developed scenarios allowed us to calculate a set of equivalent dose (HT) and effective dose (E) for patients and surgeons. In additional, the same scenario was calculated KAP in the tube output and was used for calculating conversion coefficients (E/KAP and HT/KAP). From the knowledge of the experimental values of KAP and the results presented in this study, it is possible to estimate absolute values of effective doses for different exposure conditions. In this work, we developed scenarios with and without the surgical table with the purpose of comparison with the existing data in the literature. The absence of the bed in the scenario promoted a percentage absolute difference of 56% in the patient effective doses in relation to scenarios calculated with a bed. Regarding the surgeon, the use of the personal protective equipment (PPE) reduces between 75% and 79% the effective dose and the use of the under table shield (UTS) reduces the effective dose of between 3% and 7%. All these variations emphasize the importance of the elaboration of virtual scenarios that approach the actual clinical conditions generating E/KAP and HT/KAP closer to the actual values.

  1. Canadian Hepatitis C Look-Back Investigation to Detect Transmission from an Infected General Surgeon

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    Meenakshi Dawar


    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.

  2. Survey of current cement application by Chinese orthopedic surgeons%中国髋关节置换术中骨水泥使用状况调查

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    蔡宏; 张克; 田华


    Objective To evaluate the current situation of cement using in Chinese mainland hip arthroplasty. Methods A questionnaire was posted to 1016 surgeons of 30 provinces in Chinese mainland. It was composed of six parts about 21 questions, regarding; (1) Practice characteristic of adult reconstructive orthopedic surgeon; (2) Patient care volume of hospital and surgeon; (3) Type of cement; (4) Third generation techniques; (5) Safety; (6) Usage of antibiotics in bone-cement. All the personal informations of orthopedic surgeons were obtained from their hospitals' web sites. The surgeons who passed the following three criteria were included in this survey: (1) Performing hip arthroplasty was introduced in his resume; (2) Working in third level hospital; (3) No more than three surgeons in the same hospital were included. Results A total of 726 surgeons responded to the survey and 632 surgeons passed the fail-edit. 94% of the respondents characterized themselves as being adult joint reconstructive orthopedists. 58% and 49% of them identified themselves as having trauma or spine specialties at the same time. 65% of the surgeons performed hip arthroplasty less than 40 cases per year and only 35% stated that they used cement hip more than 40% . Of the surgeons, 69% used imported cement as usual, 31% and41% did not know the brand and the viscosity of the cement they used. Cement gun, femur plug, femur centralizer and pulse lavage were used 91% , 79% , 62% and 46% , respectively. Less than 20% of the surgeons used " modern pressure cementing techniques. 46% of surgeons concerned about the safety of cement. Antibiotic bone cement was regularly used by 12% of the respondents in their primary practice. Conclusion This survey revealed the wide diversity of cement use and inappropriate usage of modern cementing techniques in the primary total hip arthroplasty in China mainland. Educational dissemination to reduce practice variation and improve cementing techniques would be indicated

  3. How Social Are We? A Cross-Sectional Study of the Website Presence and Social Media Activity of Canadian Plastic Surgeons. (United States)

    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.

  4. Como o ortopedista brasileiro trata entorse lateral aguda do tornozelo? How does the brazilian orthopedic surgeon treat acute lateral ankle sprain?

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    Paulo Santoro Belangero


    questionnaire was developed which addressed the main aspects related to the treatmentof acute lateral ankle sprains (ALAS. The questionnaire was made available from June 15 to August 1, 2004, at the Official site of the Brazilian Society of Orthopedics and Traumatology. RESULTS: 444 questionnaires were included in the analysis. The results showed agreement among most of those interviewed in the following regards: 90.8% use some classification to guide treatment of the sprain; 59% classify the ankle sprain with certainty; 63.7% use the immobilization in cases of totally ruptured ligaments; 60.6% use anti-inflammatory medication in partial ligament ruptures; 75.9% reported that residual pain was the most frequent complication. There was no consensus regarding treatment of partial ALAS, as immobilization and functional treatment were chosen with the same frequency (47% each. There was no significant difference between the answers of residents and orthopedists. CONCLUSIONS: Orthopedic surgeons and orthopedic residents in Brazil have difficulty classifying ALAS and there is no consensus about the best therapeutic option for partial ALAS.

  5. Rabbit orthopedic surgery. (United States)

    Rich, Gregory A


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

  6. 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

    Directory of Open Access Journals (Sweden)

    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.

  7. [The beginnings of orthopedic surgery in Israel]. (United States)

    Tauber, Chanan


    In early mandatory Israel, orthopedics was mainly conservative, The first modern orthopedic surgeon was Ernst Spira from Czechoslovakia who established an orthopedic service at the Beilinson Hospital in Petah Tikva and left in 1948 to establish the Orthopedic Department and the Rehabilitation Center in Tel Hashomer, which treated the War of Independence casualties including amputees and victims of spinal cord injuries. A second orthopedic department was opened in Tel Hashomer by Shmuel Weissman who left in 1961 to open the Orthopedic Department at the Ichilov hospital in Tel Aviv. Shmuel Weissman became the first Chairman of Orthopedic Surgery at the Tel Aviv University medical school. In 1955, Myer Makin opened a modern orthopedic department in the Hadassah Hospital in Jerusalem and the Alyn Hospital for crippled children. In 1951, Assaf Harofeh Hospital opened the Department of Orthopedic Surgery headed by Anatol Axer who specialized in the treatment and rehabilitation of polio patients. The majority of the second generation of orthopedic department directors was trained by these four surgeons. Major developments in the 1960s and 1970s were the introduction of the AO system revolutionizing fracture treatment from conservative to operative treatment, the advent of total hip and knee replacements, Harrington instrumentation in spinal surgery and arthroscopy were major advances in orthopedic patient care brought to Israel by the aforementioned second generation of orthopedic surgeons. Hand surgery became an independent subspecialty of orthopedics and was lead by the internationally renowned hand surgeon, Isidore Kessler.

  8. [New routines in orthopedics department yielded more efficient care and more satisfied patients. Physiotherapist and team make the first assessment in new visits to the spine surgeon]. (United States)

    Knutsson, Björn; Torstensson, Thomas


    There is a shortage of spine surgeons in Sweden. To guarantee the legal right to healthcare, many counties must hire doctors, with increasing costs. In our new out-patient department routine, the majority of the patients are examined by a physiotherapist at their first visit. History taking and clinical and radiographic examinations are discussed in a team conference, and possible candidates for spine surgery are selected for an appointment with a spine surgeon. Furthermore, the patients were more satisfied with the new routine and management plan.

  9. Real-Time Teleguidance of a Non-Surgeon Crew Medical Officer Performing Orthopedic Surgery at the Amundsen-Scott South Pole Station During Winter-Over (United States)

    Otto, Christian


    The Amundsen-Scott South Pole Research station located at the geographic South Pole, is the most isolated, permanently inhabited human outpost on Earth. Medical care is provided to station personnel by a non-surgeon crew medical officer (CMO). During the winter-over period from February to October, the station is isolated, with no incoming or outgoing flights due to severe weather conditions. In late June, four months after the station had closed for the austral winter, a 31 year old meteorologist suffered a complete rupture of his patellar tendon while sliding done an embankment. An evacuation was deemed to be too risky to aircrews due to the extreme cold and darkness. A panel of physicians from Massachusetts General Hospital, Johns Hopkins University and the University of Texas Medical Branch were able to assess the patient remotely via telemedicine and agreed that surgery was the only means to restore mobility and prevent long term disability. The lack of a surgical facility and a trained surgical team were overcome by conversion of the clinic treatment area, and intensive preparation of medical laypersons as surgical assistants. The non-surgeon CMO and CMO assistant at South Pole, were guided through the administration of spinal anesthetic, and the two-hour operative repair by medical consultants at Massachusetts General Hospital. Real-time video of the operative field, directions from the remote consultants and audio communication were provided by videoconferencing equipment, operative cameras, and high bandwidth satellite communications. In real-time, opening incision/exposure, tendon relocation, hemostatsis, and operative closure by the CMO was closely monitored and guided and by the remote consultants. The patient s subsequent physical rehabilitation over the ensuing months of isolation was also monitored remotely via telemedicine. This was the first time in South Pole s history that remote teleguidance had been used for surgery and represents a model for

  10. Moral Dilemmas in Pediatric Orthopedics. (United States)

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


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

  11. Collaborative multicenter trials in Latin America: challenges and opportunities in orthopedic and trauma surgery

    Directory of Open Access Journals (Sweden)

    Vinicius Ynoe de Moraes

    Full Text Available CONTEXT AND OBJECTIVE Orthopedic research agendas should be considered from a worldwide perspective. Efforts should be planned as the means for obtaining evidence that is valid for health promotion with global outreach. DESIGN AND SETTING Exploratory study conducted at Universidade Federal de São Paulo (Unifesp, São Paulo, Brazil, and McMaster University, Hamilton, Canada. METHODS We identified and analyzed collaborative and multicenter research in Latin America, taking into account American and Canadian efforts as the reference points. We explored aspects of the data available from official sources and used data from traffic accidents as a model for discussing collaborative research in these countries. RESULTS The evaluation showed that the proportion of collaborative and multicenter studies in our setting is small. A brief analysis showed that the death rate due to traffic accidents is very high. Thus, it seems clear to us that initiatives involving collaborative studies are important for defining and better understanding the patterns of injuries resulting from orthopedic trauma and the forms of treatment. Orthopedic research may be an important tool for bringing together orthopedic surgeons, researchers and medical societies for joint action. CONCLUSIONS We have indicated some practical guidelines for initiatives in collaborative research and have proposed some solutions with a summarized plan of action for conducting evidence-based research involving orthopedic trauma.

  12. Twitter as a communication tool for orthopedic surgery. (United States)

    Franko, Orrin I


    Twitter is a social networking Web site that has changed the way information is communicated. This study involved identifying, categorizing, and reviewing orthopedic Twitter profiles. A total of 412 profiles were identified. Of those, 176 (50.3%) were surgeons; 89 (50.5%) were based in the United States and 77 (43.8%) were not (10 unclassified). Most surgeons were young; 66% of surgeons were board certified within the past 10 years. Only a small percentage of orthopedic surgeons and practices currently use Twitter, but the use of social networking for orthopedic communication is likely to play an increasing role in future clinical practice.

  13. Orthopedic trauma in pregnancy. (United States)

    Desai, Pratik; Suk, Michael


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

  14. Orthopedic evaluation (United States)

    Walden, T.


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

  15. Imaging of orthopedic sports injuries

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    Vanhoenacker, F.M.; Gielen, J.L. (eds.) [University Hospital Antwerp, Edegem (Belgium). Dept. of Radiology; Maas, M. [Academic Medical Centre, Amsterdam (Netherlands). Dept. of Radiology


    This volume provides an updated review of imaging abnormalities in orthopedic sports injuries. The first part of the book contains background information on relevant basic science and general imaging principles in sports traumatology. The second part comprises a topographic discussion of sports injuries. Each chapter highlights the merit of different imaging techniques, focused on a specific clinical problem. In the third part, natural history, monitoring and follow-up by imaging are discussed. This well-illustrated book will be of value for musculoskeletal radiologists, orthopedic surgeons, sports physicians and everyone else involved in sports medicine. (orig.)

  16. Orthopedic Prosthetic Infections: Plastic Surgery Management. (United States)

    Meaike, Jesse D; Kaufman, Matthew G; Izaddoost, Shayan A


    Orthopedic prosthetic infections are potentially devastating complications. Plastic surgeons are frequently consulted to aid in the management of the soft tissue defects that are created by these infections. A review of the existing literature was performed to identify established treatment methods for soft tissue coverage of orthopedic hardware infections for a variety of anatomic locations. The following treatment guidelines and soft tissue reconstructive options were identified as viable options for the management of exposed or infected orthopedic hardware. This review provides descriptions of the various soft tissue reconstructive options available as well as adjunctive treatment methods.

  17. Trends in the orthopedic job market and the importance of fellowship subspecialty training. (United States)

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


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

  18. Mentoring surgeons. (United States)

    Toledo-Pereyra, Luis H


    From time immemorial mentoring has been the angular stone sustaining the building of medical and surgical education. Good teachers are not necessarily good mentors, and good mentors are not always good teachers. A combination of both is very plausible and should be encouraged. Today, the qualities of a good mentor, in our case the surgeon-mentor, should include respect, time, commitment, trust, determination, encouragement, patience, and opportunity for independence. The mentee would need to respond to similar virtues of trust, encouragement, and respect. The reciprocal consideration of equally divided roles would be clearly desirable. Recognizing the importance of a good mentor and making this role the priority of medical schools would enhance our ability to form better professionals. It would certainly promote professionalism, better patient care, and research.

  19. [Psychosomatic aspects in orthopedics]. (United States)

    Köllner, V; Rupp, S


    Psychosomatic disease patterns are a common differential diagnosis for orthopedic symptoms. Furthermore, mental factors, such as the method of disease processing or mental comorbidities, such as depression or somatization disorders have a great influence on the chronification of orthopedic complaints and the outcome following orthopedic interventions. The aim of this article is to present the psychosomatic pathomechanisms and disease patterns relevant for orthopedics and to derive recommendations for physician-patient communication, diagnostics, therapy and assessment.

  20. 3D-printed patient-specific applications in orthopedics


    Wong KC


    Kwok Chuen Wong Department of Orthopedics and Traumatology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong Abstract: With advances in both medical imaging and computer programming, two-dimensional axial images can be processed into other reformatted views (sagittal and coronal) and three-dimensional (3D) virtual models that represent a patients’ own anatomy. This processed digital information can be analyzed in detail by orthopedic surgeons to perform p...

  1. Three-Dimensional Printing in Orthopedic Surgery. (United States)

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


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

  2. The Effect of Orthopedic Advertising and Self-Promotion on a Naïve Population. (United States)

    Mohney, Stephen; Lee, Daniel J; Elfar, John C


    There has been a marked increase in the number of physicians marketing themselves directly to patients and consumers. However, it is unclear how different promotional styles affect patients' perceptions of their physicians. We hypothesized that self-promoting orthopedic surgeons enjoy a more positive impact on nonphysician patients as compared to non-self-promoting surgeons, as well as a corresponding negative impact on their peer-surgeons. Surgeon websites were selected from the 5 largest population centers in the United States. Subjects with varying degrees of familiarity with orthopedic surgery evaluated Internet profiles of surgeons on a forced choice Likert scale to measure the amount of self-promotion. The naïve subjects judged self-promoting surgeons more favorably than the orthopedic surgeons. In contrast, board-certified orthopedic surgeons viewed self-promoting surgeons more negatively than did their nonphysician counterparts. In summary, the present study revealed that the potential for self-promotion to unduly influence potential patients is real and should be a considerable concern to surgeons, patients, and the profession.

  3. Vascular Injury in Orthopedic Trauma. (United States)

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


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

  4. Reduction in Surgical Wound Infection Rates Associated with Reporting Data to Surgeons

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    GD Taylor


    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.

  5. [Orthopedic approach to asymmetry]. (United States)

    Bardinet, Etienne; Duhart, Anne-Marie


    Asymmetry being a clinical manifestation of various pathologies, the orthopedic attitude greatly varies from one practitioner to another. Thanks to a better knowledge of the etiopathogenesis, the orthopedic approach in some particular cases reveals very effective, either alone or together with other therapeutics. In mandibular laterodeviations most often consecutive to a maxillary contraction, the best treatment is to expand maxilla which will allow a mandibular centric repositioning. This therapy is often achieved early to limit the asymmetric expression of growth and normalize the dental eruption. In unilateral condylar hypoplasias of variable extension, from a simple defect in condylar growth to a hemifacial microsomia, the therapeutic attitude has mostly evolved. A surgical orthodontic protocol can integrate an increasingly significant orthopedic phase in the course of time. Some authors show that a surgical case may be treated originally only with the help of orthopedics. The devices used are of activator or hyperpropulsor type. In unilateral condylar hyperplasias, orthopedic therapy must be considered with reservations.

  6. Designing Wearable Personal Assistants for Surgeons: An Egocentric Approach

    DEFF Research Database (Denmark)

    Jalaliniya, Shahram; Pederson, Thomas


    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...

  7. [Thermoformed orthopedic splints]. (United States)

    Amoric, M


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

  8. Social media and your practice: navigating the surgeon-patient relationship. (United States)

    McLawhorn, Alexander S; De Martino, Ivan; Fehring, Keith A; Sculco, Peter K


    Utilization of social media both in the private and professional arenas has grown rapidly in the last decade. The rise of social media use within health care can be viewed as the Internet-based corollary of the patient-centered care movement, in which patient perspectives and values are central to the delivery of quality care. For orthopedic surgeons and their practices, general-purpose online social networks, such as Facebook and Twitter, are convenient platforms for marketing, providing patient education and generating referrals. Virtual health communities are used less frequently by orthopedic surgeons but provide forums for patient engagement and active surgeon-to-patient communication via blogs and ask-the-doctor platforms. This commentary reviews the current state of social media use in orthopedic practice, with particular emphasis on managing the extension of the surgeon-patient relationship online, including the unique practice risks social media poses, such as privacy concerns, potential liability, and time consumption.

  9. Emil Theodor Kocher (1841-1917)--orthopaedic surgeon and the first surgeon Nobel Prize winner. (United States)

    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.

  10. Lasers in orthopedics (United States)

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


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

  11. Military Surgeon and Humanity

    Institute of Scientific and Technical Information of China (English)

    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.

  12. Military Surgeon and Humanity

    Institute of Scientific and Technical Information of China (English)

    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.

  13. Paying surgeons less has cost more. (United States)

    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.

  14. 3D-printed patient-specific applications in orthopedics

    Directory of Open Access Journals (Sweden)

    Wong KC


    Full Text Available Kwok Chuen Wong Department of Orthopedics and Traumatology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong Abstract: With advances in both medical imaging and computer programming, two-dimensional axial images can be processed into other reformatted views (sagittal and coronal and three-dimensional (3D virtual models that represent a patients’ own anatomy. This processed digital information can be analyzed in detail by orthopedic surgeons to perform patient-specific orthopedic procedures. The use of 3D printing is rising and has become more prevalent in medical applications over the last decade as surgeons and researchers are increasingly utilizing the technology’s flexibility in manufacturing objects. 3D printing is a type of manufacturing process in which materials such as plastic or metal are deposited in layers to create a 3D object from a digital model. This additive manufacturing method has the advantage of fabricating objects with complex freeform geometry, which is impossible using traditional subtractive manufacturing methods. Specifically in surgical applications, the 3D printing techniques can not only generate models that give a better understanding of the complex anatomy and pathology of the patients and aid in education and surgical training, but can also produce patient-specific surgical guides or even custom implants that are tailor-made to the surgical requirements. As the clinical workflow of the 3D printing technology continues to evolve, orthopedic surgeons should embrace the latest knowledge of the technology and incorporate it into their clinical practice for patient-specific orthopedic applications. This paper is written to help orthopedic surgeons stay up-to-date on the emerging 3D technology, starting from the acquisition of clinical imaging to 3D printing for patient-specific applications in orthopedics. It 1 presents the necessary steps to prepare the medical images that are

  15. Level of evidence gap in orthopedic research. (United States)

    Baldwin, Keith D; Bernstein, Joseph; Ahn, Jaimo; McKay, Scott D; Sankar, Wudbhav N


    Level of evidence is the most widely used metric for the quality of a publication, but instances exist in which a Level I study is neither feasible nor desirable. The goal of this study was to evaluate the level of evidence gap in current orthopedic research, which the authors defined as the disparity between the level of evidence that would be required to optimally answer the primary research question and the level of evidence that was actually used. Five orthopedic surgeons (K.D.B., J.B., J.A., S.D.M., W.N.S.) evaluated blinded articles from the first 6 months of 2010 in the Journal of Bone and Joint Surgery (American Volume) (JBJS-Am), classifying the study type and design and extracting a primary research question from each article. Each evaluator then defined the study type and method, along with the level of evidence that would ideally be used to address the primary research question. The level of evidence gap was then calculated by subtracting the actual level of evidence of the manuscript from the level of evidence of the idealized study. Of the 64 JBJS-Am manuscripts eligible for analysis, the average level of evidence was between Level II and III (mean, 2.73). The average level of evidence gap was 1.06 compared with the JBJS-Am-designated level of evidence and 1.28 compared with the evaluators' assessment. Because not all questions require Level I studies, level of evidence alone may not be the best metric for the quality of orthopedic surgery literature. Instead, the authors' concept of a level of evidence gap may be a better tool for assessing the state of orthopedic research publications.

  16. Business and Practice Management Knowledge Deficiencies in Graduating Orthopedic Residents. (United States)

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


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

  17. Mobile Device Trends in Orthopedic Surgery: Rapid Change and Future Implications. (United States)

    Andrawis, John P; Muzykewicz, David A; Franko, Orrin I


    Mobile devices are increasingly becoming integral communication and clinical tools. Monitoring the prevalence and utilization characteristics of surgeons and trainees is critical to understanding how these new technologies can be best used in practice. The authors conducted a prospective Internet-based survey over 7 time points from August 2010 to August 2014 at all nationwide American Council for Graduate Medical Education-accredited orthopedic programs. The survey questionnaire was designed to evaluate the use of devices and mobile applications (apps) among trainees and physicians in the clinical setting. Results were analyzed and summarized for orthopedic surgeons and trainees. During the 48-month period, there were 7 time points with 467, 622, 329, 223, 237, 111, and 134 responses. Mobile device use in the clinical setting increased across all fields and levels of training during the study period. Orthopedic trainees increased their use of Smartphone apps in the clinical setting from 60% to 84%, whereas attending use increased from 41% to 61%. During this time frame, use of Apple/Android platforms increased from 45%/13% to 85%/15%, respectively. At all time points, 70% of orthopedic surgeons believed their institution/hospital should support mobile device use. As measured over a 48-month period, mobile devices have become an ubiquitous tool in the clinical setting among orthopedic surgeons and trainees. The authors expect these trends to continue and encourage providers and trainees to be aware of the limitations and risks inherent with new technology.

  18. Sarcopenia in Orthopedic Surgery. (United States)

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


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

  19. Wilfred Trotter: surgeon, philosopher. (United States)

    Rosen, Irving B


    There is no significant biography that records the accomplishments of Sir Wilfred Trotter, who was a general surgeon in its pure sense at a time when surgical specialization was in its infancy. Trotter was born in the 1870s in England. Despite being bedridden during his childhood with a musculoskeletal condition he was able to study medicine at London University, and eventually became Professor and Chair of Surgery at the University College Hospital, a position he held until his death in November 1939. He made many contributions to surgical care, particularly in the field of oncology. He attended to many famous people, including King George V and Sigmund Freud and was greatly honoured in his own milieu. He was named honorary surgeon and Sargent Surgeon to the king. In addition, he was a thoughtful individual who addressed problems in human behaviour, contradicting the stereotype of the contemporary surgeon.

  20. Society of Thoracic Surgeons (United States)

    ... Care for You How to Use Apps and Social Media for Your Practice Why Participation in the STS ... STS_CTsurgery Surgeons Residents & Students Allied ... Hotel Discount for STS Members Copyright © 2016 The Society ...

  1. Civil Surgeon Info (United States)

    Department of Homeland Security — USCIS designates certain doctors (also known as civil surgeons) to perform the medical exam required for most Green Card applicants. This data set represents the...

  2. Searching for Surgeons (United States)

    ... Clinical Scholars in Residence Clinical Trials Methods Course Health Services Research Methods Course Surgeon Specific Registry NSQIP Annual ... Southern Territories Gabon Gambia Gaza Strip Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey ...

  3. Salespeople in the Surgical Suite: Relationships between Surgeons and Medical Device Representatives (United States)

    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

  4. Analysis of NHSLA claims in orthopedic surgery. (United States)

    Khan, Irfan H; Jamil, Wiqqas; Lynn, Sam Mathew; Khan, Osman H; Markland, Kate; Giddins, Grey


    National Health Service (NHS) statistics in the United Kingdom demonstrate an increase in clinical negligence claims over the past 30 years. Reasons for this include elements of a cultural shift in attitudes toward the medical profession and the growth of the legal services industry. This issue affects medical and surgical health providers worldwide.The authors analyzed 2117 NHS Litigation Authority (NHSLA) orthopedic surgery claims between 1995 and 2001 with respect to these clinical areas: emergency department, outpatient care, surgery (elective or trauma operations), and inpatient care. The authors focused on the costs of settling and defending claims, costs attributable to clinical areas, common causes of claims, and claims relating to elective or trauma surgery. Numbers of claims and legal costs increased most notably in surgery (elective and trauma) and in the emergency department. However, claims are being defended more robustly. The annual cost for a successful defense has remained relatively stable, showing a slight decline. The common causes of claims are postoperative complication; wrong, delayed, or failure of diagnosis; inadequate consent; and wrong-site surgery. Certain surgical specialties (eg, spine and lower-limb surgery) have the most claims made during elective surgery, whereas upper-limb surgery has the most claims made during trauma surgery.The authors recommend that individual trusts liaise with orthopedic surgeons to devise strategies to address areas highlighted in our study. Despite differences in health care systems worldwide, the underlying issues are common. With improved understanding, physicians can deliver the service they promise their patients.

  5. Factors affecting interest in orthopedics among female medical students: a prospective analysis. (United States)

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


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

  6. Leo Doyle, master surgeon. (United States)

    Vellar, I


    On 3 March 1953 Leo Doyle died at the Mercy Hospital, Melbourne. The day before he died Leo Doyle had been operating at the Mercy Hospital when he took ill. Doyle's final illness was almost certainly the result of the severe aortic stenosis that had been developing over some years. His death at the relatively young age of 61 ended the career of a man described by Sir Gordon Gordon Taylor as the greatest technical surgeon that he had ever seen. In all likelihood Australian surgery will never see the likes of Doyle, a virtuoso surgeon, again. And yet to many of the surgeons who were Doyle's contemporaries and to those who followed him he remained somewhat of an enigma. Perhaps in some way the description of the great French surgeon Baron Dupuytren may also be applicable to Leo Doyle: known to all, loved by many, understood by few. By all accounts Leo Doyle's surgical repertoire knew no bounds. He operated with equal facility on the central nervous system, the head and neck, in the thorax, abdomen and pelvis and he was more than competent in gynaecology, urology and orthopaedics. In the latter part of his career he became, par excellence, a cancer surgeon. He was, arguably, Australia's first surgical oncologist. No procedure was deemed too complicated or demanding. Like some other superb technicians his judgement at times did not match his technical ability. Doyle was one of the first surgeons in Australia to perform hindquarter amputation and he helped to pioneer the operations of total gastrectomy and oesophagogastrectomy. An avid reader of the surgical literature, he possessed an enormous library which was matched by an equally large collection of surgical instruments. Unlike Devine he published relatively little. He was not a good clinical teacher, preferring to teach by example in the operating theatre. Although interested in music and the visual arts, surgery was his life.

  7. [Shock waves in orthopedics]. (United States)

    Haupt, G


    Extracorporeal shock waves have revolutionized urological stone treatment. Nowadays shock waves are widely used in orthopedics, too. This article reviews the applications of extracorporeal shock waves on bone and adjacent soft tissue. The osteoneogenetic effect of extracorporeal shock waves has been proven and can be used to treat pseudarthrosis with a success rate of around 75%. Shock waves have a positive effect in tennis and golfer's elbow, calcaneal spur, and the complex called "periarthritis humero-scapularis." The mechanism for this is not yet known, and results from large prospective and randomized studies are still lacking. However, the treatment has been performed many thousands of times. In patients in whom conservative treatment has failed surgery used to be the only choice, but its success rate barely exceeds that of shock wave therapy and surgery can still be done if shock wave therapy fails. Extracorporeal shock waves will have an impact on orthopedics comparable to its effect in urology. Scientific evaluations, professional certifications, quality assurance and reimbursement issues present great challenges.

  8. Advances in regenerative orthopedics. (United States)

    Evans, Christopher H


    Orthopedic injuries are common and a source of much misery and economic stress. Several relevant tissues, such as cartilage, meniscus, and intra-articular ligaments, do not heal. And even bone, which normally regenerates spontaneously, can fail to mend. The regeneration of orthopedic tissues requires 4 key components: cells, morphogenetic signals, scaffolds, and an appropriate mechanical environment. Although differentiated cells from the tissue in question can be used, most cellular research focuses on the use of mesenchymal stem cells. These can be retrieved from many different tissues, and one unresolved question is the degree to which the origin of the cells matters. Embryonic and induced pluripotent stem cells are also under investigation. Morphogenetic signals are most frequently supplied by individual recombinant growth factors or native mixtures provided by, for example, platelet-rich plasma; mesenchymal stem cells are also a rich source of trophic factors. Obstacles to the sustained delivery of individual growth factors can be addressed by gene transfer or smart scaffolds, but we still lack detailed, necessary information on which delivery profiles are needed. Scaffolds may be based on natural products, synthetic materials, or devitalized extracellular matrix. Strategies to combine these components to regenerate tissue can follow traditional tissue engineering practices, but these are costly, cumbersome, and not well suited to treating large numbers of individuals. More expeditious approaches make full use of intrinsic biological processes in vivo to avoid the need for ex vivo expansion of autologous cells and multiple procedures. Clinical translation remains a bottleneck.

  9. Superelastic Orthopedic Implant Coatings (United States)

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


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

  10. Biomechanical performance of orthopedic gloves. (United States)

    Jackson, E M; Neal, J G; Williams, F M; Stern, C A; Suber, F; Thacker, J G; Edlich, R F


    The purpose of this study was to compare the biomechanical performance of commercially available orthopedic gloves to that of a single surgical glove, as well as a double glove system. The orthopedic gloves were found to be thicker than the single surgical glove. This increased thickness of the orthopedic glove was associated with a greater resistance to glove puncture. The thickest orthopedic gloves also had reduced tactile sensitivity when compared to the single surgical glove. In addition, the glove donning forces and glove hydration rates varied considerably. These latter biomechanical performance parameters were not significantly related to glove thickness. The double glove systems tested in this study had similar performance characteristics in regard to many of the orthopedic gloves. The glove donning forces for the double glove systems were the lowest of the gloves tested. In addition, the double glove systems displayed the greatest resistance to glove hydration of the gloves tested. Their performance in the glove hydration tests and the force required to don the double glove systems were much more desirable than any of the orthopedic gloves. The results of this study indicate that the double glove systems may provide a desirable alternative to the use of the single orthopedic gloves.

  11. [The robotic surgeon training]. (United States)

    Crestani, Alessandro; Rossanese, Marta; Abbinante, Maria; Calandriello, Mattia; Kungulli, Afrovita; Giannarini, Gianluca; Ficarra, Vincenzo


    The widespread robotic surgery in the world highlighted the relevance of the training programs for young urologists and residents. In the last years, urologic societies and some independent robotic surgeons strongly worked to standardize some general and specific training modules. Theoretical and practical sections of robotic training programs have been recently specified. The role of simulators, dry and wet laboratories, bedside assistance, and modular (step-by-step) training at console represent the most relevant elements of robotic surgeon training. Ideally, these didactic tools should be available in modern training centers. The development of structured robotic training programs should be considered as one of the priorities that the urologic community must take into account in the near future.

  12. [The construction of a medical discipline and its challenges: Orthopedics in Switzerland during the 19th and 20th centuries]. (United States)

    Kaba, Mariama


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

  13. Plasma Biomedicine in Orthopedics (United States)

    Hamaguchi, Satsohi


    Various effects of plasmas irradiation on cells, tissues, and biomaterials relevant for orthopedic applications have been examined. For direct application of plasmas to living cells or tissues, dielectric barrier discharges (DBDs) with helium flows into ambient air were used. For biomaterial processing, on the other hand, either helium DBDs mentioned above or low-pressure discharges generated in a chamber were used. In this presentation, plasma effects on cell proliferation and plasma treatment for artificial bones will be discussed. First, the conditions for enhanced cell proliferation in vitro by plasma applications have been examined. The discharge conditions for cell proliferation depend sensitively on cell types. Since cell proliferation can be enhanced even when the cells are cultured in a plasma pre-treated medium, long-life reactive species generated in the medium by plasma application or large molecules (such as proteins) in the medium modified by the plasma are likely to be the cause of cell proliferation. It has been found that there is strong correlation between (organic) hydroperoxide generation and cell proliferation. Second, effects of plasma-treated artificial bones made of porous hydroxyapatite (HA) have been examined in vitro and vivo. It has been found that plasma treatment increases hydrophilicity of the surfaces of microscopic inner pores, which directly or indirectly promotes differentiation of mesenchymal stem cells introduced into the pores and therefore causes faster bone growth. The work has been performed in collaboration with Prof. H. Yoshikawa and his group members at the School of Medicine, Osaka University.

  14. Orthopedic workforce planning in Germany - an analysis of orthopedic accessibility. (United States)

    Bauer, Jan; Müller, Peter; Maier, Werner; Groneberg, David A


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

  15. Designing Wearable Personal Assistants for Surgeons: An Egocentric Approach

    DEFF Research Database (Denmark)

    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...

  16. [The surgeon at retirement]. (United States)

    Fernández del Castillo-Sánchez, Carlos


    Our vocation has called us to become physicians and we have learned and practiced surgery as part of our medical training and knowledge. Surgery is an art expressed during each intervention carried out with effectiveness and devotion; enjoying the pleasure to perform it without hurry, with harmony, fluency and cleanness. Therefore, medicine and surgery belong to the same vocation being at service of people with the clear mission to heal patients and if we favor it, this activity will get our attention firmly and forever. A physician is a sensitive person that understands the sadness and happiness consequence of his actions at the office, operating room, research and relationships with colleagues. This provides him a pleasant experience of practicing medicine and especially surgery. Medical and surgical professions produce an irresistible attraction and they are very rewarding experiences; however, as time goes by there are effects over physician's health. Surgeons will switch from an active professional role into a passive agent and will need to assess himself and answer if he is still in optimal conditions to practice medicine. Therefore, every surgeon must be prepared to grow old from the start and preserve his Faith once retirement has been accepted as the next step in his career.

  17. [Aggressive fibromatoses in orthopedics]. (United States)

    Adler, C P; Stock, D


    Aggressive fibromatoses which may develop either in soft tissue or in the bone present considerable problems for the pathologist trying to establish a diagnosis as well as for the radiologist and surgeon. In radiographs, a destruction of the soft and osseous tissue is seen which suggests a malignant tumor. Histologically a monomorphic connective tissue prevails in the biopsy showing no essential signs of malignancy. Under pathoanatomical aspects often a benign proliferation of the connective tissue is assumed. Surgically the tumor may either be removed in a too radical and mutilating way, or the excision may remain incomplete. Two cases of desmoplastic bone fibroma (aggressive fibromatosis in the ulna and in the sacrum) are described in which the complete tumor removal led to healing, whereas the incomplete excision of the tumor resulted in recurrences. Aggressive fibromatosis represents a semimalignant tumor which has a locally destructive and invasive growth tendency but does not metastasize. The various fibromatoses are defined with regard to their biological growth tendency and the therapeutic consequences are discussed.

  18. Physician-Hospital Alignment in Orthopedic Surgery. (United States)

    Bushnell, Brandon D


    The concept of "alignment" between physicians and hospitals is a popular buzzword in the age of health care reform. Despite their often tumultuous histories, physicians and hospitals find themselves under increasing pressures to work together toward common goals. However, effective alignment is more than just simple cooperation between parties. The process of achieving alignment does not have simple, universal steps. Alignment will differ based on individual situational factors and the type of specialty involved. Ultimately, however, there are principles that underlie the concept of alignment and should be a part of any physician-hospital alignment efforts. In orthopedic surgery, alignment involves the clinical, administrative, financial, and even personal aspects of a surgeon's practice. It must be based on the principles of financial interest, clinical authority, administrative participation, transparency, focus on the patient, and mutual necessity. Alignment can take on various forms as well, with popular models consisting of shared governance and comanagement, gainsharing, bundled payments, accountable care organizations, and other methods. As regulatory and financial pressures continue to motivate physicians and hospitals to develop alignment relationships, new and innovative methods of alignment will also appear. Existing models will mature and evolve, with individual variability based on local factors. However, certain trends seem to be appearing as time progresses and alignment relationships deepen, including regional and national collaboration, population management, and changes in the legal system. This article explores the history, principles, and specific methods of physician-hospital alignment and its critical importance for the future of health care delivery.

  19. [Vertical control and orthopedic therapy]. (United States)

    Bardinet, E; Bazert, C; Boileau, M J; Carat, T; Darqué, F; de Brondeau, F; Dorignac, D; Duhart, A M; El Amrani Darqué, K; Pujol, A; Rzadkiewicz, A; Sampeur, M


    Control of the vertical development of the face is a key element in assuring the success of orthopedic treatment, as much for its effects on anterior vertical dimension as for its influence on correction of the sagittal discrepancy between the jaws. An effective management of this control demands respect for the equilibrium between posterior and anterior face, as described by Schudy. The authors review the details of the application of orthopedic therapy on the different elements of this equilibrium and then, present the modalities of vertical control appropriate to each appliance.


    Cazac, Cristian


    Although orthopedics and ophthalmology seem to be two different medical specialties, numerous studies that have been conducted in the past 35 years have shown a tight connection between several ocular pathologies and an increased risk of hip fractures due to falling. This article aims to review the ocular pathologies that have been proven to be associated with an increased risk of falling, to integrate the results of several studies showing a direct relationship between ocular pathologies and an increased risk of falling and finally to suggest ways in which the incidence of traumatic orthopedic injuries can be reduced by applying ophthalmologic principles.

  1. Decision making in ruminant orthopedics. (United States)

    Fessler, J F; Adams, S B


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

  2. Diagnostic imaging in bovine orthopedics. (United States)

    Kofler, Johann; Geissbühler, Urs; Steiner, Adrian


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

  3. Treatment of severe orthopedic infections. (United States)

    Dernell, W S


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

  4. Growth factors in orthopedic surgery. (United States)

    Zaharia, Comeliu; Niculescu, Marius; Despa, Nicoleta; Simionescu, Maya; Jinga, Victor; Fleseriu, Irina


    Growth factors have represented an essential issue of interest for the researchers and clinicians in orthopedics and trauma over the last 40 years. In the last 10 to 15 years, the advances registered in this field have permitted the identification of the most active cellular and humoral factors as well as the improvement of their use in the orthopedic and trauma surgery. Their domain of application has been continuously enlarged and the results have been visible from the beginning. The authors present their appreciation on the actual state of this subject as well as their experience with results and related conclusions.

  5. Can double gloves improve surgeon-patient barrier efficiency? (United States)

    Sadat-Ali, Mir; Al-Habdan, Ibrahim; AlBluwi, Mohammed; Corea, J Ran; Al-Othman, Abdallah; Shriyan, Devidas; Moussa, Mohammed; AlDhakheel, Dhakheel; AlOmran, Abdallah


    The aim of this study was to compare double gloves (DGs) with single gloves (SGs) during orthopedic and trauma surgery in prevention of blood contact between patients and surgeons. DGs and SGs were collected after orthopedic operations, tested for size, site, and number of perforations. Medical records were reviewed for age, sex, type of operation, duration, and postoperative wound infection. Data were compared using t-test with level of statistical significance at P < 0.05. Five hundred seven operations yielded 1204 DGs and 830 pairs SGs. In DGs, perforations were detected in 220 outer glove and 39 inner glove (10.7%). In SGs, 226 perforations were detected (13.3%). The incidence of perforations in inner gloves of the double indicator glove was 1.6% (P < 0.001). During surgery, perforations were recognized in DGs in 67% compared with 12% in SGs (P < 0.005). This study confirms that DGs form an efficient barrier between patients and surgeons.

  6. American Society of Plastic Surgeons (United States)

    ... know the risks and trust a board-certified plastic surgeon to perform your cosmetic or reconstructive surgery. ASPS member surgeons have the training and experience that ... 1300 Chain Bridge Road McLean, VA 22101 (703) 790-5454 Timothy Germain ...

  7. Humanism and sciences of orthopedics

    Institute of Scientific and Technical Information of China (English)

    QIU Gui-xing


    Ten years have silently passed by since the beginning of the 21st century.Looking back upon the history of Chinese Orthopedics development,we cannot but feel amazed at its great progressions and remarkable achievements in such broad fields.

  8. Financial debt of orthopedic residents. (United States)

    Hwang, John S; Beebe, Kathleen S; Benevenia, Joseph; Karanfilian, Briette; Berberian, Wayne S


    Many orthopedic residents accrue considerable debt by residency graduation. These debts for graduating medical students continue to increase due to the yearly increase of medical school tuition. The purpose of this study was to examine the causes of financial debt, as well the effects of debt on orthopedic residents.Orthopedic residents from postgraduate years 1 to 5 (N=27) completed an anonymous, optional financial survey. The survey asked questions regarding the characteristics of the residents' debt and their concern caused by their debt. All residents from our institute (N=27) voluntarily participated in the survey. The residents consisted of 4 (15%) women and 23 (85%) men, with 14 (56%) single residents and 12 (44%) married residents. No statistically significant difference existed in total debt >$100,000 between single and married residents or men and women. Forty-eight percent (n=13) of the residents had medical educational debt >$100,000, whereas 45% (n=12) had total debt >$200,000. Residents with total debt >$100,000 were concerned about their debt, whereas 1 of 4 residents with orthopedic residents financially and may cause stress and hinder their medical training. Appropriate measures should be taken to help residents properly manage their debt and to provide supplemental assistance with their financial struggles.

  9. Orthopedic Management of Spina Bifida (United States)

    Thomson, Jeffrey D.; Segal, Lee S.


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

  10. Prevalence of Internet and social media usage in orthopedic surgery

    Directory of Open Access Journals (Sweden)

    Emily Curry


    Full Text Available Prior studies in other specialties have shown that social networking and Internet usage has become an increasingly important means of patient communication and referral. The purpose of this study is to evaluate the prevalence of Internet or social media usage in new patients referred to a major academic orthopedics center and to identify new avenues to optimize patient recruitment and communication. New patients were surveyed (n=752 between December 2012 to January 2013 in a major academic orthopedic center to complete a 15-item questionnaire including social media and Internet usage information. Data was collected for all orthopedic sub-specialties and statistical analysis was performed. Fifty percent of patients use social networking sites, such as Facebook. Sports medicine patients tend to be higher social networking users (35.9% relative to other services (9.8-17.9% and was statistically higher when compared to the joints/tumor service (P<0.0001. Younger age was the biggest indicator predicting the use of social media. Patients that travelled between 120 to 180 miles from the hospital for their visits were significantly more likely to be social media users, as were patients that did research on their condition prior to their new patient appointment. We conclude that orthopedic patients who use social media/Internet are more likely to be younger, researched their condition prior to their appointment and undergo a longer average day’s travel (120-180 miles to see a physician. In an increasingly competitive market, surgeons with younger patient populations will need to utilize social networking and the Internet to capture new patient referrals.

  11. Smartphones and the plastic surgeon. (United States)

    Al-Hadithy, Nada; Ghosh, Sudip


    Surgical trainees are facing limited training opportunities since the introduction of the European Working Time Directive. Smartphone sales are increasing and have usurped computer sales for the first time. In this context, smartphones are an important portable reference and educational tool, already in the possession of the majority of surgeons in training. Technology in the palm of our hands has led to a revolution of accessible information for the plastic surgery trainee and surgeon. This article reviews the uses of smartphones and applications for plastic surgeons in education, telemedicine and global health. A comprehensive guide to existing and upcoming learning materials and clinical tools for the plastic surgeon is included. E-books, podcasts, educational videos, guidelines, work-based assessment tools and online logbooks are presented. In the limited resource setting of modern clinical practice, savvy plastic surgeons can select technological tools to democratise access to education and best clinical care.

  12. [Further training in the faculty of orthopedics and trauma surgery. Outstanding, average or insufficient?]. (United States)

    Perl, M; Stange, R; Niethard, M; Münzberg, M


    A well structured and executed and practical residency program is important to secure a sufficient number of well trained orthopedic surgeons in the future. Some of the residents, however, see substantial shortcomings here. Additionally, orthopedic residency programs struggle to be a valid alternative for graduated medical students when comparing them to residency programs in other medical specialities or alternative job options. In improving the current situation program directors as well as residents must play a key role. A rapid improvement of structural shortcomings of German residency programs does not only provide an advantage in recruiting new residents now, but may also help to maintain the high quality in orthopedic health care in the future.

  13. Development of knowledge about osteoporosis in the world of orthopedics and traumatology. (United States)

    Guida, Giuseppe; Iolascon, Giovanni; Gimigliano, Francesca; Gimigliano, Raffaele


    The development of Orthopedics and Traumatology in the last 50 years have been characterized by the concurrence of several milestone events, such as the disappearance of polio and osteoarticular tuberculosis, the progress of some disciplines such as Anesthesia and Intensive Care, Diagnostic Imaging and technology development. As for other common diseases, also for osteoporosis the evolution of knowledge about pathophysiology and treatment represents a "must" to know for the orthopaedic surgeons.

  14. Exploring Canadian Identity through Canadian Children's Literature. (United States)

    Pantaleo, Sylvia


    Considers what commonplaces of culture and identity are being, could be, transmitted through the use of children's literature in classrooms. Explores what is Canadian about Canadian children's literature. Describes a study which involved Canadian elementary school children who read Canadian children's books. Concludes that literature plays a…

  15. What Is a Foot and Ankle Surgeon? (United States)

    ... Foot & Ankle Surgeon? A A A | Print | Share What is a Foot & Ankle Surgeon? Foot and ankle ... of conditions that affect people of every age. What education has a foot and ankle surgeon received? ...

  16. 15th Chapter of Surgeons Lecture: Surgeon of the new millennium--surgeon, scientist and scholar. (United States)

    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.

  17. Diagnosis and management of reptile orthopedic injuries. (United States)

    Mitchell, Mark A


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

  18. I Am Canadian

    DEFF Research Database (Denmark)

    Goddard, Joe


    "I Am Canadian: Immigration and Multiculturalism in the True North" looks at Canadian immigration history from a contemporary point of view. The article scrutinizes recent discussions on dual nationality and what this may mean for Canadianness......."I Am Canadian: Immigration and Multiculturalism in the True North" looks at Canadian immigration history from a contemporary point of view. The article scrutinizes recent discussions on dual nationality and what this may mean for Canadianness....

  19. Wholistic orthopedics: Is this the right way to treat geriatric orthopedic patients? (United States)

    Ebnezar, John; Bali, Yogita; John, Rakesh


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

  20. Coatings and surface modifications imparting antimicrobial activity to orthopedic implants. (United States)

    Kargupta, Roli; Bok, Sangho; Darr, Charles M; Crist, Brett D; Gangopadhyay, Keshab; Gangopadhyay, Shubhra; Sengupta, Shramik


    Bacterial colonization and biofilm formation on an orthopedic implant surface is one of the worst possible outcomes of orthopedic intervention in terms of both patient prognosis and healthcare costs. Making the problem even more vexing is the fact that infections are often caused by events beyond the control of the operating surgeon and may manifest weeks to months after the initial surgery. Herein, we review the costs and consequences of implant infection as well as the methods of prevention and management. In particular, we focus on coatings and other forms of implant surface modification in a manner that imparts some antimicrobial benefit to the implant device. Such coatings can be classified generally based on their mode of action: surface adhesion prevention, bactericidal, antimicrobial-eluting, osseointegration promotion, and combinations of the above. Despite several advances in the efficacy of these antimicrobial methods, a remaining major challenge is ensuring retention of the antimicrobial activity over a period of months to years postoperation, an issue that has so far been inadequately addressed. Finally, we provide an overview of additional figures of merit that will determine whether a given antimicrobial surface modification warrants adoption for clinical use.

  1. Locking mechanism for orthopedic braces (United States)

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


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

  2. International surgery: definition, principles and Canadian practice. (United States)

    Lett, Ronald


    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.

  3. [The surgeons civil responsibility insurance]. (United States)

    Santovito, D


    After a short research in the field national insurances, the author analyses the professional physician insurance policy; the ambiguity and difficulty of contracts concerning the professional health activity of surgeon, whether as state employee or as independent professional are pointed put. With the introduction of the ministerial decree dated January 29,1992, the new labour agreement, the privacy law, the evolution of ''informed consent'', the esthetic injury concept, the safety regulations law and the administrative liability, surgeons must pay attention to draw up an insurance policy suitable to their profession.

  4. Using Aerospace Technology To Design Orthopedic Implants (United States)

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


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

  5. Kant and the cosmetic surgeon. (United States)

    Carey, J S


    Philosophers know that modern philosophy owes a great debt to the intellectual contributions of the 18th century philosopher Immanuel Kant. This essay attempts to show how cosmetic surgeons, and all surgeons at that, could learn much from his work. Not only did Kant write about the structure of human reasoning and how it relates to appearances but he also wrote about the nature of duties and other obligations. His work has strongly influenced medical ethics. In a more particular way, Kant wrote the most important work on aesthetics. His theory still influences how philosophers understand the meaning of the beautiful and how it pertains to the human figure. This essay presents an exercise in trying to apply Kantian philosophy to aesthetic plastic surgery. Its intention is to show cosmetic surgeons some of the implicit and explicit philosophical principles and potential arguments undergirding their potential surgical evaluations. It is meant to challenge the surgeon to reconsider how decisions are made using philosophical reasoning instead of some of the more usual justifications based on psychology or sociology.

  6. Anterior Cervical Discectomy and Fusion: Practice Patterns Among Greek Spinal Surgeons (United States)

    Spanos, Savvas L.; Siasios, Ioannis D.; Dimopoulos, Vassilios G.; Fountas, Kostas N.


    Background A web-based survey was conducted among Greek spinal surgeons to outline the current practice trends in regard to the surgical management of patients undergoing anterior cervical discectomy and fusion (ACDF) for degenerative cervical spine pathology. Various practice patterns exist in the surgical management of patients undergoing anterior cervical discectomy for degenerative pathology. No consensus exists regarding the type of the employed graft, the necessity of implanting a plate, the prescription of an external orthotic device, and the length of the leave of absence in these patients. Methods A specially designed questionnaire was used for evaluating the criteria for surgical intervention, the frequency of fusion employment, the type of the graft, the frequency of plate implantation, the employment of an external spinal orthosis (ESO), the length of the leave of absence, and the prescription of postoperative physical therapy. Physicians’ demographic factors were assessed including residency and spinal fellowship training, as well as type and length in practice. Results Eighty responses were received. Neurosurgeons represented 70%, and orthopedic surgeons represented 30%. The majority of the participants (91.3%) considered fusion necessary. Allograft was the preferred type of graft. Neurosurgeons used a plate in 42.9% of cases, whereas orthopedic surgeons in 100%. An ESO was recommended for 87.5% of patients without plates, and in 83.3% of patients with plates. The average duration of ESO usage was 4 weeks. Physical therapy was routinely prescribed postoperatively by 75% of the neurosurgeons, and by 83.3% of the orthopedic surgeons. The majority of the participants recommended 4 weeks leave of absence. Conclusions The vast majority of participants considered ACDF a better treatment option than an ACD, and preferred an allograft. The majority of them employed a plate, prescribed an ESO postoperatively, and recommended physical therapy to their

  7. Health care delivery and the training of surgeons. (United States)

    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.

  8. History of computer-assisted orthopedic surgery (CAOS) in sports medicine. (United States)

    Jackson, Douglas W; Simon, Timothy M


    Computer-assisted orthopedic surgery and navigation applications have a history rooted in the desire to link imaging technology with real-time anatomic landmarks. Although applications are still evolving in the clinical and research setting, computer-assisted orthopedic surgery has already demonstrated in certain procedures its potential for improving the surgeon's accuracy, reproducibility (once past the learning curve), and in reducing outlier outcomes. It is also being used as an educational tool to assist less experienced surgeons in interpreting measurements and precision placements related to well defined anatomic landmarks. It also can assist experienced surgeons, in real-time, plan their bony cuts, tunnel placement, and with ligament balancing. Presently, the additional time, the expense to acquire the needed software and hardware, and restricted reimbursement have slowed the widespread use of navigation. Its current applications have been primarily in joint replacement surgery, spine surgery, and trauma. It has not been widely used in the clinical setting for sports medicine procedures. Sports medicine applications such as individualizing tunnel placement in ligament surgery, opening wedge osteotomy with and without accompanying ligament reconstruction, and balancing and tensioning of the ligaments during the procedure (allowing real-time corrections if necessary) are currently being evaluated and being used on a limited clinical basis.

  9. Physical modification of polyetheretherketone for orthopedic implants (United States)

    Du, Ya-Wei; Zhang, Li-Nan; Hou, Zeng-Tao; Ye, Xin; Gu, Hong-Sheng; Yan, Guo-Ping; Shang, Peng


    Polyetheretherketone (PEEK) is regarded as one of the most potential candidates for replacing current implant applications. To obtain good bone-implant interfaces, many modification methods have been developed to enable PEEK and PEEK-based composites from bio-inert to bioactive. Among them, physical methods have aroused significant attention and been widely used to modify PEEK for orthopedic implants. This review summarizes current physical modification techniques of PEEK for orthopedic applications, which include composite strategies, surface coating methods and irradiation treatments. The positive consequences of those modification methods will encourage continuing investigations and stimulate the wide range of applications of PEEK-based implants in orthopedics.

  10. Applied Nanotechnology and Nanoscience in Orthopedic Oncology. (United States)

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


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

  11. Hand dominance in orthopaedic surgeons.

    LENUS (Irish Health Repository)

    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.

  12. 21 CFR 888.4540 - Orthopedic manual surgical instrument. (United States)


    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Orthopedic manual surgical instrument. 888.4540... (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Surgical Devices § 888.4540 Orthopedic manual surgical instrument. (a) Identification. An orthopedic manual surgical instrument is a nonpowered hand-held...

  13. 21 CFR 878.4460 - Surgeon's glove. (United States)


    ... DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices § 878.4460 Surgeon's glove. (a) Identification. A surgeon's glove is a device made of natural or synthetic rubber intended to be worn by... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Surgeon's glove. 878.4460 Section 878.4460...



    SriKamkshi Kothandaraman; Balasubramanian Thiagarajan


    Being a left-handed surgeon, more specifically a left-handed ENT surgeon, presents a unique pattern of difficulties.This article is an overview of left-handedness and a personal account of the specific difficulties a left-handed ENT surgeon faces.

  15. Research articles published by Korean spine surgeons: Scientific progress and the increase in spine surgery. (United States)

    Lee, Soo Eon; Jahng, Tae-Ahn; Kim, Ki-Jeong; Hyun, Seung-Jae; Kim, Hyun Jib; Kawaguchi, Yoshiharu


    There has been a marked increase in spine surgery in the 21st century, but there are no reports providing quantitative and qualitative analyses of research by Korean spine surgeons. The study goal was to assess the status of Korean spinal surgery and research. The number of spine surgeries was obtained from the Korean National Health Insurance Service. Research articles published by Korean spine surgeons were reviewed by using the Medline/PubMed online database. The number of spine surgeries in Korea increased markedly from 92,390 in 2004 to 164,291 in 2013. During the 2000-2014 period, 1982 articles were published by Korean spine surgeons. The annual number of articles increased from 20 articles in 2000 to 293 articles in 2014. There was a positive correlation between the annual spine surgery and article numbers (particles with Oxford levels of evidence 1, 2, and 3. The mean five-year impact factor (IF) for article quality was 1.79. There was no positive correlation between the annual IF and article numbers. Most articles (65.9%) were authored by neurosurgical spine surgeons. But spinal deformity-related topics were dominant among articles authored by orthopedics. The results show a clear quantitative increase in Korean spinal surgery and research over the last 15years. The lack of a correlation between annual IF and published article numbers indicate that Korean spine surgeons should endeavor to increase research value.

  16. Antimicrobial technology in orthopedic and spinal implants (United States)

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


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

  17. Core Concepts: Orthopedic Intern Curriculum Boot Camp. (United States)

    Seeley, Mark A; Kazarian, Erick; King, Brandon; Biermann, Janet S; Carpenter, James E; Caird, Michelle S; Irwin, Todd A


    Orthopedic surgical interns must gain a broad array of clinical skills in a short time. However, recent changes in health care have limited resident-patient exposures. With the reported success of simulation training in the surgical literature, the American Board of Orthopaedic Surgery (ABOS) and Residency Review Committee for Orthopaedic Surgery have required that surgical simulation training be a component of the intern curricula in orthopedic surgical residencies. This study examined the short-term effectiveness of an orthopedic "intern boot camp" covering 7 of 17 simulation training concept modules published by the ABOS. Eight orthopedic post-graduate year 1 (PGY-1) residents (study group) completed a structured 3-month curriculum and were compared with 7 post-graduate year 2 (PGY-2) residents (comparison group) who had just completed their orthopedic surgical internship. Seven core skills were assessed using both task-specific and global rating scales. The PGY-1 residents demonstrated a statistically significant improvement in all 7 modules with respect to their task-specific pre-test scores: sterile technique (P=.001), wound closure (P<.001), knot tying (P=.017), casting and splinting (P<.001), arthrocentesis (P=.01), basics of internal fixation (P<.001), and compartment syndrome evaluation (P=.004). After the camp, PGY-1 and -2 scores in task-specific measures were not significantly different. A 3-month simulation-based boot camp instituted early in orthopedic internship elevated a variety of clinical skills to levels exhibited by PGY-2 residents.

  18. Evaluation of occupational and patient radiation doses in orthopedic surgery

    Energy Technology Data Exchange (ETDEWEB)

    Sulieman, A. [Salman bin Abdulaziz University, College of Applied Medical Sciences, Radiology and Medical Imaging Department, P.O. Box 422, Alkharj (Saudi Arabia); Habiballah, B.; Abdelaziz, I. [Sudan Univesity of Science and Technology, College of Medical Radiologic Sciences, P.O. Box 1908, Khartoum (Sudan); Alzimami, K. [King Saud University, College of Applied Medical Sciences, Radiological Sciences Department, P.O. Box 10219, 11433 Riyadh (Saudi Arabia); Osman, H. [Taif University, College of Applied Medical Science, Radiology Department, Taif (Saudi Arabia); Omer, H. [University of Dammam, Faculty of Medicine, Dammam (Saudi Arabia); Sassi, S. A., E-mail: [Prince Sultan Medical City, Department of Medical Physics, Riyadh (Saudi Arabia)


    Orthopedists are exposed to considerable radiation dose during orthopedic surgeries procedures. The staff is not well trained in radiation protection aspects and its related risks. In Sudan, regular monitoring services are not provided for all staff in radiology or interventional personnel. It is mandatory to measure staff and patient exposure in order to radiology departments. The main objectives of this study are: to measure the radiation dose to patients and staff during (i) Dynamic Hip Screw (Dhs) and (i i) Dynamic Cannula Screw (Dcs); to estimate the risk of the aforementioned procedures and to evaluate entrance surface dose (ESD) and organ dose to specific radiosensitive patients organs. The measurements were performed in Medical Corps Hospital, Sudan. The dose was measured for unprotected organs of staff and patient as well as scattering radiation. Calibrated Thermoluminescence dosimeters (TLD-Gr-200) of lithium fluoride (LiF:Mg, Cu,P) were used for ESD measurements. TLD signal are obtained using automatic TLD Reader model (Plc-3). The mean patients doses were 0.46 mGy and 0.07 for Dhs and Dcs procedures, respectively. The mean staff doses at the thyroid and chest were 4.69 mGy and 1.21 mGy per procedure. The mean radiation dose for staff was higher in Dhs compared to Dcs. This can be attributed to the long fluoroscopic exposures due to the complication of the procedures. Efforts should be made to reduce radiation exposure to orthopedic patients, and operating surgeons especially those with high work load. Staff training and regular monitoring will reduce the radiation dose for both patients and staff. (Author)

  19. Harvey Cushing's Canadian connections. (United States)

    Feindel, William


    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.

  20. Surgeons' non-technical skills. (United States)

    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.

  1. The "Canadian" in Canadian Children's Literature. (United States)

    Bainbridge, Joyce; Wolodko, Brenda


    Notes that a rich body of Canadian children's literature exists that reflects the country's literary and socio-cultural values, beliefs, themes and images, including those of geography, history, language and identity. Discusses how Canadians tend to identify themselves first by region or province and then by nation. (SG)

  2. Canadian Children's Literature. (United States)

    School Libraries in Canada, 2001


    Includes 15 articles that relate to Canadian children's literature, including the power of literature; using Canadian literature in Canada; the principal's role in promoting literacy; Canadian Children's Book Centre; the National Library of Canada's children's literature collection; book promotion; selection guide; publisher's perspective; and…

  3. Chinese medicine and the surgeon. (United States)

    Leung, Ping-Chung; Biji, Sreedhar; Yeung, Chung-Kwong


    The surgeon aims at a direct, complete removal of the pathology. In spite of the modern advancements of imaging facilities and precision instrumentations, unsatisfactory results and recurrences are not uncommon. This paper provides a general review of the four specific areas in surgery that would benefit from Chinese medicine. Extensive searches were made on four surgical areas based on available English language journals, viz. low-back pain, chronic ulcers, renal calculus, and enuresis in children, in the past 10 years. The quoted communications are mainly related to clinical evidences, while a smaller number of crucial laboratory reports are also included. Low-back pain, a most frequent orthopaedic problem, would benefit from acupuncture treatment. Chronic leg ulcers could achieve better results of healing using herbal supplements. Problems of renal stones, besides the conventional methods of removal, could be further supplemented with herbal drinks that aim at prevention of recurrences. Enuresis in children, an untreatable common condition, may respond well to acupuncture. Surgeons should keep an open mind. In case of difficulties, they could seriously consider options of traditional treatment.

  4. [Hospitals and surgeons: Madrid 1940]. (United States)

    de Quevedo, Francisco Vázquez


    The history of the hospitals and general surgeons that best represent the centres in Madrid are here in reviewed, comprising the period between 1940 and the closure of the Hospital Clinico (1957) as well as the Hospital General (General Hospital) (1967), both in Atocha. Other hospitals which are reviewed and highlighted are: the H. de la Princesa (the Princess Hospital), the H. del Nifio Jesus (Hospital of the Child Jesus), the H. Militar (Military Hospital) and the Cruz Roja (Red Cross). Data is provided on the permanent surgeons in the following centres: H. General: J. Goyanes, J. Die, J. de la Villa, T. Rodriguez, E. Diaz, G. Bueno e H. Huerta; H. Clinico: L. de la Peña, L. Cardenal, L. Olivares, R. Argüelles, J. Estella y M. F. Zumel; H. Militar: M. G. Ulla, M. Bastos, M. G. Durán, J. S. Galindo, y A. G. Durán; Hospital de la Cruz Roja: V. M. Noguera, L. Serrada, F. Luque y L. L. Durán; H. de la Princesa: P. Cifuentes, P. G. Duarte, L. Estella y R. Aiguabella; H. del Niño Jesús: J. Garrido Lestache; H. Clinico, last time, Atocha: F. M. Lagos, R. Vara y A. de la Fuente.

  5. New biomaterials for orthopedic implants

    Directory of Open Access Journals (Sweden)

    Ong KL


    Full Text Available Kevin L Ong, Brian Min Yun, Joshua B WhiteExponent, Inc., Philadelphia, PA, USAAbstract: With the increasing use of orthopedic implants worldwide, there continues to be great interest in the development of novel technologies to further improve the effective clinical performance of contemporary treatment modalities and devices. Continuing research interest also exists in developing novel bulk biomaterials (eg, polycarbonate urethanes, silicon or novel formulations of existing but less widely used biomaterials (eg, polyaryletherketones, polyetheretherketone. There is also growing focus on customizing the material properties of bioabsorbables and composite materials with fillers such as bioactive ceramics. In terms of tissue engineering, more recent developments have focused on basic engineering and biological fundamentals to use cells, signaling factors, and the scaffold material itself to better restore tissue and organ structure and function. There has also been recent controversy with the use of injectables as a nonsurgical approach to treat joint disorders, but more attention is being directed toward the development of newer formulations with different molecular weights. The industry has also continuously sought to improve coatings to supplement the function of existing implants, with the goal of improving their osseointegrative qualities and incorporating antimicrobial properties. These include the use of bone morphogenetic protein, bisphosphonates, calcium phosphate, silicon nitride, and iodine. Due to the widespread use of bone graft materials, recent developments in synthetic graft materials have explored further development of bioactive glass, ceramic materials, and porous titanium particles. This review article provides an overview of ongoing efforts in the above research areas.Keywords: coatings, scaffolds, bioabsorbables, bone graft, injectables

  6. Malpractice awareness among surgeons at a teaching hospital in Pakistan

    Directory of Open Access Journals (Sweden)

    Sheikh Asfandyar


    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

  7. Bibliometric analysis of the orthopedic literature. (United States)

    Hui, Zhaoyang; Yi, Zhongmei; Peng, Jun


    Bibliometric indicators are used to assess research performance. The goal of this study was to explore publication output to construct a picture of orthopedics that may be beneficial to researchers and orthopedic specialists. All orthopedics articles published in 61 journals from 2000 to 2011 were retrieved from the Science Citation Index Expanded database. The numbers of articles, citations, authors, institutions, and journals were analyzed and subjected to quantitative and qualitative comparisons. The number of published orthopedics articles increased between 2000 and 2011. Articles published by authors from the United States always ranked first in number, although the United States' share is decreasing in the world literature. Authors from the United States published the most-cited articles and the most articles in journals with top-10 impact factors; moreover, the United States also had the greatest share of experts and highly ranked institutions. The United Kingdom, Germany, and Japan were always within the world's top 4 in terms of numbers of articles and citations. The shares of Germany, South Korea, and China among total orthopedics articles increased, especially that of China. In 2011, China ranked the fifth in the world, with its world share increasing from 0.64% in 2000 to 5.05% in 2011. However, China lags behind in average citations per article, top research institutions, and most prolific authors. According to the total citations per article, the University of Pittsburgh, Harvard University, and the Hospital for Special Surgery were the most prolific institutions.

  8. [Research and analysis to Shui nationality medicine treatment orthopedics & traumatology]. (United States)

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


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

  9. Robotics and the pediatric surgeon. (United States)

    Lorincz, Attila; Langenburg, Scott; Klein, Michael D


    Surgical robots are enabling devices for minimally invasive (laparoscopic) surgery (MIS). They use a computer to enhance a surgeon's skills as hand movements are transmitted to robotic arms. The computer filters tremor, which becomes important at high magnifications of 10 to 15 times available in MIS. It also provides motion scaling so that large hand movements are converted to very small movements of the robotic arm. The robotic arms also have wrists that make suturing and knot tying far more accurate and efficient. Surgical robots are currently used clinically for procedures such as MIS Nissen fundoplication, cholecystectomy, and splenectomy. Laboratory experience indicates that they may provide advantages for newborn procedures such as portoenterostomy for biliary atresia and repair of esophageal atresia and tracheoesophageal fistula. They have a potential for making possible MIS procedures, which can only be done open now, and for introducing entirely new procedures as well as for the performance of procedures by operators distant from the patient.

  10. Working night shifts affects surgeons' biological rhythm

    DEFF Research Database (Denmark)

    Amirian, Ilda; Andersen, Lærke T; Rosenberg, Jacob


    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....

  11. The advent of the restorative plastic surgeon. (United States)

    Carty, Matthew J; Pribaz, Julian J; Talbot, Simon G; Caterson, Edward J; Pomahac, Bohdan


    Plastic surgery is presently typified by the existence of discrete clinical identities, namely that of the cosmetic plastic surgeon and the reconstructive plastic surgeon. The emergence of vascularized composite allotransplantation has been accompanied by the development of a third distinct clinical identity, that of the restorative plastic surgeon. The authors describe the core competencies that characterize this new identity, and discuss the implications of the advent of this new professional paradigm.

  12. American Society of Colon and Rectal Surgeons (United States)

    ... Assessment and Safety Committee Initiatives Past Presidents Healthcare Economics Committee 2017 Tripartite Meeting Search form Search Login Join Now Find a Surgeon ASCRS Patients Members Physicians Latest ...

  13. Current concept review: quality and process improvement in orthopedics

    Directory of Open Access Journals (Sweden)

    Pinney SJ


    Full Text Available Stephen J Pinney,1 Alexandra E Page,2 David S Jevsevar,3 Kevin J Bozic4 1Department of Orthopaedic Surgery, St Mary's Medical Center, San Francisco, CA, USA; 2Orthopaedic Surgery, AAOS Health Care Systems Committee, San Diego, CA, USA; 3Department of Orthopaedics, Geisel School of Medicine, Dartmouth University, Hanover, NH, USA; 4Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas, Austin, TX, USAAbstract: Multiple health care stakeholders are increasingly scrutinizing musculoskeletal care to optimize quality and cost efficiency. This has led to greater emphasis on quality and process improvement. There is a robust set of business strategies that are increasingly being applied to health care delivery. These quality and process improvement tools (QPITs have specific applications to segments of, or the entire episode of, patient care. In the rapidly changing health care world, it will behoove all orthopedic surgeons to have an understanding of the manner in which care delivery processes can be evaluated and improved. Many of the commonly used QPITs, including checklist initiatives, standardized clinical care pathways, lean methodology, six sigma strategies, and total quality management, embrace basic principles of quality improvement. These principles include focusing on outcomes, optimizing communication among health care team members, increasing process standardization, and decreasing process variation. This review summarizes the common QPITs, including how and when they might be employed to improve care delivery. Keywords: clinical care pathway, musculoskeletal care, outcomes, quality management, six sigma, lean thinking

  14. 骨科手术中的临床伦理问题%Ethical Considerations of Orthopedic Surgery

    Institute of Scientific and Technical Information of China (English)

    王庚启; 王黎明; 谢林; 席志鹏; 洪友松; 贾晋辉


    骨科收治病种复杂,急症多,治疗方法较多、涉及患者肢体功能和美观,因此,它的伦理问题显得复杂.作者总结了医患之间在入院及诊治全过程中可能出现的伦理问题,并提出解决问题的初步方法.以期了解骨科诊疗过程中的伦理问题,来促进医疗行为的规范、体现骨科诊疗中的人性关怀,促进骨科医生个人的成长和骨科医学的发展.%There are some ethical issues turning up owing to complex diseases, high rate of emergent cases and relationship of appearance and function of patient's body. And it is very important for orthopedic surgeons to make the ethical considerations of orthopedic surgery. In this article, we propose a number of underlying ethical issues and try to talk about the management of handling these issues. In this way, dealing with ethical issues properly is able to raise humanistic cares and standardize medical behaviors. It will not only improve and enable growth of orthopaedic surgeons themselves, but also make a contribution to the development of orthopedics.

  15. Attitudes towards chiropractic: an analysis of written comments from a survey of north american orthopaedic surgeons

    Directory of Open Access Journals (Sweden)

    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.

  16. Danish surgeons' views on minimally invasive surgery

    DEFF Research Database (Denmark)

    Edwards, Hellen; Jørgensen, Lars Nannestad


    that the risk was equal to traditional laparoscopy (3%). The fraction of surgeons willing to learn SILS and NOTES was 44.6% and 32.7%, respectively. The desire to learn was higher among less experienced and surgically active surgeons. Of the responders, 68.8% considered SILS and 43.2% considered NOTES would...

  17. [Michel Latarjet (1913-1999), surgeon explorer!]. (United States)

    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.

  18. William Cheselden: anatomist, surgeon, and medical illustrator. (United States)

    Sanders, M A


    William Cheselden was Great Britain's foremost surgeon/scientist in the first half of the 18th century. Cheselden directly challenged the Company of Barber-Surgeons' exclusive right to control dissection in London by being the first to conduct a regular series of anatomy lectures and demonstrations outside of the Company's Hall. He incorporated his lecture syllabus into a handbook of anatomy, The Anatomy of the Humane Body, which was used by students for nearly 100 years. Cheselden also wrote the text and drew the illustrations for a majestic atlas of comparative osteology, the Osteographia, or the Anatomy of the Bones. Cheselden used his superior knowledge of anatomy to reduce the morbidity and mortality associated with perineal lithotomy, one of the few operations possible in his era. Sagacious and pragmatic, Cheselden recognized that the enlightened practice of surgery beginning to take root in 18th-century London could flourish only under an autonomous body of surgeons. Cheselden used his personal funds and political skills to urge Parliament to pass legislation for the dissolution of the combined Company of Barber-Surgeons and the establishment of separate and distinct Surgeons' and Barbers' Companies. After disjoinder of the two groups on May 2, 1745, Cheselden served as one of the Wardens of the new Company of Surgeons--a predecessor of the Royal College of Surgeons of England. In 1746, Cheselden, who helped design the first Surgeons' Hall, served as the Company's Master.

  19. 45 CFR 1308.12 - Eligibility criteria: Orthopedic impairment. (United States)


    ... 45 Public Welfare 4 2010-10-01 2010-10-01 false Eligibility criteria: Orthopedic impairment. 1308... DISABILITIES Health Services Performance Standards § 1308.12 Eligibility criteria: Orthopedic impairment. (a) A child is classified as having an orthopedic impairment if the condition is severe enough to...

  20. [Principle and application of orthopedic ESWT apparatus]. (United States)

    Wang, Qi; Jiang, Fengqing


    The paper introduced the principle of extracorporeal shock wave therapy(ESWT) for orthopedics diseases including 60 cases of periarthritis of shoulder, 60 cases of tennis elbow and each compared with 60 control cases. The cure rate of ESWT for periarthritis of shoulder and tennis elbow is more than 93%, higher than the control group.

  1. Neonatal maxillary orthopedics: past to present

    NARCIS (Netherlands)

    Kuijpers-Jagtman, A.M.; Prahl, C.; Berkowitz, S.


    Neonatal maxillary orthopedics was introduced in the treatment protocol for cleft lip and palate in the 1950s of the last century. A wide range of appliances has been designed with pin-retained active appliances at one end of the spectrum and passive appliances at the other. Although neonatal maxill

  2. Safety, Efficacy, and Cost-effectiveness of Tranexamic Acid in Orthopedic Surgery. (United States)

    Lin, Zilan X; Woolf, Shane K


    Perioperative bleeding and postsurgical hemorrhage are common in invasive surgical procedures, including orthopedic surgery. Tranexamic acid (TXA) is a pharmacologic agent that acts through an antifibrinolytic mechanism to stabilize formed clots and reduce active bleeding. It has been used successfully in orthopedics to reduce perioperative blood loss, particularly in total hip and knee arthroplasty and spine surgery. Numerous research studies have reported favorable safety and efficacy in orthopedic cases, although there is no universal standard on its administration and its use has not yet become the standard of practice. Reported administration methods often depend on the surgeon's preference, with both topical and intravenous routes showing efficacy. The type and anatomic site of the surgery seem to influence the decision making but also result in conflicting opinions. Reported complication rates with TXA use are low. The incidence of both arterial and venous thromboembolic events, particularly deep venous thrombosis and pulmonary embolism, has not been found to be significantly different with TXA use for healthy patients. The route of administration and dosage do not appear to affect complication rates either. However, data on patients with higher-risk conditions are deficient. In addition, TXA has shown potential to reduce blood loss, transfusion rates and volumes, perioperative hemoglobin change, and hospital-related costs at various degrees among the published studies. Conservation of blood products, reduced laboratory costs, and shorter hospital stays are likely the major factors driving the cost savings associated with TXA use. This article reviews current data supporting the safety, efficacy, and cost-effectiveness of TXA in orthopedic surgery.

  3. The Future of Plastic Surgery: Surgeon's Perspective. (United States)

    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.

  4. The surgeon and human immunodeficiency virus. (United States)

    Mielke, Jens; Kalangu, Kazadi K N


    The moral dilemmas faced by surgeons worldwide who treat patients infected with the human immunodeficiency virus (HIV) can be viewed against the background of experience in sub-Saharan countries, where the community prevalence is in excess of 25% (90% of hospital inpatients). When seeking consent for an HIV test before surgery, frank communication regarding the surgeons' perspective of risks to themselves and the patient is helpful. When consent for a test must be obtained from a substitute decision-maker, the surgeon should consider if the patient would want the decision-maker to know the result. Understanding the natural history of HIV in the surgical setting can help deal with the uncertainties encountered and should be a research priority for developing countries. International professional organizations are useful platforms for the exchange of ideas when surgeons encounter uncertainty by increasing access to journals and creating opportunities for discussion. Although supervisory bodies in some parts of the world prevent HIV-infected surgeons from putting patients at risk by offering surgery, the withdrawal of their services in developing countries can cause more harm than good. Surgeons in that position may be entitled to offer surgery but only with full disclosure of the risk of HIV infection to the patient. The decision-making process known as "accountability for reasonableness" allows surgeons to determine fairness, legitimacy, and acceptability when making resource allocation decisions involving patients with HIV.

  5. Regional variability in use of a novel assessment of thoracolumbar spine fractures: United States versus international surgeons

    Directory of Open Access Journals (Sweden)

    Harrop James S


    Full Text Available Abstract Background Considerable variability exists in clinical approaches to thoracolumbar fractures. Controversy in evaluation and nomenclature contribute to this confusion, with significant differences found between physicians, between different specialties, and in different geographic regions. A new classification system for thoracolumbar injuries, the Thoracolumbar Injury Severity Score (TLISS, was recently described by Vaccaro. No assessment of regional differences has been described. We report regional variability in use of the TLISS system between United States and non-US surgeons. Methods Twenty-eight spine surgeons (8 neurosurgeons and 20 orthopedic surgeons reviewed 56 clinical thoracolumbar injury case histories, which included pertinent imaging studies. Cases were classified and scored using the TLISS system. After a three month period, the case histories were re-ordered and the physicians repeated the exercise; 22 physicians completed both surveys and were used to assess intra-rater reliability. The reliability and treatment validity of the TLISS was assessed. Surgeons were grouped into US (n = 15 and non-US (n = 13 cohorts. Inter-rater (both within and between different geographic groups and intra-rater reliability was assessed by percent agreement, Cohen's kappa, kappa with linear weighting, and Spearman's rank-order correlation. Conclusion Non-US surgeons were found to have greater inter-rater reliability in injury mechanism, while agreement on neurological status and posterior ligamentous complex integrity tended to be higher among US surgeons. Inter-rater agreement on management was moderate, although it tended to be higher in US-surgeons. Inter-rater agreement between US and non-US surgeons was similar to within group inter-rater agreement for all categories. While intra-rater agreement for mechanism tended to be higher among US surgeons, intra-rater reliability for neurological status and PLC was slightly higher among non

  6. [General surgeons and varicose vein surgery]. (United States)

    Morales-Cuenca, Germán; Moreno-Egea, Alfredo; Aguayo-Albasini, Jose Luis


    Chronic venous insufficiency is a highly prevalent condition, with significant health and economic repercussions. Although important therapeutic developments have been introduced in recent years, the majority are dealt with by general surgeons in national health hospitals. These surgeons do not have the required and continuous training, and continue to perform classic surgery techniques. Also, their presence at scientific, organisational meetings and training is almost nil. We present an update on developments in phlebology, and tapping into the preliminary results of a national survey, we reflect on the current status of phlebology and beyond for those general surgeons who should have a role in this field.

  7. Surgeons' musculoskeletal pain in minimally invasive surgery

    DEFF Research Database (Denmark)

    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...

  8. Sir Donald Ross, pioneer aortic valve surgeon. (United States)

    Wheatley, David


    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.

  9. Society of American Gastrointestinal and Endoscopic Surgeons (United States)

    ... The Research Foundation of the American Society of Colon and Rectal Surgeons (ASCRS) and the Society of American ... W. OIympic Blvd Suite 600 Los Angeles, CA 90064 USA Tel: (310) 437- ...

  10. [Orthopedic aspects of congenital insensitivity to pain]. (United States)

    Bronfen, C; Bensahel, H; Teule, J G


    The congenital insensitivity to pain regroups some rare diseases which are mainly 5: congenital insensitivity to pain; congenital sensitive neuropathies; distal sensitive neuropathies; Riley-Day syndrome or hereditary dysautonomia; at last, miscellaneous troubles. Three different cases are reported in children: true congenital insensitivity to pain; hereditary dysautonomia or Riley-Day syndrome; congenital insensitivity to pain localised to a lower limb joined to amniotic disease and abnormality of this limb. The orthopedic symptoms (osteomyelitis, arthropathies as Charcot type, dislocations, fractures) lead often to diagnosis and they are an important step of the prognosis. Scoliosis seems to be frequent in this disease. The orthopedic and surgical treatment, according to each localization, is difficult and must emphasize the prevention of bones and joints injuries.

  11. Orthopedic workforce planning in Germany – an analysis of orthopedic accessibility (United States)

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


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

  12. Proximal spinal muscular atrophy: current orthopedic perspective

    Directory of Open Access Journals (Sweden)

    Haaker G


    Full Text Available Gerrit Haaker, Albert Fujak Department of Orthopaedic Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany Abstract: Spinal muscular atrophy (SMA is a hereditary neuromuscular disease of lower motor neurons that is caused by a defective "survival motor neuron" (SMN protein that is mainly associated with proximal progressive muscle weakness and atrophy. Although SMA involves a wide range of disease severity and a high mortality and morbidity rate, recent advances in multidisciplinary supportive care have enhanced quality of life and life expectancy. Active research for possible treatment options has become possible since the disease-causing gene defect was identified in 1995. Nevertheless, a causal therapy is not available at present, and therapeutic management of SMA remains challenging; the prolonged survival is increasing, especially orthopedic, respiratory and nutritive problems. This review focuses on orthopedic management of the disease, with discussion of key aspects that include scoliosis, muscular contractures, hip joint disorders, fractures, technical devices, and a comparative approach of conservative and surgical treatment. Also emphasized are associated complications including respiratory involvement, perioperative care and anesthesia, nutrition problems, and rehabilitation. The SMA disease course can be greatly improved with adequate therapy with established orthopedic procedures in a multidisciplinary therapeutic approach. Keywords: spinal muscular atrophy, scoliosis, contractures, fractures, lung function, treatment, rehabilitation, surgery, ventilation, nutrition, perioperative management

  13. Undergraduate orthopedic education: Is it adequate?

    Directory of Open Access Journals (Sweden)

    Menon Jagdish


    Full Text Available Background : Basic musculoskeletal knowledge is essential to the practice of medicine. The purpose of this study was to assess the adequacy of musculoskeletal knowledge of medical students. Materials and Methods : The validated basic competency examination in musculoskeletal medicine devised by Freidman and Bernstein was administered to final year medical students just prior to their final professional examination. Participants were also required to assess their confidence at making a musculoskeletal physical examination and diagnosis as well as comment on the adequacy of time in the curriculum devoted to Orthopedics. Results : The response rate was 83% (40/48. The average cognitive examination score was 48.3%. Two participants (5% obtained a score of ≥ 73.1%, the recommended mean passing score. Seventeen students (42.5% felt orthopedic clinical cases were the most difficult to perform a physical examination and diagnose. Thirteen students (32.5% felt that the time devoted to orthopedics in the medical curriculum was inadequate. Conclusions : Ninety-five percent of the students failed to show basic musculoskeletal competency. A change in medical curriculum and teaching methods is required to address this problem.

  14. Transplant surgeon formation: vocation, incentives, between old and new surgeon generations. (United States)

    Iaria, G; Cardillo, A


    The training of the transplant surgeon is one of the most difficult paths in medicine. The transplant surgeon must be trained as a general and a vascular surgeon; he has to be skilled and upgraded in transplant surgical technique; he has to decide the suitability of the donor and of the organs as well as the immunosuppressive therapy for each recipient; he must know the intensive care unit, hepatology, and nephrology. The transplant surgeon has to deal with surgical, infectious, and metabolic complications after organ transplantation. Thus, clinical formation of the transplant surgeon is multifactorial and always upgraded. However, transplants never happen in the morning; retrivals are more likely to be in the night (especially the holidays ones). "Weekend" is a word not frequently used by transplant surgeons. Moreover, when the transplant procedure happens, the normal activity of the ward and of the outpatient clinic were have to be done. The transplant surgeon must have a sort of "vocation" for such a job. Organ harvesting setting is a good proof of adaptability, always during nighttime, often in small hospitals with operating room nurses unfamiliar with the procedure, sometimes waiting for some colleagues or delaying the surgery. This vocation is enhanced by enthusiasm, but incentives are necessary to feed this love. Incentives should be professional and economic; transplant surgeons should be allowed to make clinical decisions, to choose the surgical technique of transplantation, to control the decision process. Lastly, due to the "total on call," the surgeon should profit from a right salary avoiding extramural activities.

  15. Prevention of VTE in orthopedic surgery patients

    Directory of Open Access Journals (Sweden)

    Federico Spandonaro


    Full Text Available Venous thromboembolism (VTE is defined as the obstruction, partial or complete, of one or more veins of deep circulation. It is a condition that can lead to a deterioration in his state of health until death, manifesting as deep vein thrombosis (DVT or pulmonary embolism (PE. The major orthopedic surgery and the surgical oncology are frequently associated with thromboembolic complications, because of conditions that are often critical in these patients. It is estimated that in Italy DVT has an incidence that varies between 50 and 150 new cases per 100,000 population, while the prevalence would be between 2.5 and 5%. In the absence of thromboprophylaxis, the orthopedic surgery lead to a high increased risk of VTE. In elective hip replacement, in the absence of prophylaxis, the incidence of DVT and of fatal PE is about 50% and 2% respectively. In elective knee arthroplasty the risk of venous thromboembolic complications is even higher. It is estimated that 56.2% of the costs of prophylaxis with Low Molecular Weight Heparin (LMWH in patients undergoing major orthopedic surgery are attributable to the cost of drugs (about € 200, followed (with 44.8% by the cost of administration (approximately € 159. The average total cost/day was estimated at € 8 per patient. In Italy, it has been estimated an annual cost for new cases between 215 and 260 million €. The clinical advantages of the New Oral Anticoagulants (NOA appear to be substantially clear, the major concern with regard to their reimbursement is therefore linked to the financial impact, due to the higher cost per day of the NOA compared with LMWH. To this end, it was built a model of budget impact, in the perspective of the Italian NHS, from the data related to cases of major surgical orthopedic procedures and a meta-analysis on the pivotal RCT, which aims to measure the differential effects in terms of prevention of VTE. The results show that the financial impact of the NOA in the

  16. Orthopedic board certification and physician performance: an analysis of medical malpractice, hospital disciplinary action, and state medical board disciplinary action rates. (United States)

    Kocher, Mininder S; Dichtel, Laura; Kasser, James R; Gebhardt, Mark C; Katz, Jeffery N


    Specialty board certification status has become the de facto standard of competency by which the profession and the public recognize physician specialists. However, the relationship between orthopedic board certification and physician performance has not been established. Rates of medical malpractice claims, hospital disciplinary actions, and state medical board disciplinary actions were compared between 1309 board-certified (BC) and 154 non-board-certified (NBC) orthopedic surgeons in 3 states. There was no significant difference between BC and NBC surgeons in medical malpractice claim proportions (BC, 19.1% NBC, 16.9% P = .586) or in hospital disciplinary action proportions (BC, 0.9% NBC, 0.8% P = 1.000). There was a significantly higher proportion of state medical board disciplinary action for NBC surgeons (BC, 7.6% NBC, 13.0% P = .028). An association between board certification status and physician performance is necessary to validate its status as the de facto standard of competency. In this study, BC surgeons had lower rates of state medical board disciplinary action.

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


    Philip McClure; David Booy; Julia Katarincic; Craig Eberson


    Background. Mobius Syndrome is a rare disease defined by bilateral congenital 7th nerve palsy. We focus on reporting the prevalence of orthopedic disease in this population. Methods. Twenty-three individuals with Mobius Syndrome underwent orthopedic physical examination, and additional 96 patients filled out a survey for self-reported orthopedic diagnoses. Results. Clubfoot was present in 60% of individuals in the physical exam series and 42% of those in the survey. Scoliosis was present in 2...

  18. Do Surgeons Treat Their Patients Like They Would Treat Themselves?

    NARCIS (Netherlands)

    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

  19. [Study on the application of Aconitum in clinical orthopedics]. (United States)

    Jin, Hong-Ting; Shen, Yan; Xiao, Lu-Wei; Tong, Pei-Jian


    Aconitum is important in clinical orthopedics. From ancient times to the present day,there were many famous doctors who used this herb to cure many diseases in orthopedics. However, the toxicity always connect with its effect. This will limit its application in clinics. So now the important thing is how to use this herb correctly. This article will give some suggestions about how to use aconitum in orthopedics and to make sure it can be used correctly in future. It has four parts: application in orthopedics, pharmacology, factors related to toxicity and the prospect of the use of aconitum.

  20. Orthopedic management of osteopetrosis: results of a survey and review of the literature. (United States)

    Armstrong, D G; Newfield, J T; Gillespie, R


    Osteopetrosis or Albers-Schonberg disease is a rare hereditary disorder of osteoclast function in which resorption of bone is diminished, resulting in abnormally dense bones. The condition is known to occur in at least four recognizable clinical patterns, each of which is variable. The optimal treatment of fractures and of bone deformity in these patients has not previously been made clear. To determine appropriate orthopedic management of the condition, we conducted a survey of the membership of the Pediatric Orthopedic Society of North America. The combined experience of 57 surgeons who treated 79 patients with osteopetrosis was compiled. Four femoral neck fractures treated by closed reduction and internal fixation had a satisfactory result, but three treated nonoperatively developed varus and required osteotomy. A total of 20 hips was treated for coxa vara by various means, none of which was free of complications. Valgus osteotomy, when used as the primary treatment for coxa vara, was the most consistently satisfactory procedure, whereas in situ pinning failed in two of three hips. Fourteen subtrochanteric fractures and 31 other fractures of the femur were treated. Good results were reported with traction or casting or both in the majority of those fractures. Twenty-nine tibia fractures were treated successfully, the majority by nonoperative means. Upper extremity fractures healed well with closed reduction and casting. Vertebral fractures, spondylolysis, and back pain were most frequently treated without surgery.

  1. Perioperative complications of orthopedic surgery for lower extremity in patients with cerebral palsy. (United States)

    Lee, Seung Yeol; Sohn, Hye-Min; Chung, Chin Youb; Do, Sang-Hwan; Lee, Kyoung Min; Kwon, Soon-Sun; Sung, Ki Hyuk; Lee, Sun Hyung; Park, Moon Seok


    Because complications are more common in patients with cerebral palsy (CP), surgeons and anesthesiologists must be aware of perioperative morbidity and be prepared to recognize and treat perioperative complications. This study aimed to determine the incidence of and risk factors for perioperative complications of orthopedic surgery on the lower extremities in patients with CP. We reviewed the medical records of consecutive CP patients undergoing orthopedic surgery. Medical history, anesthesia emergence time, intraoperative body temperature, heart rate, blood pressure, immediate postoperative complications, Gross Motor Function Classification System (GMFCS) level, Cormack-Lehane classification, and American Society of Anesthesiologists physical status classification were analyzed. A total of 868 patients was included. Mean age at first surgery was 11.8 (7.6) yr. The incidences of intraoperative hypothermia, absolute hypotension, and absolute bradycardia were 26.2%, 4.4%, and 20.0%, respectively. Twenty (2.3%) patients had major complications, and 35 (4.0%) patients had minor complications postoperatively. The incidences of intraoperative hypothermia, absolute hypotension, and major postoperative complications were significantly higher in patients at GMFCS levels IV and V compared with patients at GMFCS levels I to III (PGMFCS level, patient age, hip reconstructive surgery, and history of pneumonia are associated with adverse effects on intraoperative body temperature, the cardiovascular system, and immediate postoperative complications.

  2. Prosthesis infections after orthopedic joint replacement

    DEFF Research Database (Denmark)

    Song, Zhijun; Borgwardt, Lotte; Høiby, Niels;


    Prosthesis-related infection is a serious complication for patients after orthopedic joint replacement, which is currently difficult to treat with antibiotic therapy. Consequently, in most cases, removal of the infected prosthesis is the only solution to cure the infection. It is, therefore...... and the host immune responses. The authors reviewed the related literature in the context of their clinical experience, and discussed the possible etiology and mechanism leading to the infections, especially problems related to bacterial biofilm, and prophylaxis and treatment of infection, including both...... microbiological and surgical measures. Recent progress in research into bacterial biofilm and possible future treatment options of prosthesis-related infections are discussed....

  3. Redundant publications in the orthopedic literature. (United States)

    Eck, Jason C; Nachtigall, Dean; Hodges, Scott D; Humphreys, S Craig


    Rates of redundant publications in the general surgery literature are approximately 14%. This article identifies the rate of redundant publications in the orthopedic literature. All original articles published during the year 2000 in The Journal of Bone and Joint Surgery (American Volume), Journal of Orthopaedic Trauma, Journal of Spinal Disorders, and Spine were searched using PubMed. Redundancy rate was 4 (3.15%) of 127 for The Journal of Bone and Joint Surgery (American volume), zero (0%) of 70 for Journal of Orthopaedic Trauma, 2 (2.90%) of 69 for Journal of Spinal Disorders, and 11 (3.12%) of 353 for Spine.

  4. Imaging of orthopedic trauma and surgery

    Energy Technology Data Exchange (ETDEWEB)

    Berquist, T.H.


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

  5. American Academy of Orthopaedic Surgeons Disclosure Policy Fails to Accurately Inform Its Members of Potential Conflicts of Interest. (United States)

    Tanzer, Dylan; Smith, Karen; Tanzer, Michael


    The American Academy of Orthopaedic Surgeons (AAOS) disclosure policy is designed to ensure that members involved in education or policy development remain free of outside influence. Although mandatory for these members, it is voluntary for the rest of the AAOS membership. To determine surgeon compliance with disclosure policy, we conducted a study in which we compared surgeon-consultants' disclosures as posted on 6 major orthopedic companies' websites in 2011 with those surgeons' disclosures as listed in AAOS disclosure program records. We found that 549 AAOS members were identified by at least 1 company as having received consulting payments. Overall, 44% of AAOS members did not comply with disclosure policy, or their information was not available on the AAOS website (range, 37%-61%). This study demonstrated that AAOS's policy of mandatory disclosure for select members and voluntary disclosure for all other members is ineffective. The AAOS disclosure program and the potential consequences of noncompliance need to be reevaluated by the organization if it wants its program to succeed.


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


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

  7. Disparities in internet use among orthopedic outpatients. (United States)

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


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

  8. [New DVO guideline for osteoporosis management 2014 and its importance for trauma surgeons]. (United States)

    Neuerburg, C; Stumpf, U; Schmidmaier, R; Kammerlander, C; Pfeilschifter, J; Mutschler, W; Böcker, W


    Osteoporosis-associated fractures represent a growing challenge in the treatment of orthopedic patients. In November 2014 a new revision of the guidelines on osteoporosis by the German Osteology Society (Dachverband Osteologie DVO) was adopted, in which additional risk factors for fractures and further treatment options have been included. On the one hand the existing model used to diagnose osteoporosis and estimate a high fracture risk as a guidance for the use of specific anti-osteoporotic therapy in patients without a fragility fracture was maintained and further refined. On the other hand the guideline includes the option to initiate a specific osteoporosis therapy without a prior bone densitometry in patients with typical radiographs of a proximal femur fracture and higher grade vertebral fractures, suspicious for osteoporosis, depending on the overall clinical context. This may reduce the treatment gap of osteoporosis in Germany. In this paper the changes in the DVO guidelines 2014 on osteoporosis are summarized, focusing on the most important changes with practical relevance for orthopedic surgeons.

  9. Sorting swimmers shoulders: An observational study on swimmers that presented to a shoulder surgeon

    Directory of Open Access Journals (Sweden)

    Daniel Butler


    Full Text Available Context: It is common for swimmers to suffer shoulder injuries resulting in a wealth of research focusing on the causes and types of injury. However, there is a lack of evidence regarding current management for shoulder injuries in swimmers. Aims: To investigate the diagnosis, subsequent management, and the return to swimming outcomes for swimmers presenting to an orthopedic practice. Settings and Design: Retrospective cohort study of competitive swimmers presenting to an orthopedic practice. Materials and Methods: The diagnosis, subsequent management, and the return to swimming outcomes were analyzed for 14 swimmers whose injuries were managed by a shoulder surgeon. Statistical Analysis Used: Descriptive analysis. Results: No significant association was identified between swimming stroke and type of injury. The majority of swimmers had good scapula rhythm, with no visible dyskinesis, including those with impingement. Swimmers with impingement did not require arthroscopy, and with nonoperative management had a mean time to return to swimming of 1.6 months. All labral tears required arthroscopic labral repair, with these swimmers having a mean time of 2.9 months postsurgery to return to swimming. Conclusion: The study demonstrated that an accurate diagnosis, and appropriate choice of nonoperative and surgical treatments lead to reassuring outcomes for swimmers suffering from shoulder injuries.

  10. Clinical attitudes towards pain treatment post-orthopedic surgery: a multicenter study in Beijing

    Institute of Scientific and Technical Information of China (English)

    WANG Zhi-qiang; ZHAN Si-yan; Marlene Fransen; LIN Jian-hao


    Background Pain is a common post-operative complication.Incidence of pain directly affects patients' quality of life in terms of patient physiology,psychology,and social characteristics.This study was to understand clinical attitudes with regards to Beijing surgeons,and patients' attitude towards pain treatment after orthopedic surgery.Methods A hospital-based cross-sectional and cluster sample survey of 40 hospitals in Beijing was conducted,including 20 level Ⅲ (tier three) and 20 level Ⅱ (tier two) general hospitals.Enrolled subjects completed a specifically designed interview-questionnaire.Results The prevalence of pain 2 weeks post-orthopedic surgery was high in Beijing (96.1%).Meanwhile,collected data indicated most subjects in Beijing suffered moderate to severe pain,45.1% and 41.4%,respectively,post-surgery.And for the concern of patients before surgery,most subjects chose full recovery from surgery (78.6%),as well as,the pain after operation was 39.2% ranked the third.According to the data from the study,Tramadol use was more common in Level Ⅲ hospitals,where Somiton was preferred in Level Ⅱ hospitals.When it came to the education of pain before and after operation,more patients get educated before operation than after it,In our study,case physicians or attending physicians enacted education before and after surgery.Related to the sense of patients,among the surgeons preferring post-operative analgesia,67.6% considered administration when receiving complaints of moderate level pain,50.0%indicated they will terminate analgesic treatment once pain degree scale wise decreases to benign pain.Conclusions The majority of orthopedic patients experience post-operative pain.Identification of post-operative pain will facilitate future awareness on pain treatment and nursing care in Beijing hospitals,with pain relief through regulated improvements in strategic pain management.

  11. The nature of surgeon human capital depreciation. (United States)

    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.

  12. Contemporary social media engagement by breast surgeons. (United States)

    Ekatah, Gregory E; Walker, Stephanie G; McDonald, James J; Dixon, J Michael; Brady, Richard R W


    There continues to be a steady rise in the use of social media among healthcare professionals. We present an overview of social media use among breast surgeons within the United Kingdom including demographic variations and some of the factors that underpin these trends. The benefits and drawbacks of open social media platforms are also considered.

  13. How helpful is capsule endoscopy to surgeons?

    Institute of Scientific and Technical Information of China (English)

    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.

  14. Improving Response Rates among Students with Orthopedic and Multiple Disabilities (United States)

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


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

  15. The Study of Canadian Culture (United States)

    Mandel, Eli


    Discussed are Canadian novels, short stories, poems and a film which revolve around man's confrontation with nature, the depression, the problem of isolation, realism in Canadian literature. (Author/AF)

  16. [Surgeons in Krakow between WWI and WWII]. (United States)

    Wysocki, A; Dolecki, M


    During the war time when Polish borders had not been established yet, apart from having two surgical departments Jagiellonian University, Krakow had surgical departments in the Bonifratow, Izraelicki and Military Hospitals. More surgical departments were opened up in later years in pubic Health System Hospitals, among them were Narutowicz at near Pradnicka street and Sisters of Mercy at Lea street. Other well-known Krakow surgeons operated in smaller, private surgeries, such as: Dom Zdrowia (House of Health) or Zwiazkowy (Union) Clinic. At that time only 30 Surgeons worked in Kraków. They were outstanding specialists with a broad practice. Among them were Maksymilian Rutkowski, Jan Glatzel, Stanislaw Nowicki, Michal Hladij. Gradually, younger surgeons started to join them. they were: Jan Kowalczyk, Jerzy Jasienski, Stanislaw Kania, Wladyslaw Laszczak, Jozef Bugusz, Jozef Gasinski. Many of them who worked in the surgical hospitals in Krakow, left the city after obtaining a professorship (like Kornel Michejda, professor at the University of Wilno) or became heads of wards, like Zygmunt Drobniewicz, Alfons Mackowski and Tadeusz Guschlbauer. All of these surgeons were highly respected by the medical community as well as by the general public in their respective town and surrounding areas. A large income allowed that best of them to fund and supply their own wards. Occasionally, however, among the less successful surgeons, an uncompromising competition for patients developed. These events were disapproved and condemned by the medical establishment. Many surgeons led an active life outside of their profession. A surgeon with an exceptionally colorful personality was Jan Glatzel: witty, highly intelligent, a connoisseur of fine art, book lover with an active social life. Maksymilian Rutkowski was active in charitable organizations, helping to support Bratnia Pomoc Medykow. Michal Hladij, president of KS Cracovia, vice president of Krakowski Klub Automobilowy rendered his

  17. Comparison of patient and surgeon expectations of total hip arthroplasty.

    Directory of Open Access Journals (Sweden)

    Claire Jourdan

    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.

  18. Teaching Canadian Literature: An Evaluation. (United States)

    Harker, W. John


    Suggests granting greater recognition to the artistic integrity of Canadian literature by removing it from the broader context of Canadian studies. Indicates that understanding and appreciation of Canadian literature as a representation of reality filtered through the perception of an author should be focus of literature in schools. (NEC)

  19. Geriatric intervention in elderly patients with hip fracture in an orthopedic ward

    Directory of Open Access Journals (Sweden)

    Else Marie Damsgaard


    orthopedic surgeons and geriatricians may be associated with a reduction in length of hospital stay without negatively affecting major patient outcomes. The concept should be further developed particularly among the frail elderly.

  20. Orthopedic manifestations of the Lowe (oculocerebrorenal) syndrome. (United States)

    Holtgrewe, J L; Kalen, V


    Lowe oculocerebrorenal syndrome (OCRS), as previously described in the literature, consists of a well-defined constellation of clinical findings involving the eyes, cerebrum, and kidneys. However, the only musculoskeletal abnormalities reported in patients with OCRS have been joint hypermobility, recurrent fractures, rickets, tenosynovitis, and joint effusions. No other specific orthopedic problems have been described. This study presents new clinical findings of scoliosis, kyphosis, platyspondyly, dislocated and/or subluxed hips, and cervical spine abnormalities in six patients with OCRS treated at Carrie Tingley Hospital (Albuquerque, NM, U.S.A.). This study further supports an X-linked recessive mode of inheritance and adds clinical support to the published work that suggests that Lowe syndrome may be due to biochemical abnormalities in glycosaminoglycan metabolism.

  1. Bioactive glass coatings for orthopedic metallic implants

    Energy Technology Data Exchange (ETDEWEB)

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


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

  2. Soluble Thrombomodulin and Major Orthopedic Surgery

    Directory of Open Access Journals (Sweden)

    Irina P. Antropova


    Full Text Available Background: A high level of soluble thrombomodulin (sTM is associated with a lower risk of thrombosis but can cause severe bleeding after operations. Deep vein thrombosis (DVT and blood loss are serious threats after orthopedic surgery. The aim of our pilot study was to evaluate the effect of the preoperative level of sTM on coagulation and inflammation as well as the blood loss and the development of symptomatic DVT after total large joint replacement. Methods and Results: In all patients (n=50 who underwent total hip or knee replacement, sTM, PrC, D-dimer, vWF, CRP, and platelets were determined before and after the operation. According to the preoperative sTM level, patients were divided into 2 groups: the thrombomodulin low (TML group (n=25 and thrombomodulin high (TMH group (n=25. The concentration of sTM was 4.4 [3.4, 4.7] ng/ml in the TML-group and 8.7[7.3, 10.6] ng/ml in the TMH-group. After surgery, D-dimer, vWF, platelet count and CRP were higher and total blood loss was lower in the TML group. In the TML-group, a symptomatic DVT was detected in 3(12% patients; in the TMH-group, a symptomatic DVT was identified only in 1(4% case. Conclusion: These findings support the important role of sTM in coagulation, inflammation, bleeding, and presumably in venous thrombosis after major orthopedic surgery.

  3. Twitter and Canadian Educators (United States)

    Cooke, Max


    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,…

  4. Canadian Adult Basic Education. (United States)

    Brooke, W. Michael, Comp.

    "Trends," a publication of the Canadian Association for Adult Education, is a collection of abstracts on selected subjects affecting adult education; this issue is on adult basic education (ABE). It covers teachers and teacher training, psychological factors relating to the ABE teacher and students, manuals for teachers, instructional…

  5. Ethics and the facial plastic surgeon. (United States)

    Sethi, Neeraj


    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.

  6. Professionalism and Commercialism on Cosmetic Surgeons' Websites. (United States)

    Park, Sung-Yeon; Park, SangHee


    This study analyzed the homepages of 250 cosmetic surgeons' websites by focusing on the representation of cosmetic surgery providers, cosmetic surgery recipients, and cosmetic surgery practice itself. Based on a literature review, some common elements of the webpages were preidentified as the indicators of professionalism or commercialism. Subsequently, each homepage was scrutinized for their presence and salience. Overall, cosmetic surgeons' websites were high in professionalism and low in commercialism in their representation of the service providers. In depicting the recipients, the websites were moderate in both professionalism and commercialism. The representation of practice was low in professionalism and moderate in commercialism. Implications of these findings for doctors, regulators, and consumer advocates are discussed and directions for future research are proposed.

  7. Smart apps for the smart plastic surgeon

    Directory of Open Access Journals (Sweden)

    Aniketh Venkataram


    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.

  8. Think small: nanotechnology for plastic surgeons. (United States)

    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.

  9. [Fibromatoses in orthopedics--what is certain?]. (United States)

    Heber, A; Laberke, H G


    Based on a cauistic observation, a survey of the rare fibromatoses and desmoid fibromas, respectively, is given from the orthopaedic aspect. Considerable risk factors may be present by incorrect interpretation of these tumors, concerning the differential diagnosis which can be problematic as opposed to harmless fibrosis and highly malignant fibrosarcoma. Thus, a detailed knowledge of these semi-malignant neoplasms is imperative for orthopaedic surgeons, although they will opposite to the more frequent abdominal localizations found in surgical medicine, expect rarely find affected the extremities and the area of the dorsal scapular arch, respectively by fibromatoses.

  10. [Pilot scheme to gain young professionals in orthopedics and trauma surgery. A new optional subject for students at the medical school in Göttingen (Germany)]. (United States)

    Schüttrumpf, Jan Philipp; Münzberg, Matthias


    The Young Forum of the German Society of Orthopedics and Traumatology is an interest group of young orthopedics and trauma surgeons in Germany. Besides dealing with topics of political interest, the group tries to arouse enthusiasm and interest for musculoskeletal surgery by means of new lectures and teaching methods.An example is the newly invented optional subject for students at the Medical School in Göttingen (Germany). The idea for such a new teaching offer was built by the Young Forum itself. The optional subject was on the syllabus for the first time this year and the organization was done by the university Department of Trauma Surgery, Plastic and Reconstructive Surgery. The course is divided in two main parts: a theoretical (16 hours) and a practical (10 hours) one. A good ratio of lectures, skills stations and workshops was on choice. This article explains the course in detail and shows a first evaluation result.

  11. [The first woman surgeons in the Netherlands]. (United States)

    Mulder, M; De Jong, E


    This article describes the position of woman surgeons in the Netherlands. In 1913 the first woman, Heleen Robert, was accepted as member of the Dutch Society of Surgery. Three others, Jeanne Knoop, Frieda van Hasselt and Rosalie Wijnberg, followed during the next ten years. The nomination of Rosalie Wijnberg caused a turbulent discussion as she was working as a gynaecologist and not as a surgeon. One can wonder about this argument as other members were gynaecologists too. It seems that the male attitudes towards women were changing as more women entered the male dominated field. Nevertheless, from 1931 on, the year in which the registration of specialists was created, a number of women succeeded in obtaining a registration in surgery. Four of them were interviewed: dr. D.A.E. Norel, A.G. Wiersum-de Kwaadsteniet, J. Leeksma-Lievense and A.A. Fierstra. The general opinion still is that surgery is not a female profession. At the moment there are some twenty women working as general surgeon compared to a seven hundred men.

  12. Comprehensive feedback on trainee surgeons' non-technical skills

    DEFF Research Database (Denmark)

    Spanager, Lene; Dieckmann, Peter; Beier-Holgersen, Randi


    OBJECTIVE: This study aimed to explore the content of conversations, feedback style, and perceived usefulness of feedback to trainee surgeons when conversations were stimulated by a tool for assessing surgeons' non-technical skills. METHODS: Trainee surgeons and their supervisors used the Non......-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...

  13. 21 CFR 878.4470 - Surgeon's gloving cream. (United States)


    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Surgeon's gloving cream. 878.4470 Section 878.4470...) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices § 878.4470 Surgeon's gloving cream. (a) Identification. Surgeon's gloving cream is an ointment intended to be used to lubricate the...

  14. 21 CFR 888.5850 - Nonpowered orthopedic traction apparatus and accessories. (United States)


    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Nonpowered orthopedic traction apparatus and... HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Surgical Devices § 888.5850 Nonpowered orthopedic traction apparatus and accessories. (a) Identification. A nonpowered orthopedic traction...

  15. CANLIT (Canadian Literature) Teachers' Crash Course. (United States)

    CANLIT, Toronto (Ontario).

    As a result of a study of the situation of Canadian literature in Canadian high schools and universities, this course was developed to provide teachers with useful information about Canadian literature. Included in this kit are sections on Canadian literature (the great debate about the importance of Canadian content), history and sources…

  16. Australia's female military surgeons of World War I. (United States)

    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.

  17. Canadian Mathematical Congress

    CERN Document Server


    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 ...

  18. Canadian identity: Implications for international social work by Canadians

    DEFF Research Database (Denmark)

    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......, to critically examine and unpack our ‘Canadian’ identity in order to practice international work that is socially just and anti-imperialist. Drawing on the work of post-colonial authors, critical race theorists, and those who study national myth-making, this essay revisits Canadian identity because...... it is this identity that Canadian social workers often carry into their international work....


    Directory of Open Access Journals (Sweden)

    Ivona Malovecká


    Full Text Available Collecting information about patient satisfaction with orthopedic and prosthetic medical devices in terms of utility, tolerance, and compliance is essential for verifying and improving the quality of these devices. In addition, such information is useful for improving the patients’ quality of life, and the quality management systems of health care providers. This study assessed patient satisfaction with these devices from a sample of patients with orthopedic, neurologic, and rheumatic diseases at the Specialized Hospital for Orthopedic Prosthetics and at the premises of the Dispenser of Orthopedic and Prosthetic Medical Devices, both in Bratislava in the Slovak Republic. The assessment involved a translated and validated questionnaire about patient satisfaction with orthopedic and prosthetic medical devices to evaluate key factors of weight, fit, appearance, comfort, pain free, free of abrasiveness, ease of application, and durability of each device. The study samples consisted of patients with lower limb problems (42.5%, spine problems (26.9%, and a combination of leg and spine issues (25.9%. Orthopedic disease occurred in 73.6% of these patients, a combination of orthopedic and neurologic disease in 13.5%, and neurologic disease in 7.3%. Orthopedic insoles (36.3%, hip belts (17.6%, and the corset on the spine (5.2% were the most used devices. Overall, the medical devices rated highly, with a high proportion of patients voting “strongly satisfied” in five of the eight key factors (range 51.8 to 63.2%, followed by a moderately lower proportion for durability (43.5%, comfort (37.3%, and appearance (31.1%. The comfort in wearing the device received the greatest patient dissatisfaction (22.8% of patients, followed by appearance (12.4%, and then fit (7.3%.

  20. Modern Orthopedic Inpatient Care of the Orthopedic Patient With Diabetic Foot Disease. (United States)

    Bateman, Antony H; Bradford, Sara; Hester, Thomas W; Kubelka, Igor; Tremlett, Jennifer; Morris, Victoria; Pendry, Elizabeth; Kavarthapu, Venu; Edmonds, Michael E


    In this article, we describe emergency and elective pathways within our orthopedic multidisciplinary inpatient care of patients with diabetic foot problems. We performed a retrospective cohort review of 19 complex patients requiring orthopedic surgical treatment of infected ulceration or Charcot feet or deformity at our institution. A total of 30 admissions (19 emergency, 11 elective) were included. The pathways were coordinated by a multidisciplinary team and comprised initial assessment and investigation and a series of key events, which consisted of emergency and elective surgery together with the introduction, and change of intravenous antibiotics when indicated. Patients had rigorous microbiological assessment, in the form of deep ulcer swabs, operative tissue specimens, joint aspirates, and blood cultures according to their clinical presentation as well as close clinical and biochemical surveillance, which expedited the prompt institution of key events. Outcomes were assessed using amputation rates and patient satisfaction. In the emergency group, there were 5.6 ± 3.0 (mean ± SD) key events per admission, including 4.2 ± 2.1 antibiotic changes. In the elective group, there were 4.8 ± 1.4 key events per inpatient episode, with 3.7 ± 1.3 antibiotic changes. Overall, there were 3 minor amputations, and no major amputations. The podiatric and surgical tissue specimens showed a wide array of Gram-positive, Gram-negative, aerobic and anaerobic isolates and 15% of blood cultures showed bacteremia. When 9 podiatric specimens were compared with 9 contemporaneous surgical samples, there was concordance in 2 out of 9 pairs. We have described the successful modern care of the orthopedic diabetic foot patient, which involves close clinical, microbiological, and biochemical surveillance by the multidisciplinary team directing patients through emergency and elective pathways. This has enabled successful surgical intervention involving debridement, pressure relief, and

  1. Tuberculosis in Aboriginal Canadians

    Directory of Open Access Journals (Sweden)

    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.

  2. Discordance between patient and surgeon satisfaction after total joint arthroplasty. (United States)

    Harris, Ian A; Harris, Anita M; Naylor, Justine M; Adie, Sam; Mittal, Rajat; Dao, Alan T


    We surveyed 331 patients undergoing total hip or knee arthroplasty pre-operatively, and patients and surgeons were both surveyed 6 and 12 months post-operatively. We identified variables (demographic factors, operative factors and patient expectations) as possible predictors for discordance in patient-surgeon satisfaction. At 12 months, 94.5% of surgeons and 90.3% of patients recorded satisfaction with the outcome. The discordance between patient and surgeon satisfaction was mainly due to patient dissatisfaction-surgeon satisfaction. In an adjusted analysis, the strongest predictors of discordance in patient-surgeon satisfaction were unmet patient expectations and the presence of complications. Advice to potential joint arthroplasty candidates regarding the decision to proceed with surgery should be informed by patient reported outcomes, rather than the surgeon's opinion of the likelihood of success.

  3. A population-based study of ambulatory and surgical services provided by orthopaedic surgeons for musculoskeletal conditions

    Directory of Open Access Journals (Sweden)

    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

  4. [Technical orthopedics. Importance in an increasingly operatively oriented faculty]. (United States)

    Greitemann, B; Maronna, U


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

  5. Regional anesthesia techniques for ambulatory orthopedic surgery.

    LENUS (Irish Health Repository)

    O'Donnell, Brian D


    PURPOSE OF REVIEW: The purpose of this review is to present advances in the use of regional anesthetic techniques in ambulatory orthopedic surgery. New findings regarding the use of both neuraxial anesthesia and peripheral nerve block are discussed. RECENT FINDINGS: Neuraxial anesthesia: The use of short-acting local anesthetic agents such as mepivacaine, 2-chloroprocaine, and articaine permits rapid onset intrathecal anesthesia with early recovery profiles. Advantages and limitations of these agents are discussed.Peripheral nerve block: Peripheral nerve blocks in limb surgery have the potential to transform this patient cohort into a truly ambulatory, self-caring group. Recent trends and evidence regarding the benefits of regional anesthesia techniques are presented.Continuous perineural catheters permit extension of improved perioperative analgesia into the ambulatory home setting. The role and reported safety of continuous catheters are discussed. SUMMARY: In summary, shorter acting, neuraxial, local anesthetic agents, specific to the expected duration of surgery, may provide superior recovery profiles in the ambulatory setting. A trend towards more peripheral and selective nerve blocks exists. The infrapatellar block is a promising technique to provide analgesia following knee arthroscopy. Improved analgesia seen in the perioperative period can be safely and effectively extended to the postoperative period with the use of perineural catheters.

  6. [The cardiovascular surgeon and the Syntax score]. (United States)

    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.

  7. Sir Charles Ballance: pioneer British neurological surgeon. (United States)

    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.

  8. Postcardiotomy centrifugal assist: a single surgeon's experience. (United States)

    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.

  9. Training cardiac surgeons: the Indiana University experience. (United States)

    Brown, John W


    In this article, I will outline the origin of cardiothoracic surgical (CTS) training at Indiana University (IU) and its evolution to the present. I will describe my educational background, surgical training in this specialty, and my role as an educator of CT surgeons. I will describe our faculty and the structure of the CTS residency. Finally, I will describe a newly adopted smart phone "App" called SIMPL, which allows the resident and faculty to quickly (50% of the most critical aspects of each surgical procedure, the resident's performance during the critical portion of the operation from poor to excellent, and the degree of difficulty of the operation from simple to complex. The attending surgeon and the resident data are then forwarded to the SIMPL database where the SIMPL software aggregates data for each resident and procedure producing a report at the end of the rotation of the resident's performance relative to his peers. This additional evaluation process will better ensure that our CTS residents are "practice ready" when they complete their training.

  10. Emergency surgeon-performed hepatobiliary ultrasonography.

    LENUS (Irish Health Repository)

    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.

  11. Herniation of the cervical disk in plastic surgeons. (United States)

    Tzeng, Yuan-Sheng; Chen, Shyi-Gen; Chen, Tim-Mo


    Herniations of the cervical disk in plastic surgeons are far more common in practice than the paucity of reported cases would indicate. A likely explanation may be the peculiar, nonergonomic positions that plastic surgeons must hold during surgery while wearing a headlight and loupes. From January 2003 to December 2006, at Tri-Service General Hospital, Taiwan, 4 plastic surgeons experienced herniations of the cervical disk. Magnetic resonance imaging study indicated there was disk herniation or bulging with spinal cord impingement. Two plastic surgeons received cervical diskectomy, corpectomy with strut reconstruction using titanium cages. These 2 surgeons were symptom-free 2 years after their operations. The other 2 plastic surgeons were under conservative physical therapy with persistent symptoms. The clinical evidence indicated that cervical disk herniation is an occupational hazard in plastic surgeons. To prevent prolonged hyperflexion and twisting of the neck, we proposed wearing a cervical brace during surgery for the plastic surgeons at Tri-Service-General Hospital since January 2008. No more plastic surgeons have experienced herniation of the cervical disk since then. The results indicated that wearing a cervical brace may be an effective measure to protect plastic surgeons from cervical disk disease.

  12. William Fulton Gillespie, 1891-1949: transitional figure in western Canadian academic surgery. (United States)

    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.

  13. On Realities of Canadian Multiculturalism

    Institute of Scientific and Technical Information of China (English)



    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.

  14. Mapping a surgeon's becoming with Deleuze. (United States)

    Cristancho, Sayra; Fenwick, Tara


    The process of 'becoming' shapes professionals' capability, confidence and identity. In contrast to notions of rugged individuals who achieve definitive status as experts, 'becoming' is a continuous emergent condition. It is often a process of struggle, and is always interminably linked to its environs and relationships. 'Becoming' is a way of understanding the tensions of everyday practice and knowledge of professionals. In this paper, we explore the notion of 'becoming' from the perspective of surgeons. We suggest that 'becoming', as theorised by Deleuze, offers a more nuanced understanding than is often represented using conventional vocabularies of competence, error, quality and improvement. We develop this conception by drawing from our Deleuze-inspired study of mapping experience in surgery. We argue for Deleuzian mapping as a method to research health professionals' practice and experience, and suggest the utility of this approach as a pedagogical tool for medical education.

  15. Oral breathing: dentomaxillofacial irregularities associated with nasorespiratory and orthopedic dysfunctions.

    Directory of Open Access Journals (Sweden)

    Clotilde de la Caridad Mora Pérez


    Full Text Available Background: Human beings are conditioned to breathe through the nose and feed through the mouth, when this physiological mechanism is interrupted facial and general growth is also affected. Objective: To characterize Angle´s Class II malocclusions in oral breathers with nasorespiratory and orthopedic dysfunctions. Method: A correlational, observational and descriptive study was developed from December 2004 to November 2005 including clinical examination of 833 children out of which 60 were selected to take part in this study. Each case was analyzed in Orthodontia, Orthopedics and Otolaryngology consultations. The studied variables were: age, sex, nasorespiratory disorders, orthopedic dysfunctions, dental-maxillofacial irregularities. Results: The mot frequent dental-maxillofacial irregularities were: bilabial incompetence, transversal micrognathism, vestibular version, overjet and overbite. The most important nasorespiratory dysfunctions found in these children were adenoiditis, and tonsil hypertrophy. The most outstanding orthopedic dysfunction was ciphosis. Conclusion: It is conclusive to state that there is a high relationship between dentomaxillofacial anomalies and nasorespiratory and orthopedic dysfunctions.

  16. Canadian construction industry

    Energy Technology Data Exchange (ETDEWEB)

    Rich, M.


    The principal sectors of the Canadian construction industry - commercial, industrial, institutional and residential - are examined with regard to their technical considerations concerning the subject of sustainability. Apart from the different needs of each of the sectors of the industry there are also regional differences caused by population distribution, and differences in climate, that have to be identified and accommodated in considering attitudes to recycling and sustainable development. Some indications that there is growing awareness of recycling and reuse are: the increasing frequency of life cycle costing in the commercial and institutional sectors, the use of recycled or otherwise waste materials in concrete, examples of using steel supporting structures and roof joists salvaged from previous uncompleted projects in the industrial sector, improved building envelope and indoor air quality concerns, collective ground source heating, and new basement and framing technologies and construction materials in the residential sector. These improvements notwithstanding, there remains much to be done. The new objective-based National Building Code, for which comments are now being solicited across the country, is expected to identify new and innovative solutions and to kick-start serious efforts to come up with solutions towards increasing overall sustainability in all sectors of the Canadian construction industry.

  17. Plastic Surgery and Suicide: A Clinical Guide for Plastic Surgeons. (United States)

    Reddy, Vikram; Coffey, M Justin


    Several studies have identified an increased risk of suicide among patient populations which a plastic surgeon may have a high risk of encountering: women undergoing breast augmentation, cosmetic surgery patients, and breast cancer patients. No formal guidelines exist to assist a plastic surgeon when faced with such a patient, and not every plastic surgery team has mental health clinicians that are readily accessible for consultation or referral. The goal of this clinical guide is to offer plastic surgeons a set of practical approaches to manage potentially suicidal patients. In addition, the authors review a screening tool, which can assist surgeons when encountering high-risk patients.

  18. [Management abilities of the head surgeon: essential for survival!]. (United States)

    Jähne, J


    Due to increased economic challenges in the management of hospitals head surgeons do not only need excellent surgical expertise but also significant management qualities. The personality of head surgeons should include authenticity, sincerity, fairness and the ability to cooperate. Visionary leadership, strategic thinking and strategic management of the personnel are further prerequisites for success. Besides good abilities in communication head surgeons need knowledge of the operating figures for interpretation. To keep up with the own capabilities time and self-management is essential. A survival as head surgeon is likely if these qualities and abilities exist.

  19. Two surgeons and the ECG-a double blind study

    Institute of Scientific and Technical Information of China (English)

    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.

  20. Can Orthopedic Oncologists Predict Functional Outcome in Patients with Sarcoma after Limb Salvage Surgery in the Lower Limb? A Nationwide Study

    Directory of Open Access Journals (Sweden)

    Sjoerd Kolk


    Full Text Available Accurate predictions of functional outcome after limb salvage surgery (LSS in the lower limb are important for several reasons, including informing the patient preoperatively and, in some cases, deciding between amputation and LSS. This study aimed to elucidate the correlation between surgeon-predicted and patient-reported functional outcome of LSS in the Netherlands. Twenty-three patients (between six months and ten years after surgery and five independent orthopedic oncologists completed the Toronto Extremity Salvage Score (TESS and the RAND-36 physical functioning subscale (RAND-36 PFS. The orthopedic oncologists made their predictions based on case descriptions (including MRI scans that reflected the preoperative status. The correlation between patient-reported and surgeon-predicted functional outcome was “very poor” to “poor” on both scores (r2 values ranged from 0.014 to 0.354. Patient-reported functional outcome was generally underestimated, by 8.7% on the TESS and 8.3% on the RAND-36 PFS. The most difficult and least difficult tasks on the RAND-36 PFS were also the most difficult and least difficult to predict, respectively. Most questions had a “poor” intersurgeon agreement. It was difficult to accurately predict the patient-reported functional outcome of LSS. Surgeons’ ability to predict functional scores can be improved the most by focusing on accurately predicting more demanding tasks.

  1. Evolving trauma and orthopedics training in the UK. (United States)

    Inaparthy, Praveen K; Sayana, Murali K; Maffulli, Nicola


    The ever-growing population of the UK has resulted in increasing demands on its healthcare service. Changes have been introduced in the UK medical training system to avoid loss of training time and make it more focused and productive. Modernizing medical careers (MMC) was introduced in 2005. This promised to reduce the training period for a safe trauma specialist, in trauma and orthopedics, to 10 years. At around the same time, the European Working Time Directive (EWTD) was introduced to reduce the working hours for junior doctors in training, to improve patient safety and also work-life balance of junior doctors. Introduction of the assessment tools from Orthopedic Competency assessment project (OCAP) will help tailor the training according to the needs of the trainee. The aim of this article is to review the changes in the UK orthopedic surgical training over the past two decades.

  2. Grade 3 Students Explore the Question, "What's Canadian about Canadian Children's Literature?" (United States)

    Pantaleo, Sylvia


    Explores third graders' responses to the question "What's Canadian about Canadian Children's Literature?" Describes 6 picture books and summarizes students' responses to each. Finds students mentioned geographical aspects as characteristic of Canadian literature, and they felt Canadian children's literature should reflect Canadian "experiences."…

  3. Problems in the Study of Canadian Literature. (United States)

    Cameron, Barry


    Considers reasons for studying Canadian literature. Notes the relative infancy of Canadian literature and the need for maintaining objectivity in the study of Canadian literature. Proposes that teachers of Canadian literature focus on individual, contemporary works, examining language, form, and craftsmanship. (RL)

  4. [Canadian Literature. "Featuring: CanLit." (United States)

    Haycock, Ken, Ed.; Haycock, Carol-Ann, Ed.


    The feature articles in this journal issue deal with various aspects of Canadian literature. The articles include: (1) a discussion of who's who and what's what in Canadian literature; (2) reviews of worthwhile but overlooked Canadian children's literature; (3) a list of resource guides to Canadian literature and a short quiz over famous first…

  5. Novel approaches for treating musculoskeletal diseases: molecular orthopedics and systems medicine. (United States)

    Mashayekhi, Kaveh; O'Brien, Margaret; Zugun-Eloae, Florin; Labusca, Luminita


    Molecular medicine uses knowledge about cell structure and function for disease, diagnostics, stage characterisation and treatment. The advent of genomic technologies is considerably leading to developments in the field of molecular medicine. The accumulation of detailed information about gene expression, epigenetic variability, protein transcription and functional modulation is contributing to a new era in medicine. Rapid and early diagnostic procedures, molecular characterisation of degenerative and proliferative diseases and personalized therapies are predicted to lead to advancements in health prevention and treatment of disease. Diagnostic tools and therapies based on local and /or general modulation of cellular processes for traumatic or degenerative musculoskeletal conditions are becoming available. A logical consequence of the information derived from extensive data gathering, systems biology and systemic medicine has lead to significant improvements in understanding biological structure and function in a simultaneous bottom top and integrative, holistic manner. The description of disease mechanism at an intimate, subcellular level has a dual benefit. A thorough understanding of the crosstalk involved in molecular pathways both in the normal and the diseased state are expanding scientific knowledge and simultaneously are enabling design cell-targeted and individualized therapies. This paper presents a brief overview of current molecular based treatments available to the orthopedic surgeon and introduces the concept of systemic medicine from the perspective of musculoskeletal pathology.

  6. The Impact of Individual Surgeon Volume on Hysterectomy Costs (United States)

    Shepherd, Jonathan P.; Kantartzis, Kelly L.; Lee, Ted; Bonidie, Michael J.


    Background and Objective: Hysterectomy is one of the most common surgical procedures women will undergo in their lifetime. Several factors affect surgical outcomes. It has been suggested that high-volume surgeons favorably affect outcomes and hospital cost. The objective is to determine the impact of individual surgeon volume on total hospital costs for hysterectomy. Methods: This is a retrospective cohort of women undergoing hysterectomy for benign indications from 2011 to 2013 at 10 hospitals within the University of Pittsburgh Medical Center System. Cases that included concomitant procedures were excluded. Costs by surgeon volume were analyzed by tertile group and with linear regression. Results: We studied 5,961 hysterectomies performed by 257 surgeons: 41.5% laparoscopic, 27.9% abdominal, 18.3% vaginal, and 12.3% robotic. Surgeons performed 1–542 cases (median = 4, IQR = 1–24). Surgeons were separated into equal tertiles by case volume: low (1–2 cases; median total cost, $4,349.02; 95% confidence interval [CI] [$3,903.54–$4,845.34]), medium (3–15 cases; median total cost, $2,807.90; 95% CI [$2,693.71–$2,926.93]) and high (>15 cases, median total cost $2,935.12, 95% CI [$2,916.31–$2,981.91]). ANOVA analysis showed a significant decrease (P < .001) in cost from low-to-medium– and low-to-high–volume surgeons. Linear regression showed a significant linear relationship (P < .001), with a $1.15 cost reduction per case with each additional hysterectomy. Thus, if a surgeon performed 100 cases, costs were $115 less per case (100 × $1.15), for a total savings of $11,500.00 (100 × $115). Conclusion: Overall, in our models, costs decreased as surgeon volume increased. Low-volume surgeons had significantly higher costs than both medium- and high-volume surgeons.

  7. Nanomedicine applications in orthopedic medicine: state of the art. (United States)

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


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

  8. Orthopedic conditions of small ruminants. Llama, sheep, goat, and deer. (United States)

    Kaneps, A J


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

  9. Novel nanostructured hydroxyapatite coating for dental and orthopedic implants (United States)

    Liu, Huinan; Jiang, Wenping; Malshe, Ajay


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

  10. Applications of Metal Additive Manufacturing in Veterinary Orthopedic Surgery (United States)

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


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

  11. Organism Encumbrance of Cardiac Surgeon During Surgery (United States)

    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

  12. Patients' Opinions about Polish Surgeons and Surgical Treatment. (United States)

    Olakowski, Marek; Hładoń, Aleksandra; Seweryn, Mariusz; Ciosek, Jakub; Świątkiewicz, Wojciech


    In Polish society Stereotypes about the surgeons are deeply rooted, which could really affect their relationship with the patient and the entire treatment process. The aim of the study was to evaluate the results of an opinion survey on the image of the surgeon and operative treatment.

  13. Decreased heart rate variability in surgeons during night shifts

    DEFF Research Database (Denmark)

    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'...

  14. Changing perceptions of beauty: a surgeon's perspective. (United States)

    Adamson, Peter A; Zavod, Matthew B


    Beauty is a mystery that has been with us for ages. Scholars and scientists have investigated its roots and effects, and its presence is ubiquitous. Has the construct of beauty changed over time? Is our sense of beauty learned or innate? What IS beauty, and can we quantify it? A substantial amount of work supports a Darwinian theory of selection, which predicts a survival advantage based on physical attractiveness. However, there is evidence that certain perceptions of beauty change with time. Indeed, the recent globalization of modern society has wrought changes in our perceptions of beauty. Are patients electing cosmetic surgery procuring a survival advantage, or are they bypassing genetics and setting a new standard for beauty? As facial plastic surgeons, we must be poised to respond to this metamorphosis and understand its roots. Although there is some equivocation and debate about this elusive subject, it is our duty to stay abreast of the current dynamic to make sound judgments that are in the best interests of our patients.

  15. Richard von Volkmann: surgeon and Renaissance man. (United States)

    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.

  16. Canadian National Vegetation Classification (CNVC) (United States)

    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...

  17. Canadian Literature Is Comparative Literature. (United States)

    Blodgett, E. D.


    Argues that the way out of worn out analogies of Canadian literature is found not only by acquiring knowledge of other cultures, but also by abandoning the deceptive parallelisms that overcome differences only by hiding them. (RAE)

  18. A commentary on the disparate perspectives of clinical microbiologists and surgeons (United States)

    O’Connell, Nuala H; O’Connor, Ciara; O’Mahony, Jim; Lobo, Ronstan; Hayes, Maria; Masterson, Eric; Larvin, Michael; Coffey, J Calvin; Dunne, Colum


    Prosthetic joints and other orthopedic implants have improved quality of life for patients world-wide and the use of such devices is increasing. However, while infection rates subsequent to associated surgery are relatively low (<3%), the consequences of incidence are considerable, encompassing morbidity (including amputation) and mortality in addition to significant social and economic costs. Emphasis, therefore, has been placed on mitigating microbial risk, with clinical microbiologists and surgeons utilizing rapidly evolving molecular laboratory techniques in detection and diagnosis of infection, which still occurs despite sophisticated patient management. Multidisciplinary approaches are regularly adopted to achieve this. In this commentary, we describe an unusual case of Actinomyces infection in total hip arthroplasty and, in that context, describe the perspectives of the clinical microbiology and surgical teams and how they contrasted. More specifically, this case demonstrates an ad hoc approach to structured eradication of biofilms and intracellular bacteria related to biomaterials, as reflected in early usage of linezolid. This is a complex topic and, as described in this case, such accelerated treatment can be effective. This commentary focuses on the merits of such inadvisable use of potent antimicrobials amid the risk of diminishing valuable antimicrobial efficacy, albeit resulting in desirable patient outcomes. PMID:25122489

  19. Quality of life of indian pediatric surgeons: Results of a survey (of indian association of pediatric surgeons members

    Directory of Open Access Journals (Sweden)

    M M Zameer


    Conclusion: This is the first study which objectively highlights that most surgeons are happy professionally and financially in due course of time and demolishes the common belief that pediatric surgeons are unsatisfied. It also acts as a point of reference and encouragement to newer aspirants in pediatric surgery.

  20. Socioeconomic value of orthopedic devices: evidence and methodological challenges

    Directory of Open Access Journals (Sweden)

    Sorenson C


    Full Text Available Corinna Sorenson,1,2 Michael Drummond2,31LSE Health, London School of Economics, London, UK; 2European Health Technology Institute for Socioeconomic Research, Brussels, Belgium; 3Centre for Health Economics, University of York, York, UKAbstract: With continued technological advances in orthopedic devices and increasingly limited health care resources, greater attention will be placed on substantiating the socioeconomic value of these devices. Therefore, this study focused on a systematic review of available economic evaluations of selected orthopedic devices (n = 33 studies to assess their impact on different clinical and economic outcomes. The existing evidence suggests that they have important benefits to patients, including reduced risk of fractures, increased mobility and functioning, and enhanced quality of life, and do so cost effectively or with cost savings. However, we have identified several methodological obstacles to sufficient ascertainment of value, such as a lack of robust information on health economic outcomes and long-term evidence. We also identify areas where additional research is needed to assess more fully the value of orthopedic devices.Keywords: medical devices, orthopedics, health economic evaluation

  1. Comparing consensus guidelines on thromboprophylaxis in orthopedic surgery

    NARCIS (Netherlands)

    M.C. Struijk-Mulder; H.B. Ettema; C.C. Verheyen; H.R. Büller


    BACKGROUND: Different guidelines exist regarding the prevention of venous thromboembolism (VTE) in orthopedic surgery. OBJECTIVES: We aimed to compare (inter)national guidelines and analyse differences. Methods: MEDLINE, the Cochrane Library and the internet were searched for guidelines on the preve

  2. Reviewer agreement in scoring 419 abstracts for scientific orthopedics meetings.

    NARCIS (Netherlands)

    Poolman, R.W.; Keijser, L.C.M.; Waal Malefijt, M.C. de; Blankevoort, L.; Farrokhyar, F.; Bhandari, M.


    BACKGROUND: The selection of presentations at orthopedic meetings is an important process. If the peer reviewers do not consistently agree on the quality score, the review process is arbitrary and open to bias. The aim of this study was: (1) to describe the inter-reviewer agreement of a previously d

  3. Higher Education and Students with Orthopedic Disabilities: A Survey Instrument. (United States)

    Singh, Delar K.

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

  4. Looking at the Social Activity for Adolescents with Orthopedic Impairments (United States)

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


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

  5. Frequency of orthopedic diseases in horses: A retrospective study

    Directory of Open Access Journals (Sweden)

    Kovač Milomir


    Full Text Available This retrospective study determined the frequency of orthopedic diseases in horses. It was possible to establish 141 specific orthopedic diagnoses in 1955 horses with lameness. In 14.58 % horses, multiple pathologic orthopedic changes were determined. In 61.84 % cases, the pathologic changes were present on the thoracic limb, 28,86 % on the pelvic limb and other parts of the oganism (neck, spine, muscles in 9.29 % cases. Pathologic changes on the tendons, ligaments, tendon sheats, bursae and muscles were determined in 31.51 % cases. Diseases of the hoof were present in 25.82 % cases. According to our investigation the most frequent orthopedic diseases are: podarthritis (acute, chronic, septic (5.04 %, navicular disease (4.69 %, tendinitis m. flexor digitalis superfacialis (4.51 %, kissing spine syndrom (4.30 % periarthritis et osteoarthrosis tarsi (3.30 %, distal metacarpal/metatarzophalengeal tendovaginitis (3.30 % and high suspensory ligament desmitis (3.12 %. Most frequent fractures were diagnosed on the metacarpal/metatarsal bone II and IV (2.56 %. Osteochondrossis dissecans was most frequently determined in the tarsocrural (1.26 % and the metacarpophalengeal joint (1.56 %.

  6. Left-Handed Preschool Children with Orthopedic Disabilities. (United States)

    Banham, Katharine M.


    The mental development of 332 preschool-age children with orthopedic disabilities was assessed at a children's hospital over a 10-year period, and comparisons were made for right-handed and left-handed. The left-handed children were slower than right-handed children in learning speech and language skills (Author/SEW)

  7. Rivaroxaban for Thromboprophylaxis After Nonelective Orthopedic Trauma Surgery in Switzerland

    DEFF Research Database (Denmark)

    Hoffmeyer, Pierre; Simmen, Hanspeter; Jakob, Marcel


    This study investigated the effectiveness and the outcomes of rivaroxaban vs the standard of care for venous thromboembolic prophylaxis in patients undergoing fracture-related surgery. A total of 413 patients undergoing fracture-related surgery from 9 Swiss orthopedic and trauma centers were enro...

  8. 第一届全国脊柱外科青年医师暨脊柱脊髓护理学术论坛会议纪要%Conference summary of the ifrst National Academic Forum of Young Spine Surgeons (Spine and Spinal Cord Care Forum)

    Institute of Scientific and Technical Information of China (English)

    王冰; 赵兴娥


    To further promote the academic exchanges of national young spine surgeons and nurses, the ifrst Academic Forum of National Young Spine Surgeons ( Spine and Spinal Cord Care Forum ) was held in Changsha on January 10-11, 2014, which was sponsored by the first Youth Commission and Nursing Group of Specialized Committee of Spine and Spinal Cord Injury of Chinese Association of Rehabilitation Medicine. It was organized by the department of spinal surgery of the second Xiangya hospital of central south university. About 300 spine surgery and nursing specialists, young technical experts and representatives in China attended this academic event. The topics about spine surgery and nursing as well as academical training of Chinese orthopedic surgeons, 3D printing technology in spine surgery, surgical treatment of thoracic ossiifcation of the posterior longitudinal ligament ( OPLL ) combined with thoracic spinal stenosis, management of orthopedic perioperative period, spinal cord injury rehabilitation, cervical spine, lower lumbar, minimally invasive technique and malformation were heatedly discussed in the forms of subject presentation and special report in this forum. It represented good spirits of national young spine surgeons and nurses in critical thinking and pursuing technological innovation and professional development. During the forum, the ifrst nursing group of specialized committee of spine and spinal cord injury of Chinese association of rehabilitation medicine was established. The academical level of national young spine surgeons and nurses would be advanced after such a successful conference.

  9. Ethical challenges in surgery as narrated by practicing surgeons

    Directory of Open Access Journals (Sweden)

    Nordam Ann


    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.

  10. [X-ray in trauma and orthopedic surgery. Physical and biological impact, reasonable use, and radiation protection in the operating room]. (United States)

    Dresing, K


    Orthopedic and especially trauma surgeons' use of x-rays during operations vary extensively, especially in minimally invasive osteosynthesis procedures. Radiation hazards often are neglected. In this paper, a short overview of physical and biological effects of radiation are given. In addition, practical information about how to lower radiation exposure in the daily work in the operating room (OR) is given. The operating team is exposed mainly to scattered radiation. The radiation exposure is 10 times higher on the tube side than on the amplifier side. The distance between tube and surgeon must be as great as possible. The tube should be positioned under the OR table, and the distance between tube and patient should be as short as possible. The positioning of the C-arm device without radiation is important. The use of patient landmarks is used to position the C-arm over the region of interest, but the preoperative training of surgeons and team with virtual learning tools, e.g., virtX, is very effective in reducing radiation hazards.

  11. The effects of surgeons and anesthesiologists on operating room efficiency

    Directory of Open Access Journals (Sweden)

    Nessa Timoney


    Conclusion: In some procedures types a significant part of the variability in operative time is due to the interaction between the surgeon and anesthesiologist. Reviewing operative records should allow identification of efficient/inefficient combinations.

  12. A Methodological Critique of the ProPublica Surgeon Scorecard. (United States)

    Friedberg, Mark W; Pronovost, Peter J; Shahian, David M; Safran, Dana Gelb; Bilimoria, Karl Y; Elliott, Marc N; Damberg, Cheryl L; Dimick, Justin B; Zaslavsky, Alan M


    On July 14, 2015, ProPublica published its Surgeon Scorecard, which displays "Adjusted Complication Rates" for individual, named surgeons for eight surgical procedures performed in hospitals. Public reports of provider performance have the potential to improve the quality of health care that patients receive. A valid performance report can drive quality improvement and usefully inform patients' choices of providers. However, performance reports with poor validity and reliability are potentially damaging to all involved. This article critiques the methods underlying the Scorecard and identifies opportunities for improvement. Until these opportunities are addressed, the authors advise users of the Scorecard-most notably, patients who might be choosing their surgeons-not to consider the Scorecard a valid or reliable predictor of the health outcomes any individual surgeon is likely to provide. The authors hope that this methodological critique will contribute to the development of more-valid and more-reliable performance reports in the future.

  13. [Andreas Vesalius, distinguished surgeon of the 16th century]. (United States)

    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.

  14. The surgeon and self-harm: at the cutting edge. (United States)

    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.

  15. Surgeons' Emotional Experience of Their Everyday Practice - A Qualitative Study.

    Directory of Open Access Journals (Sweden)

    Massimiliano Orri

    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.

  16. How Should Canadian Literature Be Taught? (United States)

    Colborne, Garnet


    Discusses the rationale for and several approaches to teaching Canadian literature, including a cultural and regional approach to Canadian literature, a comparative approach, and a language study approach. (HTH)

  17. Depth Perception of Surgeons in Minimally Invasive Surgery. (United States)

    Bogdanova, Rositsa; Boulanger, Pierre; Zheng, Bin


    Minimally invasive surgery (MIS) poses visual challenges to the surgeons. In MIS, binocular disparity is not freely available for surgeons, who are required to mentally rebuild the 3-dimensional (3D) patient anatomy from a limited number of monoscopic visual cues. The insufficient depth cues from the MIS environment could cause surgeons to misjudge spatial depth, which could lead to performance errors thus jeopardizing patient safety. In this article, we will first discuss the natural human depth perception by exploring the main depth cues available for surgeons in open procedures. Subsequently, we will reveal what depth cues are lost in MIS and how surgeons compensate for the incomplete depth presentation. Next, we will further expand our knowledge by exploring some of the available solutions for improving depth presentation to surgeons. Here we will review the innovative approaches (multiple 2D camera assembly, shadow introduction) and devices (3D monitors, head-mounted devices, and auto-stereoscopic monitors) for 3D image presentation from the past few years.

  18. A change in opinion on surgeon's performance indicators. (United States)

    Maytham, Gary; Kessaris, Nicos


    Individual performance indicators for cardiac surgeons in the UK were published in 2004. A comprehensive update published in 2009 reported statistically significant decreases in mortality rates suggesting that the publication of this data may have contributed to this improvement in outcomes. In view of this, the authors present an assessment of the attitudes of cardiac surgeons to individual performance tables, having performed this by sending questionnaires exploring the surgeon's views on performance tables to UK cardiac surgeons in 2005 and 2009. The responses demonstrated that whilst the majority of cardiac surgeons (68.8%) were initially opposed to performance tables, the number welcoming their introduction increased significantly (22.9-48.5%) over the four-year period. The attitude of the consultants towards the possible effect of this data on the management of high-risk patients also changed, with fewer consultants believing they would (P=0.0001) or may (P=0.023) avoid these patients. The observed change in attitude of cardiac surgeons may be due to acclimatization to an established system of audit, improved mortality rates, a desire for more transparency following the Bristol Enquiry, or improved risk stratification. These findings may be of benefit to those tasked with initiating these indicators elsewhere.

  19. Radiographic workload and use factors for orthopedic facilities

    Energy Technology Data Exchange (ETDEWEB)

    Bushong, S.C.; Glaze, S.A.


    Observations of technique factors at 9 radiographic installations dedicated to orthopedic radiography have been made. Monthly area radiation measurements with thermoluminescent dosimeters were made at three of these facilities. The results of these observations and measurements suggest that current NCRP recommended assumptions utilized in protective barrier computations result in considerably more shielding than is necessary. We observed an average workload of 224 mA min/wk and a maximum weekly average of 670 mA min/wk. The use factor for the chest wall averaged 5%. That for all other vertical barriers was less than 1%. The average operating potential was 75 kVp. Room radiation measurements confirm the suggestion that at least two of the walls and the control booth barrier in an orthopedic radiographic facility may be considered secondary barriers.

  20. Potential utility of liposome bupivacaine in orthopedic surgery. (United States)

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


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

  1. Responsible Canadian energy progress report

    Energy Technology Data Exchange (ETDEWEB)



    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.

  2. Birth of the Canadian Digestive Health Foundation


    Beck, Ivan T.


    The Canadian Digestive Disease Foundation, renamed the Canadian Digestive Health Foundation -- Fondation canadienne pour la promotion de la santé digestive -- in December 2001, is the culmination of ongoing efforts by the Canadian Association of Gastroenterology to establish an independent charitable organization. In February 2001, it was officially endorsed as the Foundation for the Canadian Association of Gastroenterology. The initial efforts to establish this Foundation, led by Dr Richa...

  3. Venous thromboembolism in 13 Indonesian patients undergoing major orthopedic surgery

    Directory of Open Access Journals (Sweden)

    Karmel L. Tambunan


    Full Text Available Aim: To estimate the incidence of VTE in Indonesian patients undergoing major orthopedic surgery and not receiving thromboprophylaxis.Methods: This was an open clinical study of consecutive Indonesian patients undergoing major orthopedic surgery, conducted in 3 centers in Jakarta. Bilateral venography was performed between days 5 and 8 after surgery to detect the asymptomatic and to confi rm the symptomatic VTE. These patients were followed up to one month after surgery.Results: A total of 17 eligible patients were studied, which a median age of 69 years and 76.5% were females. Sixteen out of the 17 patients (94.1% underwent hip fracture surgery (HFS. The median time from injury to surgery was 23 days (range 2 to 197 days, the median duration of surgery was 90 minutes (range 60 to 255 minutes, and the median duration of immobilization was 3 days (range 1 to 44 days. Thirteen out of the 17 patients were willing to undergo contrast venography. A symptomatic VTE was found in 9 patients (69.2% at hospital discharge. Symptomatic VTE was found in 3 patients (23.1%, all corresponding to clinical signs of DVT and none with clinical sign of PE. These patients were treated initially with a low molecular weight heparin, followed by warfarin. Sudden death did not occur up to hospital discharge. From hospital discharge until 1-month follow-up, there were no additional cases of symptomatic VTE. No sudden death, bleeding complication, nor re-hospitalization was found in the present study.Conclusion: The incidence of asymptomatic (69.2% and symptomatic (23.1% VTE after major orthopedic surgery without thromboprophylaxis in Indonesian patients (SMART and AIDA, and still higher than the results of the Western studies. A larger study is required to establish the true incidence, and more importantly, that the use of thromboprophylaxis in these patients is warranted. (Med J Indones 2009; 18: 249-56Keywords: venous thromboembolism (VTE, orthopedic surgery, Indonesia

  4. Features of Teaching Maxillofacial Orthopedics to Foreign Students



    This article highlights features of the teaching Maxillofacial Orthopedics to foreign students. Prosthetic dentistry consists of general and specialized courses. The anatomical and physiological features of the masticatory apparatus, general and special methods of diagnostics, symptoms and semiotics of the disease, dental materials science, laboratory and prosthetic appliances are taught in general course. A specialized course consists of three main sections – dental prosthetics, maxillofacia...

  5. Brazilian Board of Orthodontics and Facial Orthopedics: certifying excellence


    Lima Filho,Roberto M. A.; VogelI, Carlos Jorge; Zen,Estélio; Bolognese,Ana Maria; Mucha,José Nelson; Araújo,Telma Martins de


    p. 148-157 The Brazilian Board of Orthodontics and Facial Orthopedics (BBO) is the institution that certifies the standards of clinical excellence in the practice of this specialty. This article describes the history of BBO's creation and the examination structure and phases to obtain the BBO Certification. It also presents a detailed report of the first exam applied in Brazil. Its purpose is to expand the knowledge, among professionals in the area, about the importance of BBO Certificatio...

  6. Preventing infection in general surgery: improvements through education of surgeons by surgeons.

    LENUS (Irish Health Repository)

    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.

  7. Motivado por cirujanos Motivated by Surgeons

    Directory of Open Access Journals (Sweden)

    Carlos Salazar-Vargas


    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....

  8. Quality of Life of Indian Pediatric Surgeons: Results of a Survey (of Indian Association of Pediatric Surgeons Members) (United States)

    Zameer, M. M.; Rao, Sanjay; Vinay, C.; D’Cruz, Ashley


    Introduction: Much is debated on the quality of life of pediatric surgeons practicing in India, all based on anecdotal and personal experiences. There is no systematic study on this. This study addresses this and attempts to glean a clearer picture of the life as a pediatric surgeon in India. Methodology: This questionnaire-based study was administered via an online survey to all Indian Association of Pediatric Surgeons members. The responses were anonymous and investigators blinded. Data were collated and analyzed using STAT11.1. Results: A total of 173 pediatric surgeons responded. Eighty-six percent were men. About 73.7% of the surgeons were between 31 and 50 years of age. Almost 63.4% practiced in urban areas, whereas 36% in other smaller towns. About 0.6% reported that their practice was rural. Almost 26.4% were in private/solo practices, whereas 53.4% were in institution-based practice. Almost 80% felt that they were adequately trained while starting their practice. About 78% are professionally satisfied with their work. Only 44.5% of surgeons felt that they were compensated adequately financially. Reading was the favorite pass time. Almost 40% of the surgeons felt that they were either overweight or obese. About 41% of the surgeons exercise more than 3 times a week. Only 11.4% smoke, whereas 36% drink. Fifty-three percent of surgeons felt that their personal savings were adequate. Seventy-six percent use Facebook. Sixty-eight percent were satisfied with their quality of life. Age was significantly associated with professional satisfaction, financial satisfaction, and quality of life and all improve as one's age progresses. None were affected with one's gender, type of practice, and the place of practice. Age, weight, exercise, and one's savings significantly affected ones quality of life. Conclusion: This is the first study which objectively highlights that most surgeons are happy professionally and financially in due course of time and demolishes the common

  9. Experience with Emergency Ultrasound Training by Canadian Emergency Medicine Residents

    Directory of Open Access Journals (Sweden)

    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.

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

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    Philip McClure


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


    Directory of Open Access Journals (Sweden)

    Milan Zdravković


    Full Text Available Efficiency and effectiveness of orthopedic surgery can be achieved by enabling proper decision-making in a shortest period of time, based on complete and updated information on the status, type of fracture and fixators used for a particular fracture. In this way, the risk of possible complications caused by a late intervention can be reduced. In such circumstances, there exist critical needs for an effective and efficient knowledge management approach where different domain models are combined and formally interrelated, so that the decisions are based on the consistent and complete information. In this paper, ontologies are used to propose a framework for implementing such an approach in the domain of orthopedic surgery. The framework combines formal models of the generic products and supply chains for their manufacturing and delivery, anatomical elements, e.g. bones, types of their fractures and fixators – the medical products which are used in the fracture treatments. Then the possible uses of this framework for the purpose of knowledge management in orthopedic surgery are discussed in the context of the assumptions of development of Next Generation Enterprise Information Systems.

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

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    Mazaheri M


    Full Text Available Mozhdeh Mazaheri,1,* Niloofar Eslahi,1,* Farideh Ordikhani,1,* Elnaz Tamjid,2 Abdolreza Simchi1,3 1Department of Materials Science and Engineering, Sharif University of Technology, 2Department of Nanobiotechnology, Faculty of Biological Sciences, Tarbiat Modares University, 3Institute for Nanoscience and Nanotechnology, Sharif University of Technology, Tehran, Iran *These authors contributed equally to this work Abstract: The technological and clinical need for orthopedic replacement materials has led to significant advances in the field of nanomedicine, which embraces the breadth of nanotechnology from pharmacological agents and surface modification through to regulation and toxicology. A variety of nanostructures with unique chemical, physical, and biological properties have been engineered to improve the functionality and reliability of implantable medical devices. However, mimicking living bone tissue is still a challenge. The scope of this review is to highlight the most recent accomplishments and trends in designing nanomaterials and their applications in orthopedics with an outline on future directions and challenges. Keywords: orthopedics, nanomedicine, tissue engineering, implantable materials, nanotoxicology

  13. A Topography for Canadian Curriculum Theory. (United States)

    Chambers, Cynthia


    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…

  14. Canadian Children's Literature: An Alberta Survey (United States)

    Bainbridge, Joyce; Carbonaro, Mike; Green, Nicole


    This article presents the findings of an online survey administered to Alberta elementary school teachers in 2000-2001. The survey explored the teachers' knowledge and use of Canadian children's literature and their thoughts about the role of Canadian literature in elementary school classrooms. Canadian children's trade books espouse particular…

  15. The Ideological Orientations of Canadian University Professors (United States)

    Nakhaie, M. Reza; Brym, Robert J.


    This paper analyzes the ideological orientations of Canadian university professors based on a unique 2000 study of a representative sample of Canadian academics (n=3,318). After summarizing methodological problems with extant research on this subject, and tentatively comparing the political views of Canadian and American academics, the paper…

  16. Transnational archives: the Canadian case

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    Julia Creet


    Full Text Available This paper is a brief overview of the concept of the transnational archive as a counterpoint to the idea that a national archive is necessarily a locus of a static idea of nation. The Canadian national archives is used as a case study of an archives that was transnational in its inception, and one that has continued to change in its mandate and materials as a response to patterns in migration and changing notions of multiculturalism as a Canadian federal policy. It introduces the most recent formation of the transnational archive and its denizens: the genealogical archive inhabited by family historians.

  17. Are shoulder surgeons any good at diagnosing rotator cuff tears using ultrasound?: A comparative analysis of surgeon vs radiologist

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    Jeyam Muthu


    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.

  18. Orthopedic surgeons’ and neurologists’ attitudes towards second opinions in the Israeli healthcare system: a qualitative study

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    Greenfield Geva


    Full Text Available Abstract Background Second opinion is a treatment ratification tool that may critically influence diagnosis, treatment, and prognosis. Second opinions constitute one of the largest expenditures of the supplementary health insurance programs provided by the Israeli health funds. The scarcity of data on physicians’ attitudes toward second opinion motivated this study to explore those attitudes within the Israeli healthcare system. Methods We interviewed 35 orthopedic surgeons and neurologists in Israel and qualitatively analyzed the data using the Grounded Theory approach. Results As a common tool, second opinion reflects the broader context of the Israeli healthcare system, specifically tensions associated with health inequalities. We identified four issues: (1 inequalities between central and peripheral regions of Israel; (2 inequalities between private and public settings; (3 implementation gap between the right to a second opinion and whether it is covered by the National Health Insurance Law; and (4 tension between the authorities of physicians and religious leaders. The physicians mentioned that better mechanisms should be implemented for guiding patients to an appropriate consultant for a second opinion and for making an informed choice between the two opinions. Conclusions While all the physicians agreed on the importance of the second opinion as a tool, they raised concerns about the way it is provided and utilized. To be optimally implemented, second opinion should be institutionalized and regulated. The National Health Insurance Law should strive to provide the mechanisms to access second opinion as stipulated in the Patient’s Rights Law. Further studies are needed to assess the patients' perspectives.

  19. A remembrance of Victoria and the Canadian Army Medical Corps in the Great War. (United States)

    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.

  20. Musculoskeletal disorders among robotic surgeons: A questionnaire analysis

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    Claudio Giberti


    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.

  1. Canadian contributions studies for the WFIRST instruments (United States)

    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.

  2. The 1998 Canadian Contraception Study. (United States)

    Fisher, William A.; Boroditsky, Richard; Bridges, Martha L.


    Describes the 1998 Canadian Contraception Study, a mailed survey which asked women about contraceptive practices past, present, and future (including use of oral contraceptives, condoms, and sterilization); familiarity with and opinion about different contraception methods; and general sexual and reproductive health. The paper also examines…

  3. Universal values of Canadian astronauts (United States)

    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.

  4. Canadian Government Electronic Information Policy. (United States)

    Nilsen, Kirsti


    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…

  5. Canadian Literature in American Libraries (United States)

    Rogers, A. Robert


    Acquisition of Canadian literature by American libraries was investigated in three ways: questionnaires were sent to selected large libraries, titles were checked against the National Union Catalog'' and published literature describing major collections was examined. With the exception of the Library of Congress, American libraries purchase…

  6. Treating Wisely: The Surgeon's Role in Antibiotic Stewardship. (United States)

    Leeds, Ira L; Fabrizio, Anne; Cosgrove, Sara E; Wick, Elizabeth C


    Antibiotic resistance continues to receive national attention as a leading public health threat. In 2015, President Barack Obama proposed a National Action Plan to Combat Antibiotic-Resistant Bacteria to curb the rise of "superbugs," bacteria resistant to antibiotics of last resort. Whereas many antibiotics are prescribed appropriately to treat infections, there continue to be a large number of inappropriately prescribed antibiotics. Although much of the national attention with regards to stewardship has focused on primary care providers, there is a significant opportunity for surgeons to embrace this national imperative and improve our practices. Local quality improvement efforts suggest that antibiotic misuse for surgical disease is common. Opportunities exist as part of day-to-day surgical care as well as through surgeons' interactions with nonsurgeon colleagues and policy experts. This article discusses the scope of the antibiotic misuse in surgery for surgical patients, and provides immediate practice improvements and also advocacy efforts surgeons can take to address the threat. We believe that surgical antibiotic prescribing patterns frequently do not adhere to evidence-based practices; surgeons are in a position to mitigate their ill effects; and antibiotic stewardship should be a part of every surgeons' practice.

  7. Musculoskeletal pain among surgeons performing minimally invasive surgery

    DEFF Research Database (Denmark)

    Dalager, Tina; Søgaard, Karen; Bech, Katrine Tholstrup


    BACKGROUND: Musculoskeletal pain is the most common occupational disease in Europe. Surgeons with awkward and static working postures are no exception. Robotic-assisted laparoscopy has been postulated to be superior to conventional laparoscopy regarding the ergonomic strain for surgeons. In this ......BACKGROUND: Musculoskeletal pain is the most common occupational disease in Europe. Surgeons with awkward and static working postures are no exception. Robotic-assisted laparoscopy has been postulated to be superior to conventional laparoscopy regarding the ergonomic strain for surgeons......, 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...

  8. The Effect of Surgeon Empathy and Emotional Intelligence on Patient Satisfaction (United States)

    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.…

  9. Modulating Wnt Signaling Pathway to Enhance Allograft Integration in Orthopedic Trauma Treatment (United States)


    TITLE: Modulating Wnt Signaling Pathway to Enhance Allograft Integration in Orthopedic Trauma Treatment PRINCIPAL INVESTIGATOR: Amarjit S...Integration in Orthopedic Trauma Treatment 5b. GRANT NUMBER W81XWH-10-1-1054 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) Amarjit S. Virdi, PhD...practical means of enhancing repair of large bone defects in orthopedic trauma and can be translated into clinical practice in the near future. Figures

  10. Simulation-based education and performance assessments for pediatric surgeons. (United States)

    Barsness, Katherine


    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.

  11. [How much business management does a surgeon need?]. (United States)

    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.

  12. Reporting sharp injuries among Surgeons in Zagazig University Hospitals, Egypt

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    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

  13. Cosmetic surgery in times of recession: macroeconomics for plastic surgeons. (United States)

    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.

  14. Genitourinary Prosthetics: A Primer for the Non-urologic Surgeon. (United States)

    Lavien, Garjae; Zaid, Uwais; Peterson, Andrew C


    Genitourinary prosthetics are used for correction of functional deficits and to improve the quality of lives of affected patients. General surgeons must evaluate patients scheduled for nonurologic surgery with urologic devices that can impact their perioperative management. Lack of recognition of these prosthetics preoperatively can lead to unnecessary morbidity for the patient and have legal implications for the surgeon. Close consultation with a urologist may avoid common complications associated with these devices and allows for surgical assistance when operative misadventures do occur. This article reviews 3 common urologic prosthetics: testicular prosthesis, artificial urinary sphincter, and penile prosthesis.

  15. Patient-specific hip prostheses designed by surgeons

    Directory of Open Access Journals (Sweden)

    Coigny Florian


    Full Text Available Patient-specific bone and joint replacement implants lead to better functional and aesthetic results than conventional methods [1], [2], [3]. But extracting 3D shape information from CT Data and designing individual implants is demanding and requires multiple surgeon-to-engineer interactions. For manufacturing purposes, Additive Manufacturing offers various advantages, especially for low volume manufacturing parts, such as patient specific implants. To ease these new approaches and to avoid surgeon-to-engineer interactions a new design software approach is needed which offers highly automated and user friendly planning steps.

  16. E-learning in orthopedic surgery training: A systematic review. (United States)

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


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

  17. Surface evaluation of orthopedic hip implants marketed in Brazil (United States)

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


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

  18. Validity of subjective smoking status in orthopedic patients

    Directory of Open Access Journals (Sweden)

    Bender D


    Full Text Available Daniel Bender,* Patrick Haubruck,* Sonja Boxriker, Sebastian Korff, Gerhard Schmidmaier, Arash Moghaddam Trauma and Reconstructive Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Heidelberg, Germany *These authors contributed equally to this work Purpose: In this level 1 diagnostic study, we analyzed the validity of subjective smoking status and, as secondary research question, the smoking cessation adherence in orthopedic patients during a routine hospital stay of nonunion patients by measuring serum cotinine.  Methods: We included patients undergoing revision surgery due to nonunion of long bones. Patients were interviewed about their smoking status. Blood samples were taken from all the patients prior to surgery and for an additional 6 weeks following surgery. Serum levels of cotinine were measured, and coherence between subjective smoking status and objective cotinine analysis was evaluated.  Results: Between March 2012 and August 2014, we enrolled 136 patients. Six of the 26 “previous smokers” (23% and four of the 65 “nonsmokers” (6% had serum cotinine above cutoff levels. In self-labeled smokers, serum cotinine levels averaged at 2,367.4±14,885.9 ng/mL (with a median of 100 ng/mL, whereas in previous smokers the levels averaged at 4,270±19,619.4 ng/mL (with a median of 0 ng/mL and in the nonsmokers group the levels averaged at 12±53.9 ng/mL (with a median of 0.03 ng/mL. Overall, the subjective smoking status matched serum cotinine testing in 88% of the cases. Sensitivity was 79.6% and specificity was 93.1%. Ninety-one percent of the patients with preoperative positive serum values were still positive at follow-up.  Conclusion: In this study, we could show that subjective smoking status in orthopedic patients is predominantly reliable as validated by objective cotinine measurements; however, patients who declare themselves as “previous smokers” are at elevated risk

  19. A new robot-assisted orthopedic surgery simulation system

    Institute of Scientific and Technical Information of China (English)

    WU Dong-mei; DU Zhi-jiang; JIA Zhi-heng; YANG Donghai; SUN Li-ning


    The paper proposes a novel desktop virtual surgical simulation system capable of not only surgical training but also operative planning, surgery rehearsal and telesurgery, which is mainly used on the robot-assisted orthopedic surgery system, HIT-RAOS. The paper first introduces the hardware system: HIT-RAOS. Then presents several major characters of the virtual system: developing tools, building schemes and collision detection algorithm. Additionally, virtual reality based telesurgery is implemented. Based on these works, experiments of locking of intramedullary nails are conducted, and results are content.

  20. Wear Tests of a Potential Biolubricant for Orthopedic Biopolymers


    Thompson, Martin; Hunt, Ben; Smith, Alan M.; Joyce, Thomas


    Most wear testing of orthopedic implant materials is undertaken with dilute bovine serum used as the lubricant. However, dilute bovine serum is different to the synovial fluid in which natural and artificial joints must operate. As part of a search for a lubricant which more closely resembles synovial fluid, a lubricant based on a mixture of sodium alginate and gellan gum, and which aimed to match the rheology of synovial fluid, was produced. It was employed in a wear test of ultra high mole...

  1. Canadian Content in Video Games


    Paul, Leonard


    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...

  2. Surgeon's view of the skull base from the lateral approach. (United States)

    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.

  3. Burnout syndrome in oral and maxillofacial surgeons: a critical analysis. (United States)

    Porto, G G; Carneiro, S C; Vasconcelos, B C; Nascimento, M M; Leal, J L F


    The aim of this study was to determine the prevalence of burnout syndrome among Brazilian oral and maxillofacial surgeons and its relationship with socio-demographic, clinical, and habit variables. The sample of this study comprised 116 surgeons. The syndrome was quantified using the Maslach Burnout Inventory (General Survey), which defines burnout as the triad of high emotional exhaustion, high depersonalization, and low personal accomplishment. The criteria of Grunfeld et al. were used to evaluate the presence of the syndrome (17.2%). No significant differences between the surgeons diagnosed with and without the syndrome were observed according to age (P=0.804), sex (P=0.197), marital status (P=0.238), number of children (P=0.336), years of professional experience (P=0.102), patients attended per day (P=0.735), hours worked per week (P=0.350), use of alcohol (P=0.148), sports practice (P=0.243), hobbies (P=0.161), or vacation period per year (P=0.215). Significant differences occurred in the variables sex in the emotional exhaustion subscale (P=0.002) and use or not of alcohol in the personal accomplishment subscale (P=0.035). Burnout syndrome among Brazilian surgeons is average, showing a low personal accomplishment.

  4. Body Dysmorphia, the Plastic Surgeon, and the Counselor. (United States)

    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…

  5. Optimal Brain Surgeon on Artificial Neural Networks in

    DEFF Research Database (Denmark)

    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...

  6. [Collaboration between geriatricians and orthopaedic surgeons on elderly patients]. (United States)

    Damsgaard, Else Marie; Borris, Lars; Duus, Benn; van der Mark, Susanne


    Close collaboration between geriatricians and orthopaedic surgeons on elderly patients with hip fractures reduces mortality, the number of complications, and the length of hospital stay and increases the functional abilities of the patients. In some Danish hospitals the two groups of doctors work closely together, in others there are few or no geriatricians.

  7. Leadership theory: implications for developing dental surgeons in primary care? (United States)

    Willcocks, S


    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.

  8. Ultrasound of the acute abdomen performed by surgeons in training

    DEFF Research Database (Denmark)

    Eiberg, J.P.; Grantcharov, T.P.; Eriksen, J.R.


    perform valid abdominal ultrasound examinations of patients referred with acute abdominal pain. METHODS: Patients referred with acute abdominal pain had an ultrasound examination by a surgeon in training as well as by an experienced consultant radiologist whose results served as the gold standard. All...

  9. H1N1 Message from the Acting Surgeon General

    Centers for Disease Control (CDC) Podcasts


    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.

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

    Directory of Open Access Journals (Sweden)

    Dan Assaf

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


    Directory of Open Access Journals (Sweden)

    Wilma Terezinha Anselmo Lima


    Full Text Available Objectives: To perform an extensive analysis of journals in Medicine III - CAPES, and specifically those in the areas of Otorhinolaryngology, Orthopedics and Traumatology and Chest Surgery. Method: An active search for the impact factors in the Journal Citation Reports, Scimago, their indexation in Scielo, Lilacs, Scopus and Google Scholar, and their stratification in WebQualis was done. Results: Forty-four journals with measured impact factors ranging from 3.006 to 0.128 were detected in the area of Otorhinolaryngology; however, only 26 of them (60% had a Qualis measured by CAPES; in the stratification, no journal was detected in A1, three were A2 and nine B1. Three journals were located for Chest Surgery, with only one of them having a measured Qualis (A2 with a mean of 3.61. Sixty-seven journals were detected for Orthopedics and Traumatology, with an impact factor ranging from 4.699 to 0.156; Qualis was measured in only 38 of them (60%; there were three journal stratified as A1, seven as A2 and 25 as B1. Conclusion: The search for journals of higher impact induces authors to not publish in journals related to their area and facing more difficulties than investigators from other areas.

  12. Aggregate Interview Method of ranking orthopedic applicants predicts future performance. (United States)

    Geissler, Jacqueline; VanHeest, Ann; Tatman, Penny; Gioe, Terence


    This article evaluates and describes a process of ranking orthopedic applicants using what the authors term the Aggregate Interview Method. The authors hypothesized that higher-ranking applicants using this method at their institution would perform better than those ranked lower using multiple measures of resident performance. A retrospective review of 115 orthopedic residents was performed at the authors' institution. Residents were grouped into 3 categories by matching rank numbers: 1-5, 6-14, and 15 or higher. Each rank group was compared with resident performance as measured by faculty evaluations, the Orthopaedic In-Training Examination (OITE), and American Board of Orthopaedic Surgery (ABOS) test results. Residents ranked 1-5 scored significantly better on patient care, behavior, and overall competence by faculty evaluation (Porthopedic resident candidates who scored highly on the Accreditation Council for Graduate Medical Education resident core competencies as measured by faculty evaluations, performed above the national average on the OITE, and passed the ABOS part 1 examination at rates exceeding the national average.

  13. Breed susceptibility for developmental orthopedic diseases in dogs. (United States)

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


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

  14. Contexts for Ethnic Identity of Japanese Canadians


    浦田, 葉子; Yoko, URATA


    In this paper I reviewed the literature in order to gain a broad understanding of the contexts for ethnic identity of Japanese Canadians guided by the premise that ethnic identity is a situational as well as a primordial phenomenon. Two main areas were reviewed - the pattern of distribution of resources in Canadian society and the particular situation in which Japanese Canadians are placed. In the distribution of material resources, individual meritocracy for mass and social closure for elite...

  15. Societal impacts of regenerative medicine: reflections on the views of orthopedic professionals

    NARCIS (Netherlands)

    Niemansburg, S.L.; Tempels, T.H.; Dhert, W.J.; Delden, van J.J.; Bredenoord, A.L.


    As the amount of clinical studies in orthopedic regenerative medicine (RM) is increasing, it is time to take into account its impact on society. A total of 36 biomedical professionals working at the front row of orthopedic RM were interviewed to explore their attitudes, opinions and expectations reg

  16. Age, Physical Activity, Physical Fitness, Body Composition, and Incidence of Orthopedic Problems. (United States)

    Research Quarterly for Exercise and Sport, 1989


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

  17. A qualitative and quantitative needs assessment of pain management for hospitalized orthopedic patients. (United States)

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


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

  18. Orthopedic Surgery Resident Debt Load and Its Effect on Career Choice. (United States)

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


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

  19. Military Curricula for Vocational & Technical Education. Orthopedic Specialist, Classroom Course 10-13. (United States)

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

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

  20. Societal impacts of regenerative medicine : reflections on the views of orthopedic professionals

    NARCIS (Netherlands)

    Niemansburg, Sophie L.; Tempels, Tjidde H.; Dhert, Wouter J. A.; van Delden, Johannes J. M.; Bredenoord, Annelien L.


    As the amount of clinical studies in orthopedic regenerative medicine (RM) is increasing, it is time to take into account its impact on society. A total of 36 biomedical professionals working at the front row of orthopedic RM were interviewed to explore their attitudes, opinions and expectations reg

  1. The Orthopedically Disabled Child: Psychological Implications with an Individual Basis. July 1984 Revision. (United States)

    Sigmon, Scott B.

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

  2. Value of radiographic examination of the knee joint for the orthopedic surgeon; Wertigkeit der radiologischen Bildgebung beim Kniegelenk fuer den Orthopaeden

    Energy Technology Data Exchange (ETDEWEB)

    Pietsch, M.; Hofmann, S. [Allgemeines und Orthopaedisches LKH Stolzalpe (Austria). Abteilung fuer Orthopaedie und orthopaedische Chirurgie


    Extended radiographic examinations offer excellent options for diagnosis and strategy for treatment of the knee joint. The whole-leg radiograph is indispensable in measuring alignment for osteotomy or total knee arthroplasty (TKA). Fluoroscopically assisted varus-valgus stress radiographs provide the possibility for verifying mechanical function of the implanted knee prosthesis. Ultrasound examinations have been widely replaced by magnetic resonance imaging (MRI). MRI is the golden standard to examine intra-articular structures of the knee (meniscus, ligaments, cartilage) and surrounding soft tissue. For evaluating femoral and tibial torsion and determining axial rotation of TKA, computed tomography (CT) is best qualified. Imaging of the patellofemoral joint (patella instability) is difficult; CT scans in combination with true lateral radiographs seem to be helpful. (orig.) [German] Die erweiterte Roentgendiagnostik bietet gute Moeglichkeiten der Diagnose und Therapieplanung beim Kniegelenk. Das Ganzbeinroentgen ist unabdingbar zur Achsvermessung bei der Planung einer Umstellungsosteotomie oder der Implantation einer Knietotalendoprothese (KTEP). Varus-/Valgusaufnahmen unter Bildwandler gestatten die Ueberpruefung der Mechanik einer liegenden KTEP. Sonographische Untersuchungen des Kniegelenks sind weitgehend durch die Magnetresonanztomographie (MRT) ersetzt. Die MRT ist die Methode der Wahl zur Beurteilung der Kniebinnenstrukturen (Meniskus, Baender, Knorpel) und der umgebenden Weichteile. Zur Bestimmung der Torsion von Femur und Tibia sowie der Rotation der Komponenten einer KTEP ist die Computertomographie (CT) am besten geeignet. Die Beurteilung des Femorpatellargelenks (Patellainstabilitaet) ist schwierig, am vielversprechendsten erscheint die CT in Kombination mit streng seitlichen Roentgenbildern. (orig.)

  3. Effect of surgeon experience on femoral component size selection during total knee arthroplasty. (United States)

    Nandi, Sumon; Bono, James V; Froimson, Mark; Jones, Morgan; Bershadsky, Boris


    Femoral component size selection during total knee arthroplasty should not vary from surgeon to surgeon for patients with the same bone size. This study explored if systematic variations in femoral component size selection exist. Thirteen surgeons' choices of femoral component size (Duracon, n = 1388; Triathlon, n = 740) were analyzed using a generalized linear model with femoral component size as the dependent variable and surgeon identification, years in practice, and adult reconstruction fellowship training as the independent variables. The model adjusted for differences in bone size. It was found that more experienced surgeons implant larger femoral components. New instruments and training protocols may be necessary to adjust for surgeon experience.

  4. Postoperative use of analgesics in dogs and cats by Canadian veterinarians. (United States)

    Dohoo, S E; Dohoo, I R


    Four hundred and seventeen Canadian veterinarians were surveyed to determine their postoperative use of analgesics in dogs and cats following 6 surgical procedures, and to determine their opinions toward pain perception and perceived complications associated with the postoperative use of potent opioid analgesics. Three hundred and seventeen (76%) returned the questionnaire. The percentage of animals receiving analgesics postoperatively ranged from 84% of dogs and 70% of cats following orthopedic surgery to 10% of dogs and 9% of cats following castration. In general, with the exception of orthopedic surgery, roughly equal percentages of dogs and cats received postoperative analgesics. Opioids were used almost exclusively to provide postoperative analgesia, with butorphanol the most commonly administered drug to both dogs and cats. Analgesics were usually administered either once or twice postoperatively. With regard to the administration of potent opioid agonists, the 3 major concerns included respiratory depression, bradycardia, and sedation in dogs, and excitement, respiratory depression, and bradycardia in cats. Seventy-seven percent of veterinarians considered their knowledge of issues related to the recognition and control of postoperative pain to be inadequate. Experience in practice is currently the major source of knowledge, with undergraduate veterinary school and research articles in journals ranked as the least important sources. Lectures or seminars delivered at the regional level were the preferred format for continuing education.

  5. A Cross-Sectional Study to Compare Caregiver Distress Among Korean Canadian, Chinese Canadian, and Other Canadian Home Care Clients

    Directory of Open Access Journals (Sweden)

    Byung Wook Chang


    Full Text Available This study examines the health of elderly Korean Canadians in home care and investigates the risk factors for caregiver distress of families caring for their elderly relatives. Korean Canadians, Chinese Canadians, and other Canadian home care clients were compared using the Resident Assessment Instrument–Home Care (RAI-HC. The assessments were done as a part of normal clinical practice between January 2002 and December 2010 within Ontario. A sample of 58,557 home care clients was analyzed using descriptive statistics and chi-square analysis at the bivariate level and multiple logistic regression models. The major finding of the present study is that Korean clients had higher physical impairments and higher prevalence of major chronic diseases, but they were less likely to receive personal support or nursing services. Moreover, the results provide clear evidence of the importance of language barriers for all linguistic minorities, including Korean Canadians.

  6. Regulatory perspective on characterization and testing of orthopedic bone cements. (United States)

    Demian, H W; McDermott, K


    This paper provides a general regulatory background of acrylic bone cements, chemical composition information on several commercially available bone cements, physical and chemical methods of analyses, mechanical test methods, and risks and failure mechanisms of acrylic bone cements. Suggestions and recommendations presented in Tables 2 and 3 are not mandatory requirements but reflect data and methodologies which the FDA's Orthopedic Devices Branch (ORDB) believes to be acceptable to evaluate most pre-clinical data. FDA may require information in addition to that contained in this paper. In some instances, a sponsor may be able to sufficiently justify the omission of some tests. Although this paper describes certain administrative requirements, it does not take the place of the requirements contained in Title 21 of the Code of Federal Regulations (21 CFR) Parts 801, 807, 812, and 814 or those found in the statute.

  7. Gallium-containing hydroxyapatite for potential use in orthopedics

    Energy Technology Data Exchange (ETDEWEB)

    Melnikov, P., E-mail: [Department of Clinical Surgery, Faculty of Medicine, Federal University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul (Brazil); Teixeira, A.R.; Malzac, A. [Department of Clinical Surgery, Faculty of Medicine, Federal University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul (Brazil); Coelho, M. de B. [Brazilian Agricultural Research Corporation - EMBRAPA (Brazil)


    A novel material that may be recommended for grafts and implants stimulating bone growth has been obtained by introducing gallium ions (up to 11.0 mass%) into crystalline lattice of hydroxyapatite. The doping was carried out using gallium nitrate and sodium gallate solutions. In both cases, lattice parameters of gallium-doped hydroxyapatite are identical to those of pure synthetic hydroxyapatite. Gallium does not replace calcium as a result of heterovalent substitution and consequently produces no distortions in the framework of hydroxyapatite matrix. It remains strongly fixed in the form of solid solution of intercalation. According to scanning electron microscopy images gallium insertion does not cause any morphological alterations in hydroxyapatite structure and the product developed meets physico-chemical criteria for biomaterial to be employed in orthopedic practice and local handling of traumatic injuries. Its future usage opens the opportunity to enhance osteosynthesis and calcium retention in loco.

  8. Medication Review and Patient Outcomes in an Orthopedic Department

    DEFF Research Database (Denmark)

    Lisby, Marianne; Bonnerup, Dorthe Krogsgaard; Brock, Birgitte


    OBJECTIVE: We investigated the health-related effect of systematic medication review performed by a clinical pharmacist and a clinical pharmacologist on nonelective elderly orthopedic patients. METHODS: This is a nonblinded randomized controlled study of 108 patients 65 years or older treated...... with at least 4 drugs. For the intervention, the clinical pharmacist reviewed the participants' medication after completion of the usual medication routine. Information was collected from medical charts, interviews with participants, and database registrations of drug purchase. Results were conferred...... with the clinical pharmacologist, and recommendations were delivered directly to the ward physicians. The control was usual medication routine, that is, physicians prescribing admitting orders. The primary outcome was time to the first unplanned contact to a physician after discharge (i.e., general practitioner...

  9. Medication use among Canadian seniors. (United States)

    McPherson, Mark; Ji, Hong; Hunt, Jordan; Ranger, Rob; Gula, Cheryl


    As they age, many seniors develop a progressively more complex mix of health conditions. Multiple prescription medications are often required to help manage these conditions and control symptoms, with the goal of maintaining seniors' health for as long as possible. This article explores trends in the number and types of medications used by seniors on public drug programs in Canada. Our findings suggest that a high proportion of Canadian seniors are taking several medications, highlighting the need for medication management systems focusing on this population.


    Institute of Scientific and Technical Information of China (English)


    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

  11. Applications of finite element simulation in orthopedic and trauma surgery. (United States)

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


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

  12. Hydroxyapatite-nanotube composites and coatings for orthopedic applications (United States)

    Lahiri, Debrupa

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

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

    Directory of Open Access Journals (Sweden)

    Andreas Baranowski

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

  14. The Society of Thoracic Surgeons National Database 2016 Annual Report. (United States)

    Jacobs, Jeffrey P; Shahian, David M; Prager, Richard L; Edwards, Fred H; McDonald, Donna; Han, Jane M; D'Agostino, Richard S; Jacobs, Marshall L; Kozower, Benjamin D; Badhwar, Vinay; Thourani, Vinod H; Gaissert, Henning A; Fernandez, Felix G; Wright, Cameron D; Paone, Gaetano; Cleveland, Joseph C; Brennan, J Matthew; Dokholyan, Rachel S; Brothers, Leo; Vemulapalli, Sreekanth; Habib, Robert H; O'Brien, Sean M; Peterson, Eric D; Grover, Frederick L; Patterson, G Alexander; Bavaria, Joseph E


    The art and science of outcomes analysis, quality improvement, and patient safety continue to evolve, and cardiothoracic surgery leads many of these advances. The Society of Thoracic Surgeons (STS) National Database is one of the principal reasons for this leadership role, as it provides a platform for the generation of knowledge in all of these domains. Understanding these topics is a professional responsibility of all cardiothoracic surgeons. Therefore, beginning in January 2016, The Annals of Thoracic Surgery began publishing a monthly series of scholarly articles on outcomes analysis, quality improvement, and patient safety. This article provides a summary of the status of the STS National Database as of October 2016 and summarizes the articles about the STS National Database that appeared in The Annals of Thoracic Surgery 2016 series, "Outcomes Analysis, Quality Improvement, and Patient Safety."

  15. [Gastrointestinal surgeons should master the adjuvant therapy of colorectal cancer]. (United States)

    Gu, Jin; Chen, Pengju


    The diagnosis and treatment of colorectal cancer is one of the main diseases of gastrointestinal surgeons. It is very important to master the adjuvant chemotherapy of colorectal cancer for gastrointestinal surgeons. In recent years, with the development of a number of clinical trials and the appearance of new drugs, fluorouracil combined with oxaliplatin had been established as the standard regimen of adjuvant chemotherapy for colorectal cancer. In the current guidelines, stage III( colon cancer is the indication for adjuvant chemotherapy, while stage II( colon cancer should receive adjuvant chemotherapy is uncertain. Unlike colon cancer, adjuvant therapy of rectal cancer is not evidence-based. Especially, the indication and duration of adjuvant chemotherapy for rectal cancer after neoadjuvant chemoradiotherapy remain controversial. Adjuvant therapy of colorectal cancer still needs further investigation.

  16. The orthopaedic surgeon and manufacturing industry relationship. Ethical guidelines. (United States)

    Lim, E V; Aquino, N J


    Orthopaedic surgery has progressed over the years because of innovative work of pioneering orthopaedic surgeons; new developments in internal fixation techniques and implants codeveloped with the orthopaedic manufacturing industry have improved treatment greatly. This article analyzes and reviews the relationship of orthopaedic surgeons to the orthopaedic implant industry, analyzing three broad categories of the relationship: (1) physicians receiving gifts from industry; (2) the orthopaedic industry's financial support of educational and research endeavors of academic trauma and other centers; and (3) the relationship of the industry with innovators in the field of orthopaedic surgery by retainer fees, royalties, and stock options from industry. The ethical relationship requires: (1) putting the patient's concerns first above vested interests; (2) an awareness of a potential for abuse; and (3) a level of awareness of the relationship and the ability to explain and inculcate this relationship in the teaching program of young residents to maintain the high standards that have been set.

  17. Rural Canadian Youth Exposed to Physical Violence (United States)

    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…


    Directory of Open Access Journals (Sweden)



    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.

  19. A Boost for Sino-Canadian Ties

    Institute of Scientific and Technical Information of China (English)



    @@ If Canadian Prime Minister Stephen Harper's visit to China last December led to a thaw in the frozen Sino-Canadian relations in recent years, Chinese President Hu Jintao's latest trip to Ottawa appeared to usher in yet another warm period for these deep-rooted relations.

  20. Canadian Library Integrated Systems: Second Annual Survey. (United States)

    Merilees, Bobbie


    Reports the results of a survey of the Canadian integrated library systems market. The analysis includes comparisons of large versus microcomputer-based installations by type of library and across all libraries, foreign sales by Canadian vendors, and trends in the library systems market. (CLB)

  1. U.S. Surgeon General Calls for Crackdown on E-Cig Use in Teens (United States)

    ... page: U.S. Surgeon General Calls for Crackdown on E-Cig ... product among American teens, according to a new U.S. Surgeon General's report that calls for a crackdown ...

  2. Acellular Dermal Matrix in Reconstructive Breast Surgery: Survey of Current Practice among Plastic Surgeons

    Directory of Open Access Journals (Sweden)

    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.

  3. Introduction to concepts in leadership for the surgeon. (United States)

    Mrkonjic, Linda; Grondin, Sean C


    As surgeons progress through their careers, they are often entrusted with leadership roles in administration, education, research, and patient management. Insights into one's own personality type and leadership style as well as an understanding of the value of emotional intelligence are critical for success. Knowledge of group dynamics and team leading; networking; techniques in leading, changing, and innovation; as well as proficiency in negotiation and conflict resolution are also essential to the development of leadership skills.

  4. Left-handed surgical instruments - a guide for cardiac surgeons. (United States)

    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.

  5. Surgeon-Based 3D Printing for Microvascular Bone Flaps. (United States)

    Taylor, Erin M; Iorio, Matthew L


    Background Three-dimensional (3D) printing has developed as a revolutionary technology with the capacity to design accurate physical models in preoperative planning. We present our experience in surgeon-based design of 3D models, using home 3D software and printing technology for use as an adjunct in vascularized bone transfer. Methods Home 3D printing techniques were used in the design and execution of vascularized bone flap transfers to the upper extremity. Open source imaging software was used to convert preoperative computed tomography scans and create 3D models. These were printed in the surgeon's office as 3D models for the planned reconstruction. Vascularized bone flaps were designed intraoperatively based on the 3D printed models. Results Three-dimensional models were created for intraoperative use in vascularized bone flaps, including (1) medial femoral trochlea (MFT) flap for scaphoid avascular necrosis and nonunion, (2) MFT flap for lunate avascular necrosis and nonunion, (3) medial femoral condyle (MFC) flap for wrist arthrodesis, and (4) free fibula osteocutaneous flap for distal radius septic nonunion. Templates based on the 3D models allowed for the precise and rapid contouring of well-vascularized bone flaps in situ, prior to ligating the donor pedicle. Conclusions Surgeon-based 3D printing is a feasible, innovative technology that allows for the precise and rapid contouring of models that can be created in various configurations for pre- and intraoperative planning. The technology is easy to use, convenient, and highly economical as compared with traditional send-out manufacturing. Surgeon-based 3D printing is a useful adjunct in vascularized bone transfer. Level of Evidence Level IV.

  6. Team Work on Burn And Surgeon as a Team Leader

    Directory of Open Access Journals (Sweden)

    Huseyin Karagoz


    Full Text Available Burn traumas are a type of trauma that causes adverse changes in all the functions of the organism. Multi-disciplinary approaches are of great importance in the treatment of burn traumas. Among those involved in the treatment of burns are people of many branches such as surgeons, infection specialists, rehabilitation specialists, psychiatrists, and nurses. And there is a need for a single specialist in charge to coordinate the disciplines in the stage of organizing to treatment. The person to take on this task is often a surgeon specialized in burns. Research has shown that auxiliary personnel involved in burn treatment in Turkey are in need of training on up-to-date information. The surgeon in charge should actively participate in research and training activities, and train the relevant personnel through knowledge transfer so that burn treatment could remain effective in the light of current developments, which would be the fundamental way for burn centers to take their technique- and skill-based practices further. [TAF Prev Med Bull 2013; 12(1.000: 111-114

  7. Sarcoidosis in a dental surgeon: a case report

    Directory of Open Access Journals (Sweden)

    Mattia Daniele


    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.

  8. Shouldice Herniorrhaphy Technique: Surgeons Need to Remember It

    Directory of Open Access Journals (Sweden)

    Adem Dervişoğlu


    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.

  9. Project Muskan : Social responsibility of the plastic surgeon

    Directory of Open Access Journals (Sweden)

    Bhatt Yogesh


    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.

  10. Influence of podiatry on orthopedic surgery at a level I trauma center. (United States)

    Jakoi, Andre M; Old, Andrew B; O'Neill, Craig A; Stein, Benjamin E; Stander, Eric P; Rosenblatt, Joseph; Herman, Martin J


    Level I trauma centers frequently see trauma at or below the ankle, which requires consultation with the orthopedic surgery department. However, as podiatry programs begin to firmly establish themselves in more Level I trauma centers, their consultations increase, ultimately taking those once seen by orthopedic surgery. A review of the literature demonstrates that this paradigm shift has yet to be discussed. The purpose of this study was to determine how many, if any, lower extremity fracture consultations a newly developed podiatry program would take from the orthopedic surgery department. A retrospective review was performed of emergency department records from January 2007 to December 2011. Seventeen different emergency department diagnoses were used to search the database. Ultimately, each patient's emergency department course was researched. Several trends were noted. First, if trauma surgery was involved, only the orthopedic surgery department was consulted for any injuries at or below the ankle. Second, the emergency department tended to consult the podiatry program only between the hours of 8 am and 6 pm. Third, as the podiatry program became more established, their number of consultations increased yearly, and, coincidentally, the orthopedic surgery department's consultations decreased. Finally, high-energy traumas involved only the orthopedic surgery department. Whether the orthopedic surgery department or podiatry program is consulted regarding trauma surgery is likely hospital dependent.

  11. What opportunities are available for resident involvement in national orthopedic and subspecialty societies? (United States)

    Dy, Christopher J; Cross, Michael B; Osbahr, Daryl C; Parks, Michael L; Green, Daniel W


    As physician involvement in health policy grows, there will be an increasing need for future leaders in orthopedics. Interested orthopedic residents may be unaware of opportunities for leadership involvement in professional and subspecialty organizations. This article investigates whether national and subspecialty organizations offer membership to residents, allow residents to participate in committees, and provide opportunities for scholarly activity and mentorship. The authors surveyed 20 national orthopedic professional and subspecialty societies to evaluate the availability and cost of resident membership, meeting attendance and participation, research funding, committee membership, and mentorship opportunities. Each society's Web site was reviewed, and societies were contacted by phone if further inquiry was needed. Of the 20 orthopedic societies surveyed, 11 allowed resident membership. Five of 20 societies allowed residents to serve on committees, with a total of 14 total positions for residents. Four organizations provided formalized mentorship programs to residents. Although opportunities for resident involvement in subspecialty and professional societies are available in the majority of groups surveyed, the Orthopaedic Trauma Association and American Society for Surgery of the Hand provided the most comprehensive collection of opportunities. Residents should also pursue involvement in other organizations that may be more readily accessible, such as local, state, and regional orthopedic and medical societies. Increased resident participation in these organizations may help in increasing the 14 nationally available committee positions for orthopedic residents. Our orthopedic profession and societies should encourage motivated residents to pursue involvement and leadership at the national level.

  12. Laparoscopic Skills and Cognitive Function are not Affected in Surgeons During a Night Shift

    DEFF Research Database (Denmark)

    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 laparoscopi...... 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....

  13. Plastic Surgeons' Opinions of Facial Surgery for Individuals with Down Syndrome. (United States)

    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…

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


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


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

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

    Directory of Open Access Journals (Sweden)

    Vijaya Prasad Kamavaram Ellore


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

  16. Canadian vascular surgery residents' perceptions regarding future job opportunities. (United States)

    Cooper, Joel A; Dubois, Luc; Power, Adam H; DeRose, Guy; MacKenzie, Kent S; Forbes, Thomas L


    The objective was to determine the employment environment for graduates of Canadian vascular surgery training programs. A cross-sectional survey of residents and graduates (2011-2012) was used. Thirty-seven residents were invited with a response rate of 57%, and 14 graduates with a response rate of 71%; 70% of graduates felt the job market played an important role in their decision to pursue vascular surgery as a career compared to 43% of trainees. The top three concerns were the lack of surgeons retiring, the overproduction of trainees, and saturation of the job market. The majority (62%) of trainees see themselves extending their training due to lack of employment. All of the graduates obtained employment, with 50% during their second year (of two years) of training and 30% after training was completed. Graduates spent an average of 12 ± 10.6 months seeking a position and applied to 3.3 ± 1.5 positions, with a mean of 1.9 ± 1.3 interviews and 2 ± 1.2 offers. There was a discrepancy between the favorable employment climate experienced by graduates and the pessimistic outlook of trainees. We must be progressive in balancing the employment opportunities with the number of graduates. Number and timing of job offers is a possible future metric of the optimal number of residents.

  17. Social Workers' Role in the Canadian Mental Health Care System (United States)

    Towns, Ashley M.; Schwartz, Karen


    Objective: Using Canadian survey data this research provides social workers in Canada with a better understanding of their role in the Canadian mental health care system. Methods: By analyzing data from the Canadian Community Health Survey, Cycle 1.2 Mental Health and Well-being, the role of social workers in the Canadian mental health system was…

  18. Knowledge and opinions on oncoplastic surgery among breast and plastic surgeons

    DEFF Research Database (Denmark)

    Carstensen, Lena Felicia; Rose, Michael; Bentzon, Niels;


    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...... 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...

  19. Craniomaxillary orthopedic correction with en masse dental control. (United States)

    Thurow, R C


    Craniomaxillary (high-pull) traction is a well-established part of today's orthodontic armamentarium. It is useful in a wide range of problems involving excessive anterior and/or downward displacement of one or more components of the maxillary complex. Such growth-related problems are most amenable to correction during the active growing period; in fact, optimum improvement is often attainable only during this period. Attachment of these devices by means of cemented orthodontic appliances is limited in some developmental stages by the teeth available for banding. It is limited at all ages by the tolerance of the periodontal ligament of the attachment teeth. In terms of over-all maxillary change, the locations of the banded teeth further restrict the orientation and application of therapeutic forces. A rigid splint precisely engaging all or part of the upper dentition expands the potential applications of this form of traction in terms of age range, force levels, and force orientation. This is basically an orthopedic applicance with concurrent orthodontic effects. In contrast to the gross destructive effects experienced in early applications of the Milwaukee brace, the application of force with this appliance can be planned to redirect maxillary growth and occlusal relationships from often progressively dysplastic patterns to a more harmonious over-all functional relationship among all facial structures. The resultant interplay of orthopedic and orthodontic effects makes close orthodontic supervision and care essential throughout the treatment and post-treatment periods. This is especially important because some of the orthodontic side effects may be unfavorable. Failure to anticipate and plan for control of these effects could be disastrous. Occasions for its use as the sole therapeutic measure are rare. The nature of treatment with this appliance is such that in most cases it must be used as a discrete stage of a comprehensive treatment plan, either before or

  20. Reliability of videotaped observational gait analysis in patients with orthopedic impairments

    NARCIS (Netherlands)

    Brunnekreef, J.J.; Uden, C. van; Moorsel, S. van; Kooloos, J.G.M.


    BACKGROUND: In clinical practice, visual gait observation is often used to determine gait disorders and to evaluate treatment. Several reliability studies on observational gait analysis have been described in the literature and generally showed moderate reliability. However, patients with orthopedic

  1. Use of orthopedic shoes in patients with degenerative disorders of the foot

    NARCIS (Netherlands)

    Jannink, Michiel J.; IJzerman, Maarten J.; Groothuis-Oudshoorn, Karin; Stewart, Roy E.; Groothoff, Johan W.; Lankhorst, Gustaaf J.


    Objectives: To study the actual use of orthopedic shoes by patients with degenerative foot disorders and to identify factors associated with use and nonuse, based on the parameters of the International Organization for Standardization definition of usability: effectiveness, efficiency, satisfaction,

  2. High Disparity Between Orthopedic Resident Interest and Participation in International Health Electives. (United States)

    Zhang, Steven; Shultz, Paul; Daniels, Alan; Ackelman, Edward; Kamal, Robin N


    Few orthopedic surgical residency programs offer international health electives (IHEs). Efforts to expand these programs have been increasing across medical disciplines. Whether orthopedic residents will participate remains unknown. This study quantified and characterized orthopedic resident interest and barriers to IHEs in US residency programs. A web-based survey was administered to residents from 154 US orthopedic residency programs accredited by the Accreditation Council for Graduate Medical Education 2014 to 2015. Questions assessed demographics and program background, previous medical experience abroad, barriers to participation, and level of interest in participating in an international health elective during their training and beyond. Twenty-seven (17.5%) residency programs responded. Chi-square analysis showed that residents who expressed interest in participating were significantly more likely to have experience abroad compared with those who expressed no interest (Porthopedic residencies (POrthopedics. 2016; 39(4):e680-e686.].

  3. [Clinical observation of traumatic ankle arthritis with orthopedics lotion on 60 cases]. (United States)

    Zhang, Hui; Yu, Jie


    Observing the clinical curative effect of orthopedics lotion to treat traumatic ankle arthritis, the outpatient department of orthopedics in Guang'anmen Hospital collected 60 cases who were diagnosed as traumatic ankle arthritis. The cases who already met the inclusion criteria, were randomly divided into the treatment group (30 cases) and control group (30 cases). Thirty patients in treatment group were received fumigation treatment with orthopedics lotion; 30 patients in control group were treated by intra-articular injection of sodium hyaluronate. After 5 weeks treatment, the effects on the both groups would be observed and analysed. Baird-Jackson scoring system was used to assess the overall curative effect. Visual analogue scales (VAS) was used to assess analgesic effect. BJ scores of pre-treatment and post-treatment in both the treatment group and the control group were compared, P orthopedics lotion is a effective way to treat traumatic ankle arthritis, and it has significant effect on analgesic.

  4. 78 FR 17940 - Certain Computerized Orthopedic Surgical Devices, Software, Implants, and Components Thereof... (United States)


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

  5. A perspective on Canadian shale gas

    Energy Technology Data Exchange (ETDEWEB)

    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.

  6. Chinese Feelings Cherished By Canadians

    Institute of Scientific and Technical Information of China (English)


    <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


    Directory of Open Access Journals (Sweden)

    Barbara Libby


    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.

  8. Do Astronauts Havbe a Higher Rate of Orthopedic Shoulder Conditions Than a Cohort of Working Professionals (United States)

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


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

  9. Posttraumatic stress disorder: a primer for trauma surgeons. (United States)

    Roberts, Jennifer C; deRoon-Cassini, Terri A; Brasel, Karen J


    In 1980, posttraumatic stress disorder (PTSD) officially became classified as an anxiety disorder in the Diagnostic and Statistical Manual of Mental Disorders, 3rd edition. Since then, there has been increasing recognition that PTSD is a prevalent disorder that may have significant impact on the quality of life for survivors of traumatic events. More recently, methodologically sound research has begun to provide important insight into this disorder. The following review serves to provide the trauma surgeons information on PTSD in terms of its diagnosis, prevalence, risk factors, treatment strategies, and outcomes, with the goal of minimizing the sequelae of PTSD and maximizing postinjury quality of life.

  10. Improvised explosive devices and the oral and maxillofacial surgeon. (United States)

    Goksel, Tamer


    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.

  11. Global plastic surgeons images depicted in motion pictures. (United States)

    Hwang, Se Jin; Park, Sowhey; Hwang, Kun


    Motion pictures are made to entertain and enlighten people, but they are viewed differently by different people. What one considers to be a tearjerker may induce giggles in another. We have gained added interest in this because our professional pictures contain plastic surgery in their venue. We have recently reviewed 21 motion pictures that were made from 1928 to 2006 and that includes plastic surgical procedures in their content. As a habit, we tried to analyze them from a surgical point of view. About one third (35.7%) of the patients were criminals, whereas 14.3% of them were spies. One third of the procedures were done by illegitimate "surgeons," whereas a quarter of the procedures (25%) were performed by renowned surgeons. Surgeons who were in love with the patients did the rest (25%) of the operations. The complication rate was 14.3%; the surgery was successful in 85.7% of cases, but were the patients happy with the results? This was not the case in the movies. Only 7.7% were happy; 14.5 % of them were eminently unhappy. Why the discrepancy? It is difficult to analyze the minds of the people in the film, but considering that the majority of the characters in the films were rather unsavory, one may deduce that a crooked mind functions differently. Motion pictures have advanced greatly in the past several decades with the advent of improved mechanical and electronic devices, and plastic surgery as also advanced in tandem. This surgical field has become a common procedure in our daily life. It is readily available and mostly painless. However, the public sees it in only one way, that is, that the performing physicians are highly compensated. Very few consider the efforts and the suffering that accompanies each and every surgical procedure as it is performed. Perhaps, it is too much to hope for a day that will come when we will see a film that portrays the mental anguish that accompanies each and every procedure the plastic surgeon makes.

  12. [Prophylaxis of venous thromboembolic disease in high-risk orthopedic surgery]. (United States)

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


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

  13. Greater osteoblast functions on multiwalled carbon nanotubes grown from anodized nanotubular titanium for orthopedic applications (United States)

    Sirivisoot, Sirinrath; Yao, Chang; Xiao, Xingcheng; Sheldon, Brian W.; Webster, Thomas J.


    Titanium (Ti) is the most widely implanted orthopedic material. However, current formulations of Ti have an average orthopedic implant functional lifetime of only 10-15 years. While there are many reasons why orthopedic implants fail, one is a lack of initial and sustained integration into juxtaposed bone. To improve the cytocompatibility properties of Ti for orthopedic applications, parallel multiwalled carbon nanotubes (CNTs) were grown from the pores of anodized nanotubular Ti by a chemical vapor deposition process in the present study. The results of this study provided evidence, for the first time, that osteoblast (bone forming cell) functions (specifically, alkaline phosphatase activity and calcium deposition) were significantly greater on CNTs grown from anodized Ti than on anodized Ti without CNTs and currently-used Ti in orthopedics for up to 21 days. In summary, this study showed that bone growth could possibly be enhanced on currently-used Ti implants with protruding CNTs and, thus, they should be further studied for orthopedic applications.

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

    Directory of Open Access Journals (Sweden)

    Alexander eConnaughton


    Full Text Available The use of orthopedic implants in joints has revolutionized the treatment of patients with many debilitating chronic musculoskeletal diseases such as osteoarthritis. However, the introduction of foreign material into the human body predisposes the body to infection. The treatment of these infections has become very complicated since the orthopedic implants serve as a surface for multiple species of bacteria to grow at a time into a resistant biofilm layer. This biofilm layer serves as a protectant for the bacterial colonies on the implant making them more resistant and difficult to eradicate when using standard antibiotic treatment. In some cases the use of antibiotics alone has even made the bacteria more resistant to treatment. (1-2 Thus, there has been surge in the creation of non-antibiotic anti-biofilm agents to help disrupt the biofilms on the orthopedic implants to help eliminate the infections. In this study we discuss infections of orthopedic implants in the shoulder then we review the main categories of anti-biofilm agents that have been used for the treatment of infections on orthopedic implants. Then we introduce some of the newer biofilm disrupting technology that has been studied in the past few years that may advance the treatment options for orthopedic implants in the future.

  15. Presurgical orthopedic premaxillary alignment in cleft lip and palate reconstruction. (United States)

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


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

  16. Amino acid containing glass-ionomer cement for orthopedic applications (United States)

    Wu, Wei

    Amino acid containing glass-ionomer cements were synthesized, formulated, and evaluated for orthopedic application. The formulation of different amino acid containing glass-ionomer bone cements was optimized, and conventional and resin-modified glass-ionomer bone cements were compared. Properties of interest included handling characteristics, physical and chemical properties, and mechanical strength of the bone cement. The study was based on the synthesis of different vinyl containing amino acids, different polyelectrolytes containing these amino acid residues, and different resin-modified polyelectrolytes, as well as formulation and evaluation of conventional and resin-modified glass-ionomer bone cements using these polyelectrolytes. Systematic preparation of polyelectrolytes and formulation of glass-ionomer bone cements were essential features of this work, since we anticipated that the mechanical properties of the glass-ionomer bone cements could be strongly affected by the nature of the polyelectrolytes and formulation. Mechanical properties were evaluated in a screw driven mechanical testing machine, and structure-property relationships were determined by scanning electron microscopic (SEM) observation of the fracture surface of the specimens. How the structure of polyelectrolytes, such as different amino acid residues, molecular weight, different modifying resin, and formulation of glass-ionomer bone cement, affected the mechanical properties was also studied.

  17. Bioactive, mechanically favorable, and biodegradable copolymer nanocomposites for orthopedic applications. (United States)

    Victor, Sunita Prem; Muthu, Jayabalan


    We report the synthesis of mechanically favorable, bioactive, and biodegradable copolymer nanocomposites for potential bone applications. The nanocomposites consist of in situ polymerized biodegradable copolyester with hydroxyapatite (HA). Biodegradable copolyesters comprise carboxy terminated poly(propylene fumarate) (CT-PPF) and poly(trimethylol propane fumarate co mannitol sebacate) (TF-Co-MS). Raman spectral imaging clearly reveals a uniform homogenous distribution of HA in the copolymer matrix. The mechanical studies reveal that improved mechanical properties formed when crosslinked with methyl methacrylate (MMA) when compared to N-vinyl pyrrolidone (NVP). The SEM micrographs of the copolymer nanocomposites reveal a serrated structure reflecting higher mechanical strength, good dispersion, and good interfacial bonding of HA in the polymer matrix. In vitro degradation of the copolymer crosslinked with MMA is relatively more than that of NVP and the degradation decreases with an increase in the amount of the HA filler. The mechanically favorable and degradable MMA based nanocomposites also have favorable bioactivity, blood compatibility, cytocompatibility and cell adhesion. The present nanocomposite is a more promising material for orthopedic applications.

  18. Hydroxyapatite electrodeposition on anodized titanium nanotubes for orthopedic applications (United States)

    Parcharoen, Yardnapar; Kajitvichyanukul, Puangrat; Sirivisoot, Sirinrath; Termsuksawad, Preecha


    Nanotubes modification for orthopedic implants has shown interesting biological performances (such as improving cell adhesion, cell differentiation, and enhancing osseointegration). The purpose of this study is to investigate effect of titanium dioxide (TiO2) nanotube feature on performance of hydroxyapatite-coated titanium (Ti) bone implants. TiO2 nanotubes were prepared by anodization using ammonium fluoride electrolyte (NH4F) with and without modifiers (PEG400 and Glycerol) at various potential forms, and times. After anodization, the nanotubes were subsequently annealed. TiO2 nanotubes were characterized by scanning electron microscope and X-ray diffractometer. The amorphous to anatase transformation due to annealing was observed. Smooth and highly organized TiO2 nanotubes were found when high viscous electrolyte, NH4F in glycerol, was used. Negative voltage (-4 V) during anodization was confirmed to increase nanotube thickness. Length of the TiO2 nanotubes was significantly increased by times. The TiO2 nanotube was electrodeposited with hydroxyapatite (HA) and its adhesion was estimated by adhesive tape test. The result showed that nanotubes with the tube length of 560 nm showed excellent adhesion. The coated HA were tested for biological test by live/dead cell straining. HA coated on TiO2 nanotubes showed higher cells density, higher live cells, and more spreading of MC3T3-E1 cells than that growing on titanium plate surface.

  19. The Top 100 Cited Articles in Clinical Orthopedic Sports Medicine. (United States)

    Nayar, Suresh K; Dein, Eric J; Spiker, Andrea M; Bernard, Johnathan A; Zikria, Bashir A


    Orthopedic sports medicine continues to evolve, owing much of its clinical management and practice to rigorous academic research. In this review, we identify and describe the top 100 cited articles in clinical sports medicine and recognize the authors and institutions driving the research. We collected articles (excluding basic science, animal, and cadaveric studies) from the 25 highest-impact sports medicine journals and analyzed them by number of citations, journal, publication date, institution, country, topic, and author. Mean number of citations was 408 (range, 229-1629). The articles were published in 7 journals, most in the 1980s to 2000s, and represented 15 countries. Thirty topics were addressed, with a heavy emphasis on anterior cruciate ligament injury and reconstruction, knee rating systems, rotator cuff reconstruction, and chondrocyte transplantation. The 3 most cited articles, by Insall and colleagues, Constant and Murley, and Tegner and Lysholm, addressed a knee, a shoulder, and another knee rating system, respectively. Several authors contributed multiple articles. The Hospital for Special Surgery and the University of Bern contributed the most articles (5 each). This study provides a comprehensive list of the past century's major academic contributions to sports medicine. Residents and fellows may use this list to guide their scholarly investigations.

  20. Wear Tests of a Potential Biolubricant for Orthopedic Biopolymers

    Directory of Open Access Journals (Sweden)

    Martin Thompson


    Full Text Available Most wear testing of orthopedic implant materials is undertaken with dilute bovine serum used as the lubricant. However, dilute bovine serum is different to the synovial fluid in which natural and artificial joints must operate. As part of a search for a lubricant which more closely resembles synovial fluid, a lubricant based on a mixture of sodium alginate and gellan gum, and which aimed to match the rheology of synovial fluid, was produced. It was employed in a wear test of ultra high molecular weight polyethylene pins rubbing against a metallic counterface. The test rig applied multidirectional motion to the test pins and had previously been shown to reproduce clinically relevant wear factors for ultra high molecular weight polyethylene. After 2.4 million cycles (125 km of sliding in the presence of the new lubricant, a mean wear factor of 0.099 × 10−6 mm3/Nm was measured for the ultra high molecular weight polyethylene pins. This was over an order of magnitude less than when bovine serum was used as a lubricant. In addition, there was evidence of a transfer film on the test plates. Such transfer films are not seen clinically. The search for a lubricant more closely matching synovial fluid continues.

  1. Preoperative Planning of Orthopedic Procedures using Digitalized Software Systems. (United States)

    Steinberg, Ely L; Segev, Eitan; Drexler, Michael; Ben-Tov, Tomer; Nimrod, Snir


    The progression from standard celluloid films to digitalized technology led to the development of new software programs to fulfill the needs of preoperative planning. We describe here preoperative digitalized programs and the variety of conditions for which those programs can be used to facilitate preparation for surgery. A PubMed search using the keywords "digitalized software programs," "preoperative planning" and "total joint arthroplasty" was performed for all studies regarding preoperative planning of orthopedic procedures that were published from 1989 to 2014 in English. Digitalized software programs are enabled to import and export all picture archiving communication system (PACS) files (i.e., X-rays, computerized tomograms, magnetic resonance images) from either the local working station or from any remote PACS. Two-dimension (2D) and 3D CT scans were found to be reliable tools with a high preoperative predicting accuracy for implants. The short learning curve, user-friendly features, accurate prediction of implant size, decreased implant stocks and low-cost maintenance makes digitalized software programs an attractive tool in preoperative planning of total joint replacement, fracture fixation, limb deformity repair and pediatric skeletal disorders.

  2. Canadian national nuclear forensics capability project

    Energy Technology Data Exchange (ETDEWEB)

    Ball, J.; Dimayuga, I., E-mail: [Canadian Nuclear Laboratories, Chalk River, Ontario (Canada); Summerell, I. [Royal Canadian Mounted Police, Ottawa, Ontario (Canada); Totland, M. [Canadian Nuclear Laboratories, Chalk River, Ontario (Canada); Jonkmans, G. [Defence Research and Development Canada, Ottawa, Ontario (Canada); Whitlock, J. [Canadian Nuclear Laboratories, Chalk River, Ontario (Canada); El-jaby, A. [Canadian Nuclear Safety Commission, Ottawa, Ontario (Canada); Inrig, E. [Defence Research and Development Canada, Ottawa, Ontario (Canada)


    Following the 2010 Nuclear Security Summit, Canada expanded its existing capability for nuclear forensics by establishing a national nuclear forensics laboratory network, which would include a capability to perform forensic analysis on nuclear and other radioactive material, as well as on traditional evidence contaminated with radioactive material. At the same time, the need for a national nuclear forensics library of signatures of nuclear and radioactive materials under Canadian regulatory control was recognized. The Canadian Safety and Security Program, administered by Defence Research and Development Canada's Centre for Security Science (DRDC CSS), funds science and technology initiatives to enhance Canada's preparedness for prevention of and response to potential threats. DRDC CSS, with assistance from Canadian Nuclear Laboratories, formerly Atomic Energy of Canada Limited, is leading the Canadian National Nuclear Forensics Capability Project to develop a coordinated, comprehensive, and timely national nuclear forensics capability. (author)

  3. Canadian Law Schools: In Search of Excellence. (United States)

    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)

  4. Facts about Canadian musk-oxen (United States)

    US Fish and Wildlife Service, Department of the Interior — This paper discusses the historical and current status of the Canadian musk-oxen. The musk-oxen's distribution, social structure, food and range, and breeding...

  5. Canadian Business Schools: Going out of Business? (United States)

    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)

  6. Canadian National Identity and Anti-Americanism

    Institute of Scientific and Technical Information of China (English)



    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.

  7. Canadian National Identity and Anti-Americanism

    Institute of Scientific and Technical Information of China (English)



    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.

  8. Hip resurfacing: a large, US single-surgeon series. (United States)

    Brooks, P J


    Hip resurfacing has been proposed as an alternative to traditional total hip arthroplasty in young, active patients. Much has been learned following the introduction of metal-on-metal resurfacing devices in the 1990s. The triad of a well-designed device, implanted accurately, in the correct patient has never been more critical than with these implants. Following Food and Drug Administration approval in 2006, we studied the safety and effectiveness of one hip resurfacing device (Birmingham Hip Resurfacing) at our hospital in a large, single-surgeon series. We report our early to mid-term results in 1333 cases followed for a mean of 4.3 years (2 to 5.7) using a prospective, observational registry. The mean patient age was 53.1 years (12 to 84); 70% were male and 91% had osteoarthritis. Complications were few, including no dislocations, no femoral component loosening, two femoral neck fractures (0.15%), one socket loosening (0.08%), three deep infections (0.23%), and three cases of metallosis (0.23%). There were no destructive pseudotumours. Overall survivorship at up to 5.7 years was 99.2%. Aseptic survivorship in males under the age of 50 was 100%. We believe this is the largest United States series of a single surgeon using a single resurfacing system.

  9. Imaging of bone tumors for the musculoskeletal oncologic surgeon

    Energy Technology Data Exchange (ETDEWEB)

    Errani, C., E-mail: [Department of Orthopaedic Oncology, Istituto Ortopedico Rizzoli, Bologna (Italy); Kreshak, J., E-mail: [Department of Orthopaedic Oncology, Istituto Ortopedico Rizzoli, Bologna (Italy); Department of Pathology, Istituto Ortopedico Rizzoli, Bologna (Italy); Ruggieri, P., E-mail: [Department of Orthopaedic Oncology, Istituto Ortopedico Rizzoli, Bologna (Italy); Alberghini, M., E-mail: [Department of Pathology, Istituto Ortopedico Rizzoli, Bologna (Italy); Picci, P., E-mail: [Department of Pathology, Istituto Ortopedico Rizzoli, Bologna (Italy); Department of Research, Istituto Ortopedico Rizzoli, Bologna (Italy); Vanel, D., E-mail: [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.

  10. John M. T. Finney: distinguished surgeon and Oslerphile (United States)


    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

  11. Arthur Rainsford Mowlem (1902-1986), plastic surgeon. (United States)

    Griffiths, Richard W


    Arthur Rainsford Mowlem, the junior of the 'big four' plastic surgeons, with Harold Delf Gillies, Thomas Pomfret Kilner and Archibald Hector McIndoe, came to prominence managing casualties of the Second World War. Rainsford Mowlem's ancestor was John Mowlem, the creator of the construction firm. Rainsford worked his passage to the United Kingdom from New Zealand in 1927 and did not return to New Zealand but retired at the age of 60 to enjoy 23 more years in Spain. He was the driving force between 1934 and 1939 at the Plastic Surgery Unit at St James's Hospital, Balham, and instigated the North London Plastic Surgery Unit at Hill End, St Albans, from 1939 to 1953 and subsequently developed the Unit after moving to Mount Vernon Hospital, Northwood, Middlesex. After successfully hosting the International Meeting of Plastic Surgeons in London in 1959, he received recognition and honours in America but soon afterwards he surprised colleagues by retiring in 1962. Despite his significant contributions, he did not receive national honours but his life outside surgery was active including Trusteeship of the Mowlem Estate at Swanage in Dorset for 40 years.

  12. The Affordable Care Act: a primer for plastic surgeons. (United States)

    Chen, Jenny T; Israel, Jacqueline S; Poore, Samuel O; Rao, Venkat K


    The Patient Protection and Affordable Care Act, sometimes referred to as Obamacare, was signed into law on March 23, 2010. It represents the most extensive overhaul of the country's health care system since the passage of Medicare and Medicaid in 1965. The Affordable Care Act has two goals. The first goal is to reduce the uninsured population in the United States. Key elements to covering the uninsured include the following: (1) expanding Medicaid coverage for low-income individuals and (2) establishing health insurance marketplaces for moderate-income individuals with subsidies and tax cuts in an effort to make health insurance more affordable. The second goal of the Affordable Care Act is to address concerns about quality and the overall cost of U.S. health care. It is imperative that plastic surgeons thoroughly understand the impact that the Affordable Care Act will undoubtedly have on the country, on our patients, and on our clinical practices. Plastic surgery will see many changes in the future. This will include an overall increase in the number of insured patients, a push toward joining accountable care organizations, and a shift in payment systems to bundled reimbursement for episodes of care. In this article, the authors describe how these changes are likely to occur and what plastic surgeons must do to be part of the change.

  13. Vascular injuries during gynecological laparoscopy: the vascular surgeon's advice

    Directory of Open Access Journals (Sweden)

    Marcello Barbosa Barros

    Full Text Available CONTEXT: Iatrogenic vascular problems due to laparoscopy are a well recognized problem and lead to significant repercussions. In this context, a ten-year review of cases topic is presented, based on experience gained while heading two important vascular surgery services. CASES: Five patients with vascular injuries during elective laparoscopy are described. These patients presented with seven lesions of iliac vessels. All cases were evaluated immediately and required laparotomy, provisional hemostasis and urgent attendance by a vascular surgeon. Direct suturing was performed in three cases. One aortoiliac bypass and one ilioiliac reversed venous graft were made. Venous lesions were sutured. One case of a point-like perforation of the small bowel was found. There were no deaths and no complications during the postoperative period. DISCUSSION: Important points on this subject are made, and advice is given. There needs to be immediate recognition of the vascular injury, and expert repair by a vascular surgeon is recommended, in order to significantly reduce the degree of complications.

  14. Level of billing as a function of resident documentation and orthopedic subspecialty at an academic multispecialty orthopedic surgery practice. (United States)

    Dezfuli, Bobby; Smith, Jordan L


    Documentation, coding, and billing for physician-patient encounters have evolved over time and have significant variability. Appropriate and complete documentation of these encounters can contribute to the financial viability of private and academic medical centers. The objectives of this study were to assess the financial effect of documentation on billing and to compare the authors' institution's distribution of billing level compared with Medicare normative data. Four orthopedic surgery subspecialty clinics were evaluated at a university outpatient clinic over a 1-year period. A single full-day clinic per week was used for each subspecialty. Residents dictated the majority of the reports. All reports were transcribed by medical transcriptionists and coded by certified professional coders. The sports medicine subspecialty generated the highest volume of patient clinic visits, followed by foot and ankle, trauma, and spine (Porthopedic practice (P<.01). The estimated loss of revenue from the fewer level 4 reports was $81,281.11 for 1 year. These findings highlight the need for greater educational interventions to improve provider documentation, coding, and billing. The effect of new electronic medical record systems that prompt providers to include key evaluation and management components will likely affect practices and warrant further analysis.

  15. Canadian suppliers of mining goods and services: Links between Canadian mining companies and selected sectors of the Canadian economy

    Energy Technology Data Exchange (ETDEWEB)

    Lemieux, A. [Natural Resources Canada, Ottawa, ON (Canada)


    Economic links between Canada's minerals and metals industry and Canadian suppliers of mining goods and services are examined to provide an insight into the interdependencies of these two key resource-related components of Canada's economy. The impact of globalization of the mining industry, estimates of its economic potential and the potential for exporting goods and services in conjunction with Canadian mining projects abroad are also assessed. The study concludes that the links between Canadian mining companies and the rest of the economy are difficult to quantify, due to the absence of statistical data that would differentiate supplier transactions with mining companies from those with other areas of the economy. At best, the approaches used in this study give but an imperfect understanding of the complex relationships between mining companies and their suppliers. It is clear, however, that as much of the demand for mining products is global, so is the supply, therefore, globalization of the mining industry, while creating unprecedented opportunities for Canadian suppliers to provide expertise, goods and services to Canadian and other customers offshore, the fact remains that mining multinationals buy a lot of their supplies locally. As a result, only some of the opportunities created by mining companies based in Canada and elsewhere will translate into sales for Canadian suppliers. Nevertheless, Canadian suppliers appear to have considerable depth in products related to underground mining, environment protection, exploration, feasibility studies, mineral processing, and mine automation. There appear to be considerable opportunities to derive further benefits from these areas of expertise. Appendices contain information about methodological aspects of the survey. 8 tabs., 32 figs., 6 appendices.

  16. Theorizing Gender in Contemporary Canadian Citizenship: Lessons Learned from the CBC's "Greatest Canadian" Contest (United States)

    Jubas, Kaela


    In this article, I have used the 2004 Greatest Canadian contest as an example of media's educational function. Contrary to mainstream discourse of gender-neutral citizenship, this contest reiterates a notion of Canadian citizenship as masculinized, classed, and raced. Gramsci's concepts of "hegemony," "ideology", and…

  17. Machining of a bioactive nanocomposite orthopedic fixation device. (United States)

    Sparnell, Amie; Aniket; El-Ghannam, Ahmed


    Bioactive ceramics bond to bone and enhance bone formation. However, they have poor mechanical properties which restrict their machinability as well as their application as load bearing implants. The goal of this study was to machine bioactive fixation screws using a silica-calcium phosphate nanocomposite (SCPC50). The effect of compact pressure, holding time, and thermal treatment on the microstructure, machinability, and mechanical properties of SCPC50 cylinders were investigated. Samples prepared by powder metallurgy technique at compact pressure range of 100-300 MPa and treated at 900°C/1 h scored a poor machinability rating of (1/5) due to the significant formation of amorphous silicate phase at the grain boundaries. On the other hand, lowering of compact pressure and sintering temperature to 30 MPa/3 h and 700°C/2 h, respectively, minimized the formation of the amorphous phase and raised the machinability rating to (5/5). The modulus of elasticity and ultimate strength of machinable SCPC50 were 10.8 ± 2.0 GPa and 72.8 ± 22.8 MPa, respectively, which are comparable to the corresponding values for adult human cortical bone. qRT-PCR analyses showed that bone cells attached to SCPC50 significantly upregulated osteocalcin mRNA expression as compared to the cells on Ti-6Al-4V. Moreover, cells attached to SCPC50 produced mineralized bone-like tissue within 8 days. On the other hand, cells attached to Ti-6Al-4V failed to produce bone mineral under the same experimental conditions. Results of the study suggest that machinable SCPC50 has the potential to serve as an attractive new material for orthopedic fixation devices.

  18. Hydroxyapatite electrodeposition on anodized titanium nanotubes for orthopedic applications

    Energy Technology Data Exchange (ETDEWEB)

    Parcharoen, Yardnapar [Department of Biological Engineering, Faculty of Engineering, King Mongkut' s University of Technology Thonburi, Bangkok (Thailand); Kajitvichyanukul, Puangrat [Center of Excellence on Environmental Research and Innovation, Faculty of Engineering, Naresuan University, Phitsanulok (Thailand); Sirivisoot, Sirinrath [Department of Biological Engineering, Faculty of Engineering, King Mongkut' s University of Technology Thonburi, Bangkok (Thailand); Termsuksawad, Preecha, E-mail: [Division of Materials Technology, School of Energy, Environment and Materials, King Mongkut' s University of Technology Thonburi, 126 Pracha Uthit Rd., Bang Mod, ThungKhru, Bangkok 10140 (Thailand)


    Highlights: • We found that different anodization time of titanium significantly effects on nanotube length which further impacts adhesion strength of hydroxyapatite coating layers. • Adhesion strength of Hydroxyapatite (HA) coated on titanium dioxide nanotubes is better than that of HA coated on titanium plate. • Hydroxyapatite coated on titanium dioxide nanotubes showed higher cell density and better spreading of MC3T3-E1 cells (bone-forming cells) than that coated on titanium plate surface. - Abstract: Nanotubes modification for orthopedic implants has shown interesting biological performances (such as improving cell adhesion, cell differentiation, and enhancing osseointegration). The purpose of this study is to investigate effect of titanium dioxide (TiO{sub 2}) nanotube feature on performance of hydroxyapatite-coated titanium (Ti) bone implants. TiO{sub 2} nanotubes were prepared by anodization using ammonium fluoride electrolyte (NH{sub 4}F) with and without modifiers (PEG400 and Glycerol) at various potential forms, and times. After anodization, the nanotubes were subsequently annealed. TiO{sub 2} nanotubes were characterized by scanning electron microscope and X-ray diffractometer. The amorphous to anatase transformation due to annealing was observed. Smooth and highly organized TiO{sub 2} nanotubes were found when high viscous electrolyte, NH{sub 4}F in glycerol, was used. Negative voltage (−4 V) during anodization was confirmed to increase nanotube thickness. Length of the TiO{sub 2} nanotubes was significantly increased by times. The TiO{sub 2} nanotube was electrodeposited with hydroxyapatite (HA) and its adhesion was estimated by adhesive tape test. The result showed that nanotubes with the tube length of 560 nm showed excellent adhesion. The coated HA were tested for biological test by live/dead cell straining. HA coated on TiO{sub 2} nanotubes showed higher cells density, higher live cells, and more spreading of MC3T3-E1 cells than that

  19. Chitosan for gene delivery and orthopedic tissue engineering applications. (United States)

    Raftery, Rosanne; O'Brien, Fergal J; Cryan, Sally-Ann


    Gene therapy involves the introduction of foreign genetic material into cells in order exert a therapeutic effect. The application of gene therapy to the field of orthopaedic tissue engineering is extremely promising as the controlled release of therapeutic proteins such as bone morphogenetic proteins have been shown to stimulate bone repair. However, there are a number of drawbacks associated with viral and synthetic non-viral gene delivery approaches. One natural polymer which has generated interest as a gene delivery vector is chitosan. Chitosan is biodegradable, biocompatible and non-toxic. Much of the appeal of chitosan is due to the presence of primary amine groups in its repeating units which become protonated in acidic conditions. This property makes it a promising candidate for non-viral gene delivery. Chitosan-based vectors have been shown to transfect a number of cell types including human embryonic kidney cells (HEK293) and human cervical cancer cells (HeLa). Aside from its use in gene delivery, chitosan possesses a range of properties that show promise in tissue engineering applications; it is biodegradable, biocompatible, has anti-bacterial activity, and, its cationic nature allows for electrostatic interaction with glycosaminoglycans and other proteoglycans. It can be used to make nano- and microparticles, sponges, gels, membranes and porous scaffolds. Chitosan has also been shown to enhance mineral deposition during osteogenic differentiation of MSCs in vitro. The purpose of this review is to critically discuss the use of chitosan as a gene delivery vector with emphasis on its application in orthopedic tissue engineering.

  20. The impact of patients controlled analgesia undergoing orthopedic surgery

    Directory of Open Access Journals (Sweden)

    Aluane Silva Dias


    Full Text Available ABSTRACT INTRODUCTION: The currently common musculoskeletal disorders have been increasingly treated surgically, and the pain can be a limiting factor in postoperative rehabilitation. RATIONALE: Patient controlled analgesia (PCA controls pain, but its adverse effects can interfere with rehabilitation and in the patient discharge process. This study becomes important, since there are few studies evaluating this correlation. OBJECTIVES: To compare the outcomes of patients who used and did not use patient controlled analgesia in postoperative orthopedic surgery with respect to pain, unscheduled need for O2 (oxygen, and time of immobility and in-hospital length of stay. METHODS: This is an observational, prospective study conducted at Hospital Abreu Sodré from May to August 2012. The data was daily obtained through assessments and interviews of patients undergoing total hip arthroplasty (THA and total knee arthroplasty (TKA, thoracolumbar spine arthrodesis (long PVA, cervical spine arthrodesis (cervical AVA and lumbar spine arthrodesis (lumbar PVA. RESULTS: The study showed some differences between groups, namely: the painful level was higher in the group undergoing lumbar PVA without PCA compared with the group with PCA (p = 0.03 and in the group of long PVA without PCA in the early postoperative period. This latter group used O2 for a longer time (p = 0.09. CONCLUSION: In this study, PCA was useful for analgesia in patients undergoing lumbar PVA and probably would have influenced the usage time of O2 in the group of long PVA in face of a larger sample. The use of PCA did not influence the time of leaving the bed and the in-hospital length of stay for the patients studied.

  1. Chemokines Associated with Pathologic Responses to Orthopedic Implant Debris (United States)

    Hallab, Nadim J.; Jacobs, Joshua J.


    Despite the success in returning people to health saving mobility and high quality of life, the over 1 million total joint replacements implanted in the US each year are expected to eventually fail after approximately 15–25 years of use, due to slow progressive subtle inflammation to implant debris compromising the bone implant interface. This local inflammatory pseudo disease state is primarily caused by implant debris interaction with innate immune cells, i.e., macrophages. This implant debris can also activate an adaptive immune reaction giving rise to the concept of implant-related metal sensitivity. However, a consensus of studies agree the dominant form of this response is due to innate reactivity by macrophages to implant debris danger signaling (danger-associated molecular pattern) eliciting cytokine-based and chemokine inflammatory responses. This review covers implant debris-induced release of the cytokines and chemokines due to activation of the innate (and the adaptive) immune system and how this leads to subsequent implant failure through loosening and osteolysis, i.e., what is known of central chemokines (e.g., IL-8, monocyte chemotactic protein-1, MIP-1, CCL9, CCL10, CCL17, and CCL22) associated with implant debris reactivity as related to the innate immune system activation/cytokine expression, e.g., danger signaling (e.g., IL-1β, IL-18, IL-33, etc.), toll-like receptor activation (e.g., IL-6, tumor necrosis factor α, etc.), bone catabolism (e.g., TRAP5b), and hypoxia responses (HIF-1α). More study is needed, however, to fully understand these interactions to effectively counter cytokine- and chemokine-based orthopedic implant-related inflammation.

  2. Prediction of bone density around orthopedic implants delivering bisphosphonate. (United States)

    Stadelmann, Vincent A; Terrier, Alexandre; Gauthier, O; Bouler, J-M; Pioletti, Dominique P


    The fixation of an orthopedic implant depends strongly upon its initial stability. Peri-implant bone may resorb shortly after the surgery. This resorption is directly followed by new bone formation and implants fixation strengthening, the so-called secondary fixation. If the initial stability is not reached, the resorption continues and the implant fixation weakens, which leads to implant loosening. Studies with rats and dogs have shown that a solution to prevent peri-implant resorption is to deliver bisphosphonate from the implant surface. The aims of the study were, first, to develop a model of bone remodeling around an implant delivering bisphosphonate, second, to predict the bisphosphonate dose that would induce the maximal peri-implant bone density, and third to verify in vivo that peri-implant bone density is maximal with the calculated dose. The model consists of a bone remodeling equation and a drug diffusion equation. The change in bone density is driven by a mechanical stimulus and a drug stimulus. The drug stimulus function and the other numerical parameters were identified from experimental data. The model predicted that a dose of 0.3 microg of zoledronate on the implant would induce a maximal bone density. Implants with 0.3 microg of zoledronate were then implanted in rat femurs for 3, 6 and 9 weeks. We measured that peri-implant bone density was 4% greater with the calculated dose compared to the dose empirically described as best. The approach presented in this paper could be used in the design and analysis processes of experiments in local delivery of drug such as bisphosphonate.

  3. Knowledge and opinions on oncoplastic surgery among breast and plastic surgeons

    DEFF Research Database (Denmark)

    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...... 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...

  4. Medical cannabis - the Canadian perspective. (United States)

    Ko, Gordon D; Bober, Sara L; Mindra, Sean; Moreau, Jason M


    Cannabis has been widely used as a medicinal agent in Eastern medicine with earliest evidence in ancient Chinese practice dating back to 2700 BC. Over time, the use of medical cannabis has been increasingly adopted by Western medicine and is thus a rapidly emerging field that all pain physicians need to be aware of. Several randomized controlled trials have shown a significant and dose-dependent relationship between neuropathic pain relief and tetrahydrocannabinol - the principal psychoactive component of cannabis. Despite this, barriers exist to use from both the patient perspective (cost, addiction, social stigma, lack of understanding regarding safe administration) and the physician perspective (credibility, criminality, clinical evidence, patient addiction, and policy from the governing medical colleges). This review addresses these barriers and draws attention to key concerns in the Canadian medical system, providing updated treatment approaches to help clinicians work with their patients in achieving adequate pain control, reduced narcotic medication use, and enhanced quality of life. This review also includes case studies demonstrating the use of medical marijuana by patients with neuropathic low-back pain, neuropathic pain in fibromyalgia, and neuropathic pain in multiple sclerosis. While significant preclinical data have demonstrated the potential therapeutic benefits of cannabis for treating pain in osteoarthritis, rheumatoid arthritis, fibromyalgia, and cancer, further studies are needed with randomized controlled trials and larger study populations to identify the specific strains and concentrations that will work best with selected cohorts.

  5. No Circadian Variation in Surgeons' Ability to Diagnose Acute Appendicitis

    DEFF Research Database (Denmark)

    Jørgensen, Anders Bech; Amirian, Ilda; Watt, Sara Kehlet;


    OBJECTIVE: To examine if there were circadian variations in surgeons' ability to diagnose acute appendicitis. DESIGN: Retrospective database study of all patients admitted to an acute surgical procedure under the potential diagnosis of acute appendicitis in a 4-year period. The day was divided...... patients were included. There were no age limitations or selection in sex. RESULTS: There was no significant difference in the ability to diagnose appendicitis in day-evening hours vs night hours (p = 0.391), nor was any significant difference found on weekdays (Monday-Thursday) vs weekends (Friday...... of imaging had no effect on the ability to diagnose appendicitis. Male sex showed a higher probability of the diagnosis being appendicitis compared with other or no pathology (odds ratio: 3.094; p

  6. Ureteral inguinal hernia: an uncommon trap for general surgeons (United States)

    Yahya, Zarif; Al-habbal, Yahya; Hassen, Sayed


    Inguinal hernias involving the ureter, a retroperitoneal structure, is an uncommon phenomenon. It can occur with or without obstructive uropathy, the latter posing a trap for the unassuming general surgeon performing a routine inguinal hernia repair. Ureteral inguinal hernia should be included as a differential when a clinical inguinal hernia is diagnosed concurrently with unexplained hydronephrosis, renal failure or urinary tract infection particularly in a male. The present case describes a patient with a known ureteroinguinal hernia who proceeded to having a planned hernia repair and ureteric protection. The case is a reminder that when faced with an unexpected finding such an indirect sliding inguinal hernia, extreme care should be taken to ensure that no structures are inadvertently damaged and that a rare possibility is the entrapment of the ureter in the inguinal canal. PMID:28275027

  7. Old Disease…New Location…Surgeons Be Alerted

    Directory of Open Access Journals (Sweden)

    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.

  8. [Surgeon 2.0: the challenge is on the Web]. (United States)

    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.

  9. Jean Falcon (1491-1541), a great surgeon and anatomist of the 16th century. (United States)

    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.

  10. Work-related musculoskeletal disorders among dental surgeons: A pilot study

    Directory of Open Access Journals (Sweden)

    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

  11. Clinical Core Competency Training for NASA Flight Surgeons (United States)

    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.

  12. A Survey on the Hatpic Interaction Models in Virtual Orthopedic Surgery%虚拟骨科手术中触觉交互建模方法综述

    Institute of Scientific and Technical Information of China (English)

    王琼; 陈辉; 王平安


    虚拟骨科手术可以让骨科医生使用多种虚拟骨科手术器械在三维重建的骨性解剖结构模型上进行骨科手术操作和训练。力触觉交互在骨科手术中起着不容忽视的作用,如何在骨科手术模拟中实现真实快速的触觉交互,已成为近年来虚拟骨科手术研究的热点。文章主要对现有的骨科手术模拟系统中用到的触觉交互模型进行了研究、分类和总结,分析了现有的一些模型的特点和不足,并展望了骨科手术系统中未来力触觉交互的发展。%Virtual orthopedic surgery allows the surgeon to perform operations and trainings on the reconstructed anatomic bone model with a variety of virtual instruments. Haptic interaction plays an important role in the virtual surgery. How to simulate realistic and fast haptic interaction in virtual orthopedic surgery has become a concerned research topic recently. In this paper, existing haptic models used in orthopedic surgical simulation system were reviewed and analyzed, and their characteristics and disadvantages were discussed as well. Finally, some perspectives for the development of the haptic interaction in future pointed out.

  13. Gender differences in the professional and private lives of plastic surgeons. (United States)

    Halperin, Terri J; Werler, Martha M; Mulliken, John B


    There are over 700 female members in the American Society of Plastic Surgeons. The purpose of this study was to assess possible differences between female and male plastic surgeons with respect to their practice characteristics, duration of practice, and some aspects of their private lives. We designed a 41 question survey to compare the practice features and personal demographics of female and male members of the American Society of Plastic Surgeons. A total of 1498 questionnaires were sent via e-mail to all female members (n = 687) and a random cohort of male members (n = 811). The respondents were age stratified by decade and their responses were compared by gender using chi tests. The overall response rate was 36.3%: 337 females (49%) and 207 males (25.5%) (P plastic surgeons were more than twice as likely as female plastic surgeons to earn an income greater than $400,000 per year (P plastic surgeons are significantly more likely to be unmarried, to postpone having children or be childless, as compared to their male counterparts. Furthermore, female plastic surgeons have a lower income than their male colleagues despite similar hours and practice profile. Nevertheless, female plastic surgeons appear to have similar career satisfaction and are no more likely to retire earlier or more frequently than male plastic surgeons.

  14. The paediatric surgeon and his working conditions in Francophone sub-Saharan Africa

    Directory of Open Access Journals (Sweden)

    K Gnassingbé


    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.

  15. Opioid use for chronic pain management in Italy: results from the Orthopedic Instant Pain survey project

    Directory of Open Access Journals (Sweden)

    Guido Fanelli


    Full Text Available Pain is a common symptom in orthopedic patients, but is managed sub-optimally, partly due to scarce opioid use in severe cases. The aim of the Orthopedic Instant Pain Survey (POIS was to evaluate changes in pain management in Italian orthopedic practice 2 years after a legislative change (Law 38/2010 simplifying opioid access for pain control. A web-based survey on the knowledge of this law and trends observed in clinical practice for severe pain treatment was administered to 143 Italian orthopedic specialists. In total, 101 (70% respondents showed a high level of knowledge. Nevertheless, 54.5% stated that they do not use opioids for severe osteo-articular pain management. Main barriers to opioid use are fear of adverse events (61.4%, especially nausea/vomiting and constipation, and patient resistance (29.7%. A modest knowledge of pain classification was also demonstrated. Opioid use remains very limited in Italian orthopedic practice. Physicians’ fear of side effects showed poor knowledge of strategies for effective management of opioid-related adverse events, such as combined oral prolonged-release oxycodone/naloxone. Continuing educational programs could improve delivery of evidence-based pain management.

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

    Directory of Open Access Journals (Sweden)

    Gerrit Haaker


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

  17. Hospital characteristics and patient populations served by physician owned and non physician owned orthopedic specialty hospitals

    Directory of Open Access Journals (Sweden)

    Vaughan-Sarrazin Mary S


    Full Text Available Abstract Background The emergence of physician owned specialty hospitals focusing on high margin procedures has generated significant controversy. Yet, it is unclear whether physician owned specialty hospitals differ significantly from non physician owned specialty hospitals and thus merit the additional scrutiny that has been proposed. Our objective was to assess whether physician owned specialty orthopedic hospitals and non physician owned specialty orthopedic hospitals differ with respect to hospital characteristics and patient populations served. Methods We conducted a descriptive study using Medicare data of beneficiaries who underwent total hip replacement (THR (N = 10,478 and total knee replacement (TKR (N = 15,312 in 29 physician owned and 8 non physician owned specialty orthopedic hospitals during 1999–2003. We compared hospital characteristics of physician owned and non physician owned specialty hospitals including procedural volumes of major joint replacements (THR and TKR, hospital teaching status, and for profit status. We then compared demographics and prevalence of common comorbid conditions for patients treated in physician owned and non physician owned specialty hospitals. Finally, we examined whether the socio-demographic characteristics of the neighborhoods where physician owned and non physician owned specialty hospitals differed, as measured by zip code level data. Results Physician owned specialty hospitals performed fewer major joint replacements on Medicare beneficiaries in 2003 than non physician owed specialty hospitals (64 vs. 678, P Conclusion Physician owned specialty orthopedic hospitals differ significantly from non physician owned specialty orthopedic hospitals and may warrant the additional scrutiny policy makers have proposed.

  18. Web-based home telemedicine system for orthopedics (United States)

    Lau, Christopher; Churchill, Sean; Kim, Janice; Matsen, Frederick A., III; Kim, Yongmin


    Traditionally, telemedicine systems have been designed to improve access to care by allowing physicians to consult a specialist about a case without sending the patient to another location, which may be difficult or time-consuming to reach. The cost of the equipment and network bandwidth needed for this consultation has restricted telemedicine use to contact between physicians instead of between patients and physicians. Recently, however, the wide availability of Internet connectivity and client and server software for e- mail, world wide web, and conferencing has made low-cost telemedicine applications feasible. In this work, we present a web-based system for asynchronous multimedia messaging between shoulder replacement surgery patients at home and their surgeons. A web browser plug-in was developed to simplify the process of capturing video and transferring it to a web site. The video capture plug-in can be used as a template to construct a plug-in that captures and transfers any type of data to a web server. For example, readings from home biosensor instruments (e.g., blood glucose meters and spirometers) that can be connected to a computing platform can be transferred to a home telemedicine web site. Both patients and doctors can access this web site to monitor progress longitudinally. The system has been tested with 3 subjects for the past 7 weeks, and we plan to continue testing in the foreseeable future.

  19. Acute adrenal crisis after orthopedic surgery for pathologic fracture

    Directory of Open Access Journals (Sweden)

    Hashimoto Nobuyuki


    Full Text Available Abstract Background Adrenal crisis after surgical procedure is a rare but potentially catastrophic life-threatening event. Its manifestations, such as hypotension, tachycardia, hypoxia, and fever mimic the other more common postoperative complications. Clinical outcome is dependent upon early recognition of the condition and proper management with exogenous steroid administration. Case presentation We report a 75-year-old man who presented with shock immediately after surgery for a femoral fracture from lung cancer metastasis. Anemia and severe hyponatremia were detected. Despite adequate fluid resuscitation, nonspecific symptoms including hypotension, tachycardia, hypoxia, fever and confusion occurred. Emergent CT revealed enlarged bilateral adrenal glands. Under the diagnosis of adrenal crisis due to metastatic infiltration of adrenal glands, the patient was treated with appropriate steroid replacement resulting in rapid improvement and recovery. Conclusion We describe a case of adrenal crisis caused by the lack of adrenal reserve based on metastatic involvement and surgical stress, the first published case of adrenal crisis after surgery for a pathologic fracture from lung cancer metastasis. Surgeons treating pathologic fractures should be aware of this complication and familiar with its appropriate therapy because of increasing opportunity to care patients with metastatic bone tumors due to recent advances in cancer treatment.


    Directory of Open Access Journals (Sweden)

    Peter McCormick


    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.

  1. New perspectives and recommendations for anticoagulant therapy post orthopedic surgery

    Directory of Open Access Journals (Sweden)

    Marcelo Kropf


    Full Text Available Anticoagulant therapy is essential for the prevention of risks associated with the formation of thrombus in patients after surgery, especially in orthopedics. Recently, new oral anticoagulants were introduced in the therapeutic arsenal. This fact is important, because the current drug of choice in clinical practice is enoxaparin, a low molecular weight heparin. As all injecting drugs, enoxaparin may reduce patients' adherence to treatment by dissatisfaction with and resistance to the administration. This article reviews the available literature on the overall utility of these innovative medicines, approaching the pharmacology, the compared efficacy in relation to current agents, and the potential targets for new agents, as well as points to new trends in research and development. The article also contributes with a practical guide for use and recommendations to health professionals, especially focusing on the reversibility of hemorrhagic events, and discusses the importance of convenience/satisfaction of use, the cost of treatment, and the risk-benefit profile for patients.A terapia anticoagulante é fundamental para a prevenção de riscos associados à formação de trombos em pacientes pós-cirúrgicos, principalmente em ortopedia. Recentemente, novos anticoagulantes orais foram introduzidos no arsenal terapêutico. Tal fato é importantíssimo, visto que o atual medicamento de primeira escolha na prática clínica é a enoxaparina, uma heparina de baixo peso molecular. Por ser de uso injetável, a enoxaparina pode diminuir a adesão do paciente ao tratamento, devido à insatisfação e à resistência quanto à via de administração. Este artigo revisa a literatura disponível sobre a utilidade total desses medicamentos inovadores ao abordar a farmacologia, a eficácia em comparação com os agentes atuais e os alvos potenciais para novos agentes, bem como aponta as novas tendências em pesquisa e desenvolvimento. O artigo também contribui

  2. Functional orthopedic magnetic appliance (FOMA) II--modus operandi. (United States)

    Vardimon, A D; Stutzmann, J J; Graber, T M; Voss, L R; Petrovic, A G


    A new functional appliance (FA) to correct Class II dentoskeletal malocclusions is introduced. The functional orthopedic magnetic appliance (FOMA) II uses upper and lower attracting magnetic means (Nd2Fe14B) to constrain the lower jaw in an advanced sagittal posture. In vitro, a special gauge transducer measured the magnetic attractive path and forces. In vivo, 13 prepubertal female Macaca fascicularis monkeys received facial implants and were treated for 4 months with the following appliances: conventional FA (four subjects), FOMA II (five subjects), a combined FOMA II + FA (two subjects), and sham (control) appliance (two subjects). The in vitro results showed the following: vertico-sagitally displaced upper and lower magnets attracted ultimately along an oblique line with a terminal horizonal slide to become fully superimposed; the functional performance improved when the magnetic interface acted as a magnetic inclined plane; and the magnetic force was able to guide and constrain the mandible toward the constructive protrusive closure position (CPCP) (1.2 mm, F = 570 gm) from levels below the habitual rest position (3 mm, F = 219 gm) and the electromyographic (EMG) relaxed position (8.5 mm, F = 45 gm). The in vivo results demonstrated the following: functional performance increased in FOMA II (22%) and in the combined FOMA II + FA (28%) over the conventional FA; mandibular length increased significantly in the treated animals (means = 2.83 +/- 0.70 mm) over the control animals (means = 0.43 +/- 0.08 mm); incisor proclination was lower in magnetic appliances (means = 4.57 +/- 1.76 degrees) than in the conventional FA (means = 8.75 +/- 1.85 degrees); mandibular elongation and condylar posterior inclination resulted from posterosuperior endochondral growth (increased cell proliferation and/or hyperplasia of functional chondroblasts) and by bony remodeling of the condylar neck (apposition posterior border, resorption anterior border), respectively; virtually no

  3. Society of U.S. Air Force Surgeons’ 2010 State of the Flight Surgeon Survey: The Medical Treatment Facility Commander’s Perspective (United States)


    filling an active billet as a flight surgeon may be very short (i.e., immediate), as in the case of a general medical officer ( GMO ), or very long...Inexperience (9/19) • The two assigned flight surgeons are general medical officers ( GMOs ). It is difficult to complete the necessary training at a...other two are newly assigned GMOs , who are motivated but are still in the learning phase. I have no doubt they will eventually grow into outstanding

  4. [How many generalists and how many specialists does orthopedics and traumatology need?]. (United States)

    Achatz, G; Perl, M; Stange, R; Mutschler, M; Jarvers, J S; Münzberg, M


    The training in orthopedic and trauma surgery has changed significantly with the introduction of the new residency program. The contents taught have already been reduced in breadth and the current developments in the outpatient and particularly in the clinical landscape also contribute to increasing specialization. This trend favors structures in which comprehensive medical care for the population in Germany in orthopedic and trauma surgery appears to be endangered and in which the future efforts for e.g. polytraumatised patients need to be questioned. The Young Forum of the German Society for Orthopedics and Traumatology actively accompanies a discussion about the necessity and value of generalists to ensure the level of care in Germany in addition to the specialists.

  5. [Application and research advances of metabolomics in the field of orthopedics]. (United States)

    Sun, Zhijian; Qiu, Guixing; Zhao, Yu


    Metabolomics is a subject of systematic, qualitative and quantitative analysis of all metabolites in all organisms, which is applied to finding biomarkers and studying pathogenesis of diseases. Study procedures of metabolomics include data acquisition by spectroscopic/spectrometric techniques, multivariate statistical analysis and projection of the acquired metabolomic information. In recent years, metabolomics have gained popularity in orthopedic field. Metabolomic study of osteoarthritis was firstly conducted and widely developed. Metabolite profiles of different samples, including serum/plasma, urine, synovial fluid and synovial tissue, were studied and dozens of differential metabolites and several disturbed metabolic pathways were found. In addition, metabolomic studies of osteoporosis, ankylosing spondylitis and bone tumors were also conducted, which identified many potential biomarkers and made further understanding of pathogenesis of corresponding disease. However, metabolomic studies in orthopedic field just begin. More orthopedic diseases will be researched thank to the satisfactory results of previous reports.

  6. A Roadmap for Canadian Submillimetre Astronomy

    CERN Document Server

    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.

  7. Birth of the Canadian Digestive Health Foundation. (United States)

    Beck, Ivan T


    The Canadian Digestive Disease Foundation, renamed the Canadian Digestive Health Foundation--Fondation canadienne pour la promotion de la santé digestive--in December 2001, is the culmination of ongoing efforts by the Canadian Association of Gastroenterology to establish an independent charitable organization. In February 2001, it was officially endorsed as the Foundation for the Canadian Association of Gastroenterology. The initial efforts to establish this Foundation, led by Dr Richard McKenna in 1963, were unsuccessful. In 1991, Glaxo Canada (now GlaxoSmithKline) became a founding donor, and with the four founding physicians--Drs Ivan T Beck, Richard H Hunt, Suzanne E Lemire and Alan BR Thomson--the expenses to establish the Foundation were met. A charitable number was obtained in 1995 (0997427-11). The second founding donor was Janssen Canada (now Janssen-Ortho), and public education support came from Astra Canada (now AstraZeneca Canada). The Foundation initially relied on corporate donors, but now approaches physicians, patients and the general public. The objectives of the Foundation are to advance the science of gastroenterology and to provide knowledge of digestive diseases and nutrition to the general public, to enhance the quality of life of persons who are afflicted with these disorders. The major achievements of the Foundation are the provision of one-year operating grants to new investigators, which have allowed them to accumulate early data and subsequently obtain support from other major granting organizations. It also provides Fellowships and studentship support grants, in conjunction with the Canadian Institutes of Health Research and the pharmaceutical industry. The education committee found that there was little research support in this field, considering the large economic burden of digestive disease and the amount of outstanding work done by Canadian researchers. A bilingual Web site, a web-based specialist's discussion program and bilingual

  8. A Course in Canadian Film for U.S. Students (United States)

    Gutenko, Gregory


    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),…

  9. 47 CFR 101.1423 - Canadian and Mexican coordination. (United States)


    ... 47 Telecommunication 5 2010-10-01 2010-10-01 false Canadian and Mexican coordination. 101.1423... GHz Band § 101.1423 Canadian and Mexican coordination. Pursuant to § 2.301 of this chapter, MVDDS systems in the United States within 56 km (35 miles) of the Canadian and Mexican border will be...

  10. Management of hereditary angioedema: 2010 Canadian approach

    Directory of Open Access Journals (Sweden)

    Bowen Tom


    Full Text Available Abstract C1-inhibitor (C1-INH deficiency is a rare blood disorder resulting in angioedema attacks that are debilitating and may be life-threatening. Prophylaxis and therapy of events has changed since our first Canadian Consensus Conference on the diagnosis, therapy and management of HAE. We have formed the Canadian Hereditary Angioedema Network (CHAEN/Réseau Canadien d'Angioédème Héréditaire (RCAH - to advance care of patients with this disorder in Canada. We here present a review of management of HAE in Canada.

  11. Statistics in action a Canadian outlook

    CERN Document Server

    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

  12. Do Astronauts have a Higher Rate of Orthopedic Shoulder Conditions than a Cohort of Working Professionals? (United States)

    Laughlin, Mitzi S.; Murray, Jocelyn D.; Young, Millenia; Wear, Mary L.; Tarver, W. J.; Van Baalen, Mary


    Occupational surveillance of astronaut shoulder injuries began with operational concerns at the Neutral Buoyancy Laboratory (NBL) during Extra Vehicular Activity (EVA) training. NASA has implemented several occupational health initiatives during the past 20 years to decrease the number and severity of injuries, but the individual success rate is unknown. Orthopedic shoulder injury and surgery rates were calculated, but classifying the rates as normal, high or low was highly dependent on the comparison group. The purpose of this study was to identify a population of working professionals and compare orthopedic shoulder consultation and surgery rates.

  13. Multi-detector CT imaging in the postoperative orthopedic patient with metal hardware. (United States)

    Vande Berg, Bruno; Malghem, Jacques; Maldague, Baudouin; Lecouvet, Frederic


    Multi-detector CT imaging (MDCT) becomes routine imaging modality in the assessment of the postoperative orthopedic patients with metallic instrumentation that degrades image quality at MR imaging. This article reviews the physical basis and CT appearance of such metal-related artifacts. It also addresses the clinical value of MDCT in postoperative orthopedic patients with emphasis on fracture healing, spinal fusion or arthrodesis, and joint replacement. MDCT imaging shows limitations in the assessment of the bone marrow cavity and of the soft tissues for which MR imaging remains the imaging modality of choice despite metal-related anatomic distortions and signal alteration.

  14. Noticeable Variations in the Educational Exposure During Residency in Danish Orthopedic Departments

    DEFF Research Database (Denmark)

    Brand, Eske; Fridberg, Marie; Knudsen, Ulrik Kragegaard;


    OBJECTIVE: The objective of the study was to examine the educational exposure during residency in Danish orthopedic departments. DESIGN: Questionnaire-based cross-sectional study. SETTING: Data were gathered from January 1, 2014 to April 30, 2014 through a nationwide web-based questionnaire....... CONCLUSIONS: A large variation in the educational exposure was found among the Danish orthopedic departments. Numbers indicate that Danish residents, compared with their US counterparts, operate considerably less during residency. Most residents work overtime and many of them work for free to participate...

  15. Skeletal metastases - the role of the orthopaedic and spinal surgeon. (United States)

    Eastley, Nicholas; Newey, Martyn; Ashford, Robert U


    Developments in oncological and medical therapies mean that life expectancy of patients with metastatic bone disease (MBD) is often measured in years. Complications of MBD may dramatically and irreversibly affect patient quality of life, making the careful assessment and appropriate management of these patients essential. The roles of orthopaedic and spinal surgeons in MBD generally fall into one of four categories: diagnostic, the prophylactic fixation of metastatic deposits at risk of impending fracture (preventative surgery), the stabilisation or reconstruction of bones affected by pathological fractures (reactive surgery), or the decompression and stabilisation of the vertebral column, spinal cord, and nerve roots. Several key principals should be adhered to whenever operating on skeletal metastases. Discussions should be held early with an appropriate multi-disciplinary team prior to intervention. Detailed pre-assessment is essential to gauge a patient's suitability for surgery - recovery from elective surgery must be shorter than the anticipated survival. Staging and biopsies provide prognostic information. Primary bone tumours must be ruled out in the case of a solitary bone lesion to avoid inappropriate intervention. Prophylactic surgical fixation of a lesion prior to a pathological fracture reduces morbidity and length of hospital stay. Regardless of a lesion or pathological fracture's location, all regions of the affected bone must be addressed, to reduce the risk of subsequent fracture. Surgical implants should allow full weight bearing or return to function immediately. Post-operative radiotherapy should be utilised in all cases to minimise disease progression. Spinal surgery should be considered for those with spinal pain due to potentially reversible spinal instability or neurological compromise. The opinion of a spinal surgeon should be sought early, as delays in referral directly correlate to worse functional recovery following intervention

  16. 21 CFR 878.4480 - Absorbable powder for lubricating a surgeon's glove. (United States)


    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Absorbable powder for lubricating a surgeon's... HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices § 878.4480 Absorbable powder for lubricating a surgeon's glove. (a) Identification. Absorbable powder...

  17. A First Hard Look at the Surgeon General's Report on Television and Violence. (United States)

    Cater, Douglass; Strickland, Stephen

    In March of 1972 the Aspen Program on Communications and Society convened a meeting which brought together the Surgeon General, staff members connected with the Surgeon General's Report on Television and Violence, and social scientists. The purpose of the meeting was to evaluate the Report, which had just been issued. This conference report…

  18. Emergent management of postpartum hemorrhage for the general and acute care surgeon

    Directory of Open Access Journals (Sweden)

    Blankenship Charles L


    Full Text Available Abstract Background Postpartum hemorrhage is one of the rare occasions when a general or acute care surgeon may be emergently called to labor and delivery, a situation in which time is limited and the stakes high. Unfortunately, there is generally a paucity of exposure and information available to surgeons regarding this topic: obstetric training is rarely found in contemporary surgical residency curricula and is omitted nearly completely from general and acute care surgery literature and continuing medical education. Methods The purpose of this manuscript is to serve as a topic specific review for surgeons and to present a surgeon oriented management algorithm. Medline and Ovid databases were utilized in a comprehensive literature review regarding the management of postpartum hemorrhage and a management algorithm for surgeons developed based upon a collaborative panel of general, acute care, trauma and obstetrical surgeons' review of the literature and expert opinion. Results A stepwise approach for surgeons of the medical and surgical interventions utilized to manage and treat postpartum hemorrhage is presented and organized into a basic algorithm. Conclusion The manuscript should promote and facilitate a more educated, systematic and effective surgeon response and participation in the management of postpartum hemorrhage.

  19. A comparison of surgeon's postural muscle activity during robotic-assisted and laparoscopic rectal surgery. (United States)

    Szeto, Grace P Y; Poon, Jensen T C; Law, Wai-Lun


    This study compared the muscular activity in the surgeon's neck and upper limbs during robotic-assisted laparoscopic (R-Lap) surgery and conventional laparoscopic (C-Lap) surgery. Two surgeons performed the same procedure of R-Lap and C-Lap low anterior resection, and real-time surface electromyography was recorded in bilateral cervical erector spinae, upper trapezius (UT) and anterior deltoid muscles for over 60 min in each procedure. In one surgeon, forearm muscle activities were also recorded during robotic surgery. Similar levels of cervical muscle activity were demonstrated in both types of surgery. One surgeon showed much higher activity in the left UT muscle during robotic surgery. In the second surgeon, C-Lap was associated with much higher levels of muscle activity in both UT muscles. This may be related to the bilateral abducted arm posture required in maneuvering the laparoscopic instruments. In the forearm region, the "ulnaris" muscles for wrist flexion and extension bilaterally showed high amplitudes during robotic-assisted surgery. Robotic-assisted surgery seemed to demand a higher level of muscle work in the forearm region while greater efforts of shoulder muscles were involved during laparoscopic surgery. There are also individual variations in postural habits and motor control that can affect the muscle activation patterns. This study demonstrated a method of objectively examining the surgeon's physical workload during real-time surgery in the operating theatre, and further research should explore the surgeon's workload in a larger group of surgeons performing different surgical procedures.

  20. Da Vinci© Skills Simulator™: is an early selection of talented console surgeons possible? (United States)

    Meier, Mark; Horton, Kevin; John, Hubert


    To investigate whether the learning curve of robotic surgery simulator training depends on the probands' characteristics, such as age and prior experience, we conducted a study of six distinct proband groups, using the da Vinci Skills Simulator: experienced urological robotic surgeons, surgeons with experience as da Vinci tableside assistants, urological surgeons with laparoscopic experience, urological surgeons without laparoscopic experience, and complete novices aged 25 and younger and 40 and older. The results showed that all experienced robotic surgeons reached expert level (>90 %, as defined previously in the literature) within the first three repetitions and remained on a high level of performance. All other groups performed worse. Tableside assistants, laparoscopically experienced surgeons, and younger novices showed a better performance in all exercises than surgeons without laparoscopic experience and older novices. A linear mixed-effects model analysis demonstrated no significant difference in learning curves between proband groups in all exercises except the RW1 exercise for the younger proband group. In summary, we found that performance in robotic surgery, measured by performance scores in three virtual simulator modules using the EndoWrist techniques, was dependent on age and prior experience with robotic and laparoscopic surgery. However, and most importantly, the learning curve was not significantly affected by these factors. This suggests that the da Vinci Skills Simulator™ is a useful practice tool for everyone learning or performing robotic surgery, and that early selection of talented surgeons is neither possible nor necessary.

  1. Rising incidence of Enterococcus species in microbiological specimens from orthopedic patients correlates to increased use of cefuroxime

    DEFF Research Database (Denmark)

    Siesing, Peter Christian; Alva-Jørgensen, Jens Peter; Brodersen, Jakob


    Enterococci are emerging causes of severe infections, including wound and bone infections in orthopedic patients. The main purpose of this study was to determine whether there was a correlation between the incidence of enterococci in tissue samples (biopsies) from orthopedic patients...

  2. Surgical management of acute cholecystitis. Results of a nation-wide survey among Spanish surgeons. (United States)

    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.

  3. Technical modifications for laparoscopic cholecystectomy by the left-handed surgeon. (United States)

    Herrero-Segura, Antonio; López-Tomassetti Fernández, Eudaldo M; Medina-Arana, Vicente


    There is a complete paucity of literature for left-handed surgeons. Some studies revealed that left-handed surgical residents have lesser operating skills and some surgeons have considered leaving surgery at some point in their career owing to laterality-related frustrations. Most important, whereas minimally invasive surgical techniques have had a profound impact on the treatment of diseased gallbladder, these procedures do not eliminate laterality related to the discomfort of left-handed surgeons. Usually, left-handed surgeons must teach themselves a procedure. They must make modifications and learn some technical tips to make a more comfortable, convenient, and safe intervention. The aim of this study was to describe some modifications made by a left-handed surgeon to perform 52 safe laparoscopic cholecystectomies with standard right-handed instruments in our hospital. These surgical steps could be used in a reproducible way to minimize the recurring difficulties of left-handed learners in a surgical residency program.

  4. Resident surgeon efficiency in femtosecond laser-assisted cataract surgery (United States)

    Pittner, Andrew C; Sullivan, Brian R


    Purpose Comparison of resident surgeon performance efficiencies in femtosecond laser-assisted cataract surgery (FLACS) versus conventional phacoemulsification. Patients and methods A retrospective cohort study was conducted on consecutive patients undergoing phacoemulsification cataract surgery performed by senior ophthalmology residents under the supervision of 1 attending physician during a 9-month period in a large Veterans Affairs medical center. Medical records were reviewed for demographic information, preoperative nucleus grade, femtosecond laser pretreatment, operative procedure times, total operating room times, and surgical complications. Review of digital video records provided quantitative interval measurements of core steps of the procedures, including completion of incisions, anterior capsulotomy, nucleus removal, cortical removal, and intraocular lens implantation. Results Total room time, operation time, and corneal incision completion time were found to be significantly longer in the femtosecond laser group versus the traditional phacoemulsification group (each Pcataract surgery is generally less efficient when trainees have more experience with traditional phacoemulsification. FLACS was found to have a significant advantage in completion of capsulotomy, but subsequent surgical steps were not shorter or longer. Resident learning curve for the FLACS technology may partially explain the disparities of performance. Educators should be cognizant of a potential for lower procedural efficiency when introducing FLACS into resident training. PMID:28203055

  5. Human genomics and microarrays: implications for the plastic surgeon. (United States)

    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.

  6. Day-care hypospadias surgery: Single surgeon experience

    Directory of Open Access Journals (Sweden)

    Chandrasekharam V.V.S.S


    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.

  7. The Role of Plastic Surgeons in Advancing Development Global. (United States)

    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.

  8. Recognizing surgeon's actions during suture operations from video sequences (United States)

    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.

  9. Association of Surgeons in Training Conference: Cardiff 2012. (United States)

    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.

  10. Selective laser sintering of calcium phosphate materials for orthopedic implants (United States)

    Lee, Goonhee

    control of micro and macro pore structure, to maximize bone healing and provide sufficient mechanical strength. It also permits the complete removal of the polymeric binders that are resided in the SLS process. In collaboration with the University of Texas Health Science Center at San Antonio and BioMedical Enterprises, Inc., porous implants based on anatomical geometry have been successfully implanted in rabbits and dogs. These histologic animal studies reveal excellent biocompatibility and show its great potential for commercial custom-fit implant manufacture. The second research effort involves fabrication of fully dense bone for application in dental restoration and load-bearing orthopedic functions. Calcium phosphate glass melts, proven to be biocompatible in the first effort, were cast into carbon molds. Processes were developed for preparing the molds. These carbon molds of anatomic shape can be prepared from either Computer Numerical Control (CNC) milling of slab stock or SLS processing of thermoset-coated graphite powder. The CNC milling method provides accurate dimension of the molds in a short period of time, however, the capable geometries are limited; generally two pieces of molds are required for complex shapes. The SLS method provides very complex shape green molds. However, they need to go through pyrolysis of thermoset binder to provide the high temperature capability reached at calcium phosphate melt temperatures (1100°C) and noticeable shrinkage was observed during pyrolysis. The cast glass was annealed to develop polycrystalline calcium phosphate. This process also exhibits great potential.

  11. Knowledge, Attitude, and Practices of Dental Surgeons in managing Child Patients (United States)

    Siddiqui, Talha Mufeed; Khan, Rabia; Batool, Kanza


    The aim of the study was to evaluate the knowledge, attitude, and practices of dental surgeons in the city of Karachi providing treatment to pediatric patients. A cross-sectional study was conducted to evaluate the knowledge, attitude, and practices of dental surgeons in the city of Karachi providing treatment to pediatric patients. A cluster-sampling technique was used and 200 dental surgeons from six different dental institutions were selected. A self-constructed questionnaire was distributed to the dental surgeons that comprised 20 closed-ended questions. The data was entered and analyzed for frequency and percentages by using Statistical Package for the Social Sciences (SPSS) version 19. The results showed that 76 (38%) dental surgeons took the responsibility of managing pediatric patient when given; 68 (34%) dental surgeons allowed the parents in the clinic; 111 (55.5%) dental surgeons are of the view that colorful and fun environment in dental clinic make the child at ease; 59 (29.5%) always demonstrate the dental procedure to the child to eradicate imaginary fears; 94 (47.0%) dental surgeons preferred the child to be treated in general anesthesia (GA) to avoid difficult behavior of the child; 135 (67.5%) dental surgeons did not show syringe needle or any instrument to the child. All the members of dental profession must be aware of patient perceptions, preferences, and fear to meet patient’s needs. Dental studies should include guidelines and techniques to train the upcoming dentists for excellent practice in pediatric dentistry. How to cite this article Wali A, Siddiqui TM, Khan R, Batool K. Knowledge, Attitude, and Practices of Dental Surgeons in managing Child Patients. Int J Clin Pediatr Dent 2016;9(4):372-378. PMID:28127171

  12. Canadian Association of Gastroenterology and the Canadian Digestive Health Foundation: Guidelines on Colon Cancer Screening

    Directory of Open Access Journals (Sweden)

    Desmond Leddin


    Full Text Available Colorectal cancer is the third most prevalent cancer affecting both men and women in Canada. Many of these cancers are preventable, and the Canadian Association of Gastroenterology (CAG and the Canadian Digestive Health Foundation (CDHF strongly support the establishment of screening programs for colorectal cancer. These guidelines discuss a number of screening options, listing the advantages and disadvantages of each. Ultimately, the test that is used for screening should be determined by patient preference, current evidence and local resources.

  13. The Canadian Hypertension Education Program – a unique Canadian knowledge translation program


    Tobe, Sheldon W; Touyz, Rhian M.; Campbell, Norm RC


    The Canadian Hypertension Education Program annually appraises data from hypertension research and updates clinical practice recommendation for the diagnosis and management of hypertension. Enormous effort is devoted to disseminating these recommendations to target groups throughout the country and, through the use of institutional databases, to evaluating their effectiveness in improving the health of Canadians by lowering blood pressure in people with hypertension. The mission of the Canadi...

  14. Readability of sports medicine-related patient education materials from the American Academy of Orthopaedic Surgeons and the American Orthopaedic Society for Sports Medicine. (United States)

    Ganta, Abhishek; Yi, Paul H; Hussein, Khalil; Frank, Rachel M


    Although studies have revealed high readability levels of orthopedic patient education materials, no study has evaluated sports medicine-related patient education materials. We conducted a study to assess the readability of sports medicine-related patient education materials from the American Academy of Orthopaedic Surgeons (AAOS) and the American Orthopaedic Society for Sports Medicine (AOSSM). All sports medicine patient education articles available online in 2012 from the AAOS and the AOSSM, including the Stop Sports Injuries Campaign (STOP), were identified, and their readability was assessed with the Flesch-Kinkaid (FK) readability test. Mean overall FK grade level of the 170 articles reviewed (104 from AAOS, 36 from AOSSM, 30 from STOP) was 10.2. Mean FK levels for the 3 sources were 9.5 (AAOS), 11.0 (AOSSM), and 11.5 (STOP) (P = .16). Fifteen (8.8%) of the 170 articles had a readability level at or below eighth grade (average reading level of US adults); only 2 (1.2%) of the 170 articles were at or below the recommended sixth-grade level. The majority of sports medicine-related patient education materials from AAOS and AOSSM had reading levels higher than recommended, indicating that the majority of the patient population may find it difficult to comprehend these articles.

  15. Indigenous populations health protection: A Canadian perspective

    Directory of Open Access Journals (Sweden)

    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.

  16. Canadian Ethnohistory: A Source for Social Studies? (United States)

    Wickwire, Wendy


    Presents an overview of ethnohistory, a relatively new area of historical investigation that draws on anthropology, geography, and linguistics, as well as history, to document the pasts of predominantly indigenous peoples. Encourages social studies teachers to take notice of a major body of work being produced by Canadian ethnohistorians. (DSK)

  17. Who Are the Players in Canadian Curriculum? (United States)

    Milburn, Geoffrey


    Labels range of persons advocating different theoretical positions of Canadian curriculum as "players." Describes players as "managers,""predictors,""transformers,""sleuths,""analysts." Values varied viewpoints for attention to language regarding curriculum, critical review of ideas/concepts, examination of current policies, awareness of history…

  18. Canadian Art Partnership Program in Finland (United States)

    Ketovuori, Mikko


    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…

  19. Canadian Adult Education: Still a Movement (United States)

    Nesbit, Tom


    Writing recently in this journal, two of Canada's veteran adult educators contemplated the "death" of the Canadian adult education movement. I disagree and argue that adult education in Canada is as vital an activity as ever and one that still fully justifies being called a movement. Specifically, Selman and Selman (2009) list five…

  20. Canadian Adult Education: Still a Movement? (United States)

    Selman, Mark


    In this journal's Fall 2009 issue, the Forum section included an article by Gordon Selman and Mark Selman arguing that although Canadian adult education had existed as a social movement in the middle part of the 20th century, it is no longer a social movement. They also speculated about the causes of this change. In the Spring 2011 issue, Tom…

  1. Canadian Children's Perceptions of Spirituality: Diverse Voices (United States)

    Moore, Kelsey; Talwar, Victoria; Bosacki, Sandra


    Few researchers have explored children's understandings of spirituality. Thus, Canadian children from different religious, spiritual and cultural backgrounds were asked open-ended questions concerning their spiritual thoughts, beliefs and experiences. Parents of participants completed a demographic questionnaire and reported children's religious…

  2. Canadian Perspectives on Equity in the Classroom. (United States)

    Bowlby, Brenda; Komlen, Mile


    Canadian school board administrators are increasingly expected to meet the needs of disabled or other students requiring specific types of accommodation. The duty to accommodate arises when otherwise legitimate school rules or policies affect the customs and observances of nonmajoritarian religions. (Contains 12 references.) (MLH)

  3. Asian and Pacific Migration: The Canadian Experience. (United States)

    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…

  4. Heat exposure in the Canadian workplace. (United States)

    Jay, Ollie; Kenny, Glen P


    Exposure to excessive heat is a physical hazard that threatens Canadian workers. As patterns of global climate change suggest an increased frequency of heat waves, the potential impact of these extreme climate events on the health and well-being of the Canadian workforce is a new and growing challenge. Increasingly, industries rely on available technology and information to ensure the safety of their workers. Current Canadian labor codes in all provinces employ the guidelines recommended by the American Conference of Governmental Industrial Hygienists (ACGIH) that are Threshold Limit Values (TLVs) based upon Wet Bulb Globe Temperature (WBGT). The TLVs are set so that core body temperature of the workers supposedly does not exceed 38.0 degrees C. Legislation in most Canadian provinces also requires employers to install engineering and administrative controls to reduce the heat stress risk of their working environment should it exceed the levels permissible under the WBGT system. There are however severe limitations using the WGBT system because it only directly evaluates the environmental parameters and merely incorporates personal factors such as clothing insulation and metabolic heat production through simple correction factors for broadly generalized groups. An improved awareness of the strengths and limitations of TLVs and the WGBT index can minimize preventable measurement errors and improve their utilization in workplaces. Work is on-going, particularly in the European Union to develop an improved individualized heat stress risk assessment tool. More work is required to improve the predictive capacity of these indices.

  5. Family Business Training: A Canadian Perspective (United States)

    Ibrahim, A. B.; Soufani, K.; Lam, Jose


    Family firms play an important role in the working of the Canadian economy; despite their importance to the economic activities and job creation it is observed that family businesses have lower survival rates than non-family firms, some argue that this can possibly be attributed (amongst other factors) to the lack of training. Most of the training…

  6. Canadian suicide mortality rates: first-generation immigrants versus Canadian-born. (United States)

    Strachan, J; Johansen, H; Nair, C; Nargundkar, M


    This article examines suicide mortality rates and trends in Canada for first-generation immigrants and the Canadian-born population. Data are analyzed by age, sex and country of birth. Since 1950, suicide rates worldwide for both men and women have been increasing. In North America and most of Europe, suicide has been one of the major causes of death for many years. In Canada, suicide rates are also rising. However, this increase is due entirely to a rise in the rate for men; the rate for women has remained relatively stable. Several differences are apparent between the rates for the Canadian-born population and those for first-generation immigrants. For example, three times as many Canadian-born men as women commit suicide. For first-generation immigrants, the ratio is two to one. Suicide mortality rates for the Canadian-born are higher than those for first-generation immigrants in every age group except for the 65 and over groups. Canadian born males have higher ASMR than first generation immigrant males. The rates for women show that first-generation immigrant women have higher suicide mortality rates than their Canadian-born counterparts, and that the highest rate for all women is for immigrants born in Asia.

  7. Current Practice Patterns Regarding the Conduct of Thyroidectomy and Parathyroidectomy amongst Surgeons - A Survey Study

    Directory of Open Access Journals (Sweden)

    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

  8. [Lack of new trainees in trauma surgery and orthopedics. An approach to a solution]. (United States)

    Thiele, K; Matziolis, D; Perka, C


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

  9. Aging and orthopedics: how a lifespan development model can inform practice and research. (United States)

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


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

  10. Presurgical orthopedics and satisfaction in motherhood: a randomized clinical trial (Dutchcleft).

    NARCIS (Netherlands)

    Prahl, C.; Prahl-Andersen, B.; Hof, M.A. van 't; Kuijpers-Jagtman, A.M.


    OBJECTIVE: To study the effect of infant orthopedics on satisfaction in motherhood. DESIGN: Prospective two-arm randomized controlled trial in parallel with three participating academic cleft palate centers. Treatment allocation was concealed and was performed by means of a computerized balanced all

  11. Postoperative urinary retention after general and spinal anesthesia in orthopedic surgical patients

    Directory of Open Access Journals (Sweden)

    Alaa Abdel aziz Niazi


    Conclusion: Urinary retention is more common after spinal than general anesthesia in orthopedic patients. Adding narcotics to the local anesthetics intrathecally causes more incidence of postoperative urinary retention, which may delay patients discharge and transabdominal ultrasonography is a reliable, noninvasive, inexpensive and simple method to measure bladder volume postoperatively.

  12. Infection of orthopedic implants and the use of antibiotic-loaded bone cements - A review

    NARCIS (Netherlands)

    van de Belt, H; Neut, D; Schenk, W; van Horn, [No Value; van der Mei, HC; Busscher, HJ


    Infections by bacteria are a serious complication following orthopedic implant surgery, that can usually only be cured by removing the implant, since the biofilm mode of growth of infecting bacteria on an implant surface protects the organisms from the host immune system and antibiotic therapy. Over

  13. Infant orthopedics in UCLP: effect on feeding, weight, and length: a randomized clinical trial (Dutchcleft).

    NARCIS (Netherlands)

    Prahl, C.; Kuijpers-Jagtman, A.M.; Hof, M.A. van 't; Prahl-Andersen, B.


    OBJECTIVE: To study the effects of infant orthopedics (IO) on feeding, weight, and length. DESIGN: Prospective two-arm randomized controlled trial in three academic Cleft Palate Centers. Treatment allocation was concealed and performed by means of a computerized balanced allocation method. SETTING:

  14. The Effectiveness of Active and Traditional Teaching Techniques in the Orthopedic Assessment Laboratory (United States)

    Nottingham, Sara; Verscheure, Susan


    Active learning is a teaching methodology with a focus on student-centered learning that engages students in the educational process. This study implemented active learning techniques in an orthopedic assessment laboratory, and the effects of these teaching techniques. Mean scores from written exams, practical exams, and final course evaluations…

  15. Value of 3-D CT in classifying acetabular fractures during orthopedic residency training. (United States)

    Garrett, Jeffrey; Halvorson, Jason; Carroll, Eben; Webb, Lawrence X


    The complex anatomy of the pelvis and acetabulum have historically made classification and interpretation of acetabular fractures difficult for orthopedic trainees. The addition of 3-dimensional (3-D) computed tomography (CT) scan has gained popularity in preoperative planning, identification, and education of acetabular fractures given their complexity. Therefore, the authors examined the value of 3-D CT compared with conventional radiography in classifying acetabular fractures at different levels of orthopedic training. Their hypothesis was that 3-D CT would improve correct identification of acetabular fractures compared with conventional radiography.The classic Letournel fracture pattern classification system was presented in quiz format to 57 orthopedic residents and 20 fellowship-trained orthopedic traumatologists. A case consisted of (1) plain radiographs and 2-dimensional axial CT scans or (2) 3-D CT scans. All levels of training showed significant improvement in classifying acetabular fractures with 3-D vs 2-D CT, with the greatest benefit from 3-D CT found in junior residents (postgraduate years 1-3).Three-dimensional CT scans can be an effective educational tool for understanding the complex spatial anatomy of the pelvis, learning acetabular fracture patterns, and correctly applying a widely accepted fracture classification system.

  16. Rapid Extremity Pain Relief by Battlefield Acupuncture after Orthopedic Surgery: A Randomized Clinical Trial (United States)


    FINAL REPORT Project Title: Rapid Extremity Pain Relief by Battlefield Acupuncture after Orthopedic Surgery: A Randomized Clinical Trial...prevent adverse effects of sedation and decreased job performance. Auricular acupuncture has been evaluated in multiple trials, and although...generally proven to be useful, these trials were not rigorous. This study seeks to determine if modified Battlefield Acupuncture is more effective at

  17. High energy devices versus low energy devices in orthopedics treatment modalities (United States)

    Schultheiss, Reiner


    The orthopedic consensus group defined in 1997 the 42 most likely relevant parameters of orthopedic shock wave devices. The idea of this approach was to correlate the different clinical outcomes with the physical properties of the different devices with respect to their acoustical waves. Several changes in the hypothesis of the dose effect relationship have been noticed since the first orthopedic treatments. The relation started with the maximum pressure p+, followed by the total energy, the energy density; and finally the single treatment approach using high, and then the multiple treatment method using low energy. Motivated by the reimbursement situation in Germany some manufacturers began to redefine high and low energy devices independent of the treatment modality. The OssaTron as a high energy, single treatment electro hydraulic device gained FDA approval as the first orthopedic ESWT device for plantar fasciitis and, more recently, for lateral epicondylitis. Two low energy devices have now also gained FDA approval based upon a single treatment. Comparing the acoustic data, differences between the OssaTron and the other devices are obvious and will be elaborated upon. Cluster analysis of the outcomes and the acoustical data are presented and new concepts will be suggested.

  18. Orthopedic Surgery in Rural American Hospitals: A Survey of Rural Hospital Administrators (United States)

    Weichel, Derek


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

  19. Pectus excavatum repair from a plastic surgeon's perspective. (United States)

    Schwabegger, Anton H


    Minimally invasive repair of pectus excavatum (MIRPE) or similar procedures for pectus excavatum (PE) repair, nowadays no longer performed by one single speciality, may not always achieve sufficient aesthetic results, particularly in the infrapectoral or infraxiphoidal region. Reasons for this include the diaphragm inhibiting correct positioning of the bars, as well as asymmetric deformities which may still be present after remodelling attempts. Furthermore, some cases develop a mild recurrence or partial concavity once the correction bar is removed. However, any secondary re-do MIRPE procedure remains risky because of adhesions between the pleura, lung, pericardium, thoracic wall as residuals from the primary intervention. Treatment options as secondary correction for these deformities may include open access surgery, resection or reshaping of deformed costal cartilage. Moreover, augmentation of a residual concave area can be achieved by autologous transplantation of resected over-abundant cartilage, as well as by liposhifting or implantation of customized alloplastics. A physician dealing with PE corrections should be familiar with various shaping and complementary reconstructive techniques in order to provide the best options for a variety of expressions of anterior wall deformities. Among treating surgeons, there is an awareness that no single method can be applied for every kind of funnel chest deformity. An appropriate technique, either as a single approach for the ordinary deformities or in conjunction with ancillary procedures for the intricate cases, should be selected carefully based on the heterogeneity of symptoms, severity, expectations and surgical skill in addition to the available equipment. Out of a variety of such ancillary procedures available and based on experience within general plastic reconstructive surgery, some techniques for PE repair are explained and illustrated here with their advantages and disadvantages.

  20. Mesh Plug Repair of Inguinal Hernia; Single Surgeon Experience

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    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.

  1. Why veteran orthopaedic trauma surgeons are being fired and what we can do about it? (United States)

    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.

  2. Action ethical dilemmas in surgery: an interview study of practicing surgeons

    Directory of Open Access Journals (Sweden)

    Nordam Ann


    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.

  3. Understanding the culture of antimicrobial prescribing in agriculture: a qualitative study of UK pig veterinary surgeons (United States)

    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

  4. Enhanced osteoblast adhesion on nanostructured selenium compacts for anti-cancer orthopedic applications

    Directory of Open Access Journals (Sweden)

    Phong Tran


    Full Text Available Phong Tran1, Thomas J Webster21Physics Department; 2Division of Engineering and Department of Orthopedics, Brown University, Providence, USAAbstract: Metallic bone implants possess numerous problems limiting their long-term efficacy, such as poor prolonged osseointegration, stress shielding, and corrosion under in vivo environments. Such problems are compounded for bone cancer patients since numerous patients receive orthopedic implants after cancerous bone resection. Unfortunately, current orthopedic materials were not originally developed to simultaneously increase healthy bone growth (as in traditional orthopedic implant applications while inhibiting cancerous bone growth. The long-term objective of the present research is to investigate the use of nano-rough selenium to prevent bone cancer from re-occurring while promoting healthy bone growth for this select group of cancer patients. Selenium is a well known anti-cancer chemical. However, what is not known is how healthy bone cells interact with selenium. To determine this, selenium, spherical or semispherical shots, were pressed into cylindrical compacts and these compacts were then etched using 1N NaOH to obtain various surface structures ranging from the micron, submicron to nano scales. Changes in surface chemistry were also analyzed. Through these etching techniques, results of this study showed that biologically inspired surface roughness values were created on selenium compacts to match that of natural bone roughness. Moreover, results showed that healthy bone cell adhesion increased with greater nanometer selenium roughness (more closely matching that of titanium. In this manner, this study suggests that nano-rough selenium should be further tested for orthopedic applications involving bone cancer treatment.Keywords: selenium, nano-rough, osteoblast, cancer, chemopreventive

  5. Developing a Minimum Data Set of the Information Management System for Orthopedic Injuries in Iran (United States)

    Ahmadi, Maryam; Mohammadi, Ali; Chraghbaigi, Ramin; Fathi, Taimur; Shojaee Baghini, Mahdieh


    Background: Orthopedic injuries are the most common types of injuries. To identify the main causes of injuries, collecting data in a standard manner at the national level are needed, which justifies necessity of making a minimum data set (MDS). Objectives: The aim of this study was to develop an MDS of the information management system for orthopedic injuries in Iran. Materials and Methods: This descriptive cross-sectional study was performed in 2013. Data were collected from hospitals affiliated with Tehran University of Medical Sciences that had orthopedic department, medical documents centers, legal medicine centers, emergency centers, internet access, and library. Investigated documents were orthopedic injury records in 2012, documents that retrieved from the internet, and printed materials. Records with Random sampling by S22-S99 categories from ICD-10 were selected and the related internet-sourced data were evaluated entirely. Data were collected using a checklist. In order to make a consensus about the data elements, the decision Delphi technique was applied by a questionnaire. The content validity and reliability of the questionnaire were assessed by expert’s opinions and test-retest method, respectively. Results: An MDS of orthopedic injuries were assigned to two categories: administrative category with six classes including 142 data elements, and clinical category with 17 classes including 250 data elements. Conclusions: This study showed that some of the essential data elements included in other country’s MDS or required for organizations and healthcare providers were not included. Therefore, a complete list of an MDS elements was created. Existence of comprehensive data concerning the causes and mechanisms of injuries informs public health policy-makers about injuries occurrence and enables them to take rationale measures to deal with these problems. PMID:25237576

  6. Comparison of temperament and character profiles of anesthesiologists and surgeons : a preliminary study.

    Directory of Open Access Journals (Sweden)

    Mitra S


    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.

  7. Reliable assessment of general surgeons' non-technical skills based on video-recordings of patient simulated scenarios

    DEFF Research Database (Denmark)

    Spanager, Lene; Beier-Holgersen, Randi; Dieckmann, Peter;


    Nontechnical skills are essential for safe and efficient surgery. The aim of this study was to evaluate the reliability of an assessment tool for surgeons' nontechnical skills, Non-Technical Skills for Surgeons dk (NOTSSdk), and the effect of rater training.......Nontechnical skills are essential for safe and efficient surgery. The aim of this study was to evaluate the reliability of an assessment tool for surgeons' nontechnical skills, Non-Technical Skills for Surgeons dk (NOTSSdk), and the effect of rater training....

  8. Bacterial contamination of surgeons' gloves during shunt insertion; a pilot study

    DEFF Research Database (Denmark)

    Sørensen, Preben; Ejlertsen, Tove; Aaen, Dorte


    antibiotics and double gloving, by surgeons experienced in shunt surgery. Surgical incision, dissection and tunnelling were done. Then the surgeon, the scrub-nurse and, in three cases, the assistant made an imprint of their outer gloves on agar plates. Hereafter, they changed the outer pair of gloves before...... cultured from gloves in all 10 operations and coagulase-negative Staphylococci were found in eight operations. These results are preliminary, but nevertheless they are alarming. Despite the use of recommended precautions to avoid infections we found that a substantial numbers of gloves from surgeon, scrub...

  9. [Coats of arms of the Amsterdam Surgeons' Guild in the dome of the Anatomy Theatre]. (United States)

    van Gulik, Thomas M; Ijpma, Frank F A; Middelkoop, Norbert E


    In 1731, Cornelis Troost (1696-1750) painted three wardens of the surgeons' guild in Amsterdam. We know their names from the family coats of arms shown on the wall behind them. The same coats of arms and names are painted in the dome of the Anatomy Theatre in the 'Waag', the former weighing house at the Nieuwmarkt in Amsterdam, which also housed the board room of the surgeons' guild. The 84 coats of arms in the beautifully restored dome are a testimony of the rich history of the surgeons' guild.

  10. The Renaissance and the universal surgeon: Giovanni Andrea Della Croce, a master of traumatology. (United States)

    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.

  11. Implementation and evaluation of a novel research education rotation for Royal College of Physicians and Surgeons emergency medicine residents. (United States)

    Abu-Laban, Riyad B; Jarvis-Selinger, Sandra; Newton, Lana; Chung, Brian


    Royal College of Physicians and Surgeons (RCPS) emergency medicine (EM) residents must complete a scholarly project; however, significant variation exists in Canadian EM resident research education and facilitation. We developed and implemented a novel mandatory research education rotation for RCPS EM residents intended to increase knowledge, faculty/resident collaborations, and, ultimately, scholarly output. This 4-week rotation took place in the fall of 2011 and consisted of 37 faculty-led didactic, critical appraisal, and workshop seminars. Exposure to faculty research and resulting opportunities and the development of resident research projects were integrated into the rotation. Twelve participating residents completed daily evaluations and took part in an exit focus group analyzed using a constant comparative method. Knowledge acquisition was assessed with a pre/post comprehensive examination instrument evaluated by a paired t-test. Evaluations indicated generally high satisfaction throughout the rotation. Focus group analysis indicated that residents felt two important but competing goals existed: developing a research project and developing critical appraisal skills. The research knowledge of all participants improved significantly (mean/SD examination change +35.4%/+10.4%, range +20.0% to +53.6%, p < 0.001), and several new resident/faculty research collaborations arose from the rotation. A rotation of this nature is an efficient and effective means to increase research and critical appraisal knowledge and faculty/resident collaborations. As a result of our positive experience, the rotation will continue annually and has been expanded to include pediatric EM fellows. Longitudinal tracking of the participating trainee cohort will remain ongoing to assess the scholarly output impact of the rotation.

  12. Seeing Oneself in a Book: The Changing Face of Canadian Children's Literature. (United States)

    Bainbridge, Joyce; Fayjean, Janet


    Takes a look at children's literature over time, and its recent emergence as a respected body of literary work. Discusses what is Canadian about Canadian children's literature. Annotates six picture books. Notes that Canadian literature reflects the diversity of the Canadian population, the vast differences in the Canadian landscape, and the…

  13. Committing Canadian sociology: developing a Canadian sociology and a sociology of Canada. (United States)

    Matthews, Ralph


    This paper is a slightly revised version of the author's "Outstanding Career Award Lecture" presented at the Annual Meeting of the Canadian Sociological Association in Victoria, British Columbia on June 6, 2013. The paper distinguishes between Canadian Sociology and the Sociology of Canada. The former involves the explanatory stance that one takes to understanding Canada. The latter addresses the significant social dimensions that underlie Canadian social organization, culture, and behavior. I make a case for a Canadian Sociology that focuses on the unique features of Canadian society rather than adopting a comparative perspective. I also argue that there is a continuing need within the Sociology of Canada to address the issues of staples development. However, I argue that "new" staples analysis must have a directional change from that of the past, in that social processes now largely determine the pattern of staples development. Moreover, new staples analysis must include issues that were never part of earlier staples analysis, such as issues of environmental impacts and of staples depletion under conditions, such as climate change. The paper concludes by analyzing four factors that provide the dominant social contexts for analyzing modern staples development: (1) the rise of neoliberal government, (2) the implementation of globalization and its social consequences, (3) the assumption of aboriginal rights and entitlement, and (4) the rise of environmentalism. These factors were generally not considered in earlier staples approaches. They are critical to understanding the role of staples development and its impact on Canada in the present time.

  14. Canadian petroleum history bibliography. Release update

    Energy Technology Data Exchange (ETDEWEB)

    Cass, D.


    The petroleum history bibliography was created over several years as a record dedicated to preserving the history of the Canadian petroleum industry. It comprises a list of more than 5000 publications, including books, theses, films, audio tapes, published articles and stories of the many companies that have come and gone. It aims to include all publications and audio visual products from the Social Sciences and Humanities on company histories, biographies, autobiographies, fiction, poetry and humour. An author index is included. Most government documents are excluded as they are accessible through Library and Archives Canada. This bibliography is an ongoing piece of work, and welcomes any additions relating to the study and preservation of Canadian petroleum industry history.

  15. Webpages on copyright in Canadian academic libraries

    Directory of Open Access Journals (Sweden)

    Tony G Horava


    Full Text Available Academic libraries value the web as being a vital channel for communicating information and policies to their user community. Designing a webpage on copyright is a challenging task that requires a consideration of the medium and the message. This article proposes a conceptual model and proactive approach for integrating policy objective and goals into the development of a copyright webpage, based on key elements of the library’s involvement in academia. To complement this theoretical approach, an analysis of Canadian academic library websites was conducted in order to gage the effectiveness of copyright webpages, in the Canadian legal context, according to the model as well as related design issues of visibility and access.

  16. Cation Exchange Resins and colonic perforation. What surgeons need to know

    Directory of Open Access Journals (Sweden)

    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.

  17. My Family Health Portrait, A tool from the Surgeon General | NIH MedlinePlus the Magazine (United States)

    ... of this page please turn Javascript on. My Family Health Portrait, A tool from the Surgeon General ... use Why is it important to know my family medical history? Your family medical history is a ...

  18. [The Journey of a Surgeon Begins with a Camera-Holder]. (United States)

    Li, Hui


    The techniques of thoracic surgery has undergone evolutionary changes, and currently video-assisted thoracic surgery (VATS) has already been or is going to be the predominant procedure of various thoracic surgeries. The safe and artistic VATS with high quality is closely associated with the cooperation of camera-holder and the surgeon. If an excellent thoracotomy is the result of perfect integral cooperation of the brain, eyes, hands and the body of the surgeon, the camera-holder in VATS procedure, then, is responsible for the eyes of both the surgeons and himself. This is more meticulous and difficult than that for a single person's brain, eyes, hands and body. Meanwhile, an excellent camera-holder will undoubtedly become an excellent surgeon in the foreseeable future.

  19. Psychological and physical stress among experienced and inexperienced surgeons during laparoscopic cholecystectomy

    DEFF Research Database (Denmark)

    Andersen, Lars Peter Holst; Klein, Mads; Gögenur, Ismail;


    : Surgical procedures are mentally and physically demanding, and stress during surgery may compromise patient safety. We investigated the impact of surgical experience on surgeons' stress levels and how perioperative sleep quality may influence surgical performance....

  20. Recurrences and Ongoing Complaints of Diverticulitis; Results of a Survey among Gastroenterologists and Surgeons

    NARCIS (Netherlands)

    Stam, M. A W; Draaisma, W. A.; Consten, E. C J; Broeders, I. A M J


    Objective: This study aims to investigate the current opinion of gastroenterologists and surgeons on treatment strategies for patients, with recurrences or ongoing complaints of diverticulitis. Background: Treatment of recurrences and ongoing complaints remains a point of debate. No randomized trial