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Biomedical subjects

S Banks

Publications and source records attributed to S Banks.

At least 19 recordsLinked to original sources
PubMed2005

Kinematics of posterior cruciate ligament-retaining and -substituting total knee arthroplasty: a prospective randomised outcome study.

We performed a prospective, randomised trial of 44 patients to compare the functional outcomes of a posterior-cruciate-ligament-retaining and posterior-cruciate-ligament-substituting total knee arthroplasty, and to gain a better understanding of the in vivo kinematic behaviour of both devices. At follow-up at five years, no statistically significant differences were found in the clinical outcome measurements for either design. The prevalence of radiolucent lines and the survivorship were the same. In a subgroup of 15 knees, additional image-intensifier analysis in the horizontal and sagittal planes was performed during step-up and lunge activity. Our analysis revealed striking differences. Lunge activity showed a mean posterior displacement of both medial and lateral tibiofemoral contact areas (roll-back) which was greater and more consistent in the cruciate-substituting than in the cruciate-retaining group (medial p < 0.0001, lateral p = 0.011). The amount of posterior displacement could predict the maximum flexion which could be achieved (p = 0.018). Forward displacement of the tibiofemoral contact area in flexion during stair activity was seen more in the cruciate-retaining than in the cruciate-substituting group. This was attributed mainly to insufficiency of the posterior cruciate ligament and partially to that of the anterior cruciate ligament. We concluded that, despite similar clinical outcomes, there are significant kinematic differences between cruciate-retaining and cruciate-substituting arthroplasties.

Aged↗
PubMed2004

The influence of tibial slope on maximal flexion after total knee arthroplasty.

Many surgeons believe that increasing the tibial slope in total knee arthroplasty (TKA) is beneficial with regard to maximal postoperative flexion. Review of the clinical literature, however, does not confirm this hypothesis, neither does it give an answer to the question of how much flexion gain can be expected per degree extra tibial slope. The purpose of this study was, therefore, to evaluate and quantify the influence of tibial slope on maximal postoperative flexion in contemporary posterior cruciate ligament (PCL)-retaining TKA. Twenty-one cadaver simulations of a standard PCL-retaining TKA were studied while reproducing identical deep flexion femorotibial kinematics as documented by three-dimensional computer-aided videofluoroscopy from patients with well-functioning TKAs of the same design. In each knee the tibial component was consecutively implanted with 0 degrees posterior slope, 4 degrees posterior slope, and 7 degrees posterior slope. Maximal flexion was recorded for each configuration. Average maximal flexion at 0 degrees tibial slope was 104 degrees, and increased significantly to 112 degrees when the same knees were implanted with 4 degrees tibial slope. Increasing the slope further to 7 degrees again significantly improved average maximal flexion to 120 degrees. When postoperative radiographic tibial slope was compared to maximal flexion, an average gain of 1.7 degrees flexion for every degree extra tibial slope was noted. Increasing the tibial slope in PCL-retaining TKA does indeed improve maximal flexion before tibial insert impingement occurs against the femoral bone. The surgeon can expect an average gain of 1.7 degrees flexion for every degree extra tibial slope.

Arthroplasty, Replacement, Knee↗
PubMed2002

Fluoroscopic analysis of the kinematics of deep flexion in total knee arthroplasty. Influence of posterior condylar offset.

Our purpose was to determine the mechanism which allows the maximum knee flexion in vivo after a posterior-cruciate-ligament (PCL)-retaining total knee arthroplasty. Using three-dimensional computer-aided design videofluoroscopy of deep squatting in 29 patients, we determined that in 72% of knees, direct impingement of the tibial insert posteriorly against the back of the femur was the factor responsible for blocking further flexion. In view of this finding we defined a new parameter termed the 'posterior condylar offset'. In 150 consecutive arthroplasties of the knee, the magnitude of posterior condylar offset was found to correlate with the final range of flexion.

Arthroplasty, Replacement, Knee↗
PubMed2001

A five-year population study of persons involved in the mental health and local correctional systems: implications for service planning.

This study investigates the relationship between recipients of mental health services and incarceration within local jails. The analyses showed that male and female recipients of mental health services are incarcerated in local jails at a higher rate than the general community but that most are not long-term incarcerations. The study further showed that the rate of incarceration for recipients of mental health services decreases with age but the relative risk of incarceration, when compared with the general population, actually increases with age. In addition, across all age groups female recipients of mental health services were found to be at greater risk of incarceration than male recipients.

Adult↗
PubMed2001

A retrospective study of clubhouse-based transitional employment.

This study of clubhouse-based transitional employment (TE) examined the ability of demographic data, diagnosis, and data on TE participation to predict TE tenure and a one-year competitive employment outcome following TE among clubhouse members. Baseline data on 138 club members who participated in TE over a 6-year period were retrospectively retrieved from a computerized database and written records. Most of the jobs held by members were maintenance or production jobs; members' average tenure on TE was 131.26 days. Older members, those with a longer club membership before their last TE job, and those working more days per week had longer average tenure on TE. Average tenure was unrelated to the severity of disability. Forty-two (30.4%) members obtained competitive employment in the one year following their last TE job. Members who worked more total hours on TE were more likely to obtain competitive employment. While aspects of the TE experience predict the move to competitive employment, further studies are needed.

Adult↗
PubMed2001

An audit of accidental dural puncture during epidural insertion of a Tuohy needle in obstetric patients.

We report a prospective audit of 100 parturients who experienced accidental dural puncture by a Tuohy needle, while attending a tertiary referral obstetric unit during the period 1993-1999. The post dural puncture headache rate was 81% and the diagnosis of dural puncture was delayed until presentation of the headache in 27% of these cases. The incidence of unrecognised dural puncture was not influenced by the technique used for identification of the epidural space. Intraspinal opioid administration after dural puncture was associated with a significant reduction in the incidence of headache (P < 0.04). There was no association between mode of delivery and post dural puncture headache. Deliberate cannulation of the subarachnoid space with an epidural catheter at the time of dural puncture, for continuous spinal analgesia or anaesthesia, did not affect the incidence of post dural puncture headache but was associated with a significantly reduced rate of epidural blood patch (43% versus 80%, P < 0.01). Of those who developed post dural puncture headache, 48% were classified 'severe' and in 49% the headache presented within 24 h of dural puncture. There was a trend to earlier onset of headache (either immediate or within 24 h) when the epidural identification technique was loss-of-resistance to air rather than saline (54% versus 33%, P = 0.07). Twenty-eight percent of those suffering from post dural puncture headache were treated expectantly and 72% received a therapeutic blood patch. Of seven parturients who received sumatriptan, six found it ineffective and five subsequently received a blood patch.

Journal Article↗
PubMed2001

An audit of epidural blood patch after accidental dural puncture with a Tuohy needle in obstetric patients.

We report the results of a prospective audit of accidental dural puncture in 100 obstetric patients in a single tertiary referral institution during the period 1993 to 1999. The post dural puncture headache rate was 81%. Of the 81 parturients with post dural puncture headache, 58 (72%) received a therapeutic epidural blood patch, using 7 to 25 mL of autologous blood. After the initial blood patch, complete relief of headache was obtained in 67% and complete or partial relief in 95%. However, severe headache returned in 31% and 28% received more than one blood patch. The incidence of complete relief of headache with one blood patch or more was 50%, with 38% achieving partial relief and 12% having unrelieved headache. There was no significant association between volume of blood used for blood patch and success rate. The initial rate of resolution of headache did not differ significantly between parturients receiving a blood patch within 48 h of dural puncture and after 48 h (P =0.70). However, in the former group, the incidence of recurrent headache was significantly higher (59% versus 11%, P<0.001).

Journal Article↗
PubMed2001

A portable, disposable device for patient-controlled epidural analgesia following Caesarean section: evaluation by patients and nurses.

Twenty patients undergoing elective Caesarean section were provided with a pethidine-primed disposable Go Medical epidural infuser for postoperative pain control. Patients and nurses evaluated the device by completing a questionnaire. The infuser delivered adequate analgesia, was easy to understand and use, provided the patients with control over their pain relief and allowed good mobility The nursing staff found the device easy to prime and understand, the only drawback being the occasional incidence of equipment failure. The patients expressed a high level of satisfaction with the device and all would use it again if offered the chance. We conclude that the Go Medical epidural infuser is a safe and effective device as used in the postnatal ward setting.

Adult↗
PubMed2001

Clinical factors related to admission and release decisions in psychiatric emergency services.

OBJECTIVE: The purpose of the study was to identify important clinical variables that influence admission and release decisions in psychiatric emergency services. METHODS: Physicians at four urban psychiatric emergency services rated 465 patients on ten clinical dimensions, including depression and psychosis. Information on five other variables-age, gender, ethnicity, diagnosis, and previous inpatient admission-were extracted from the patients' charts, as was information on case disposition. RESULTS: Logistic regression produced a model with five variables that significantly predicted admission or release. In order of importance, they were level of danger to self, severity of psychosis, ability to care for self, impulse control, and severity of depression. The model explained 51 percent of the variance in case disposition and correctly classified 84 percent of the cases. CONCLUSIONS: Guidelines addressing the variables that should be considered in making disposition decisions in psychiatric emergency services should be developed. The study found five variables that should be considered for inclusion.

Adult↗
PubMed2000

A classification tree approach to the development of actuarial violence risk assessment tools.

Since the 1970s, a wide body of research has suggested that the accuracy of clinical risk assessments of violence might be increased if clinicians used actuarial tools. Despite considerable progress in recent years in the development of such tools for violence risk assessment, they remain primarily research instruments, largely ignored in daily clinical practice. We argue that because most existing actuarial tools are based on a main effects regression approach, they do not adequately reflect the contingent nature of the clinical assessment processes. To enhance the use of actuarial violence risk assessment tools, we propose a classification tree rather than a main effects regression approach. In addition, we suggest that by employing two decision thresholds for identifying high- and low-risk cases--instead of the standard single threshold--the use of actuarial tools to make dichotomous risk classification decisions may be further enhanced. These claims are supported with empirical data from the MacArthur Violence Risk Assessment Study.

Actuarial Analysis↗
PubMed2000

Bed closures and incarceration rates among users of Veterans Affairs mental health services.

OBJECTIVE: This study examined incarceration rates of users of Department of Veterans Affairs (VA) mental health services in 16 northeastern New York State counties between 1994 and 1997-a time of extensive bed closures in the VA system-to determine whether incarceration rates changed during this period. METHODS: Data were obtained for male patients who used inpatient and outpatient VA mental health services between 1994 and 1997 and for men incarcerated in local jails during this period. For comparison, services use and incarceration data were obtained for all men who received inpatient behavioral health care at community general hospitals and state mental hospitals between 1994 and 1996 in the same counties. Probabilistic population estimation, a novel statistical technique, was employed to evaluate the degree of overlap between clinical and incarceration populations without relying on person-specific identifiers. RESULTS: Of all male users of VA mental health services between 1994 and 1997, a total of 15.7 percent-39.6 percent of those age 18 to 39 years and 9.1 percent of those age 40 years and older-were incarcerated at some time during that period. Dual diagnosis patients had the highest rate of incarceration (25 percent), followed by patients with substance abuse problems only (21 percent) and those with mental health problems only (11 percent). The rate of incarceration among male patients hospitalized in VA facilities was lower than among men in general hospitals or state hospitals (11.6 percent, 23 percent, and 21.7 percent, respectively), but was not significantly different. No significant increase occurred in the annual rate of incarceration among VA patients from 1994 to 1997 (3.7 percent to 4 percent), despite extensive VA bed closures during these years. CONCLUSIONS: Substantial proportions of mental health system users were incarcerated during the study period, especially younger men and those with both substance use and mental health disorders. Rates of incarceration were similar across health care systems. The closure of a substantial number of VA mental health inpatient beds did not seem to affect the rate of incarceration among VA service users.

Adolescent↗
PubMed2000

Integration tutorials and seminars: examining the integration of academic and fieldwork learning by student occupational therapists.

This paper, the second of two companion papers, describes a collaborative research study conducted by academic and fieldwork educators of an undergraduate educational programme in occupational therapy. The study examined the perception of student occupational therapists' ability to integrate and apply academic and theoretical knowledge in fieldwork education sites following the introduction of Integration Tutorials and Seminars to the curriculum. The literature review supports the need to develop educational strategies to improve this integration process. The qualitative research design consisted of guided interviews with preceptors and students during two consecutive fieldwork education experiences. Inductive data analysis revealed three themes that contribute to understanding students' ability to integrate academic learning during their fieldwork education: the fieldwork learning environment; preceptor influence on student learning; and the student learning process over time. The discussion section raises implications for academic and fieldwork education approaches.

Adult↗
PubMed2000

Interprofessional learning modules at Dalhousie University.

Interprofessional education has been advocated to improve teamwork in the health sector. This paper reports on the first two years of operational experience by a School of Health Services Administration (SHSA) with three-hour interprofessional learning modules (IPLMs). SHSA students participated along with students from nursing, medicine, social work, physiotherapy, occupational therapy, pharmacy, speech language pathology, audiology, dental hygiene, dentistry, leisure studies, health education and kinesiology. The five IPLMs required for SHSA students were: professional roles and values, integrity in scholarly activity, disability, interpersonal violence and HIV/AIDS. This article describes the development, delivery and evaluation of these modules from an SHSA perspective. The IPLMs' evaluation findings indicated that IPLMs are worthwhile, but have taken years and ongoing senior management support to operationalize; inclusion of health services administration is worthwhile but challenging; vigilance is needed to retain an IP rather than module content focus; and faculty and facilitator development, along with student preparation and debriefing, is required. Student feedback was favourable; faculty members have gained by their involvement; and field practitioner support has been sustained. Evaluation and reflection are critical to IPLM evolution. The norms, strengths and constraints of the university must be taken into account, and thus IPLMs must be adapted for each educational setting. Schools of health services administration must decide whether they wish to be involved in interprofessional learning.

Allied Health Personnel↗
PubMed1999

Culturing and bioassay testing of Daphnia magna using Elendt M4, Elendt M7, and COMBO media.

A performance-based, tiered approach was used to evaluate survival, growth, and reproduction of Daphnia magna in three selected synthetic media: Elendt M4, Elendt M7, and COMBO. Both Elendt M4 and Elendt M7 are high-hardness media currently recommended for Organization for Economic Cooperation and Development (OECD) testing. COMBO is a softer medium similar in total hardness to natural water found in the environment. Tier I consistent of an acclimation phase; Tier II involved a 21-day evaluation of survival, growth, and reproduction; and Tier III used each medium in a 21-day chronic study using a reference toxicant, 3,4-dichloroaniline (3,4-DCA). The evaluation of the performance of each medium was based on acceptance criteria similar to those used by the U.S. Environmental Protection Agency and the European Commission. Tests were run concurrently at three laboratories to assess interlaboratory variability. Daphnids were acclimated to the media for less than 1 month. Daphnid performance in all media exceeded the European Economic Community (EEC) validity criteria; however, reproductive performance and growth were significantly greater in the Elendt media than in COMBO. 3,4-DCA exerted more toxicity to daphnids in COMBO medium [no-observed-effect concentration (NOEC), <3.1microg/liter] compared with those in the Elendt media (NOEC, </=8.8 microg/liter). Elendt M7 medium provided the most consistent NOECs between laboratories (3. 1-8.8 microg/liter). However, results from two of three laboratories indicated decreases in fecundity over time in all media. The use of synthetic media for long-term culturing and bioassay testing of D. magna is still in question.

Animals↗
PubMed1999

Comparison of MicroScan MICroSTREP, PASCO, and Sensititre MIC panels for determining antimicrobial susceptibilities of Streptococcus pneumoniae.

The MicroScan MICroSTREP MIC panel was compared with PASCO and Sensititre systems against 157 isolates of Streptococcus pneumoniae chosen to include penicillin-susceptible, intermediate, and resistant strains. Arbitration testing was performed by microbroth dilution using National Committee for Clinical Laboratory Standards guidelines. Overall essential agreement of 94-97% and categorical agreement of 91-94% with the reference method was achieved for the three systems. There were 8 very major errors (false susceptibility) for PASCO, 10 for Sensititre, and 9 for MICroSTREP; 4 major errors (false resistance) each for PASCO and MICroSTREP, and 6 for Sensititre. Most of these errors occurred with trimethoprim/sulfamethoxazole. Minor errors (susceptible or resistant versus intermediate) totaled 47 for PASCO, 69 for Sensititre, and 53 for MICroSTREP. Minor interpretive errors were most common with penicillin and ceftriaxone. This study showed that all three MIC panels provided interpretive results comparable to one another and to the reference method.

Adult↗
PubMed1999

Educating nursing assistants to communicate more effectively with nursing home residents with dementia.

This article describes the development and evaluation of a Nursing Assistant Communication Skills Program (NACSP). NACSP was designed to help nursing assistants (NAs) interact more effectively with nursing home residents with moderate and severe dementia. In two skilled-care nursing homes, NAs in four units were randomly assigned by unit to NACSP or to a wait-list control condition (UC) and were assessed at baseline, 3 months, and 6 months. NACSP resulted in improvement in the well-being of nursing home residents being cared for by NAs who had received the NACSP training. It was also found that NACSP resulted in greater knowledge of caregiving responses and reduced turnover rates among NAs, but the program had no impact on their knowledge of dementia. To disseminate the NACSP program, a leader manual, an accompanying training videotape, and a workbook for participants were developed.

Adult↗