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At least 1,117 records · Page 62Linked to original sources
PubMed2005

[Development and application of a computerized nursing process program for orthopedic surgery inpatients-- NANDA, NOC, and NIC linkages].

PURPOSE: The purpose of this study was to develop and to apply the NANDA, NOC, and NIC (NNN) linkages into a computerized nursing process program using the classification systems of nursing diagnoses, nursing outcomes and nursing interventions. METHOD: The program was developed with planning, analysis, design and performance stages. The program was applied to 117 patients who were admitted to orthopedic surgery nursing units from January to February, 2004. RESULTS: Thirty-five of fifty-three nursing diagnoses were identified. Five nursing diagnoses in order of frequency were: Acute pain (28.4%), Impaired physical mobility (15.6%), Impaired walking (8.7%), Chronic pain (5.5%) and Risk for disuse syndrome (5.0%). The nursing outcomes of the 'Acute pain' nursing diagnosis tended to have higher frequencies (cumulative) in order of Pain management (95.2%), Comfort level (35.5%) and Pain level (17.7%). The nursing interventions of the 'Acute pain' nursing diagnosis tended to have higher frequencies (cumulative) in order of Pain management (71.0%), Splinting (24.2%) and Analgesic administration (17.7%). In comparison of outcome indicator scores between before and after the intervention according to the 61 nursing outcomes, the mean scores of 52 outcome indicators after the intervention were significantly higher than before the intervention. CONCLUSION: It is expected that this program will help nurses perform their nursing processes more efficiently.

Adult↗
PubMed1997

Effect of age, gender, and platelet count on Sonoclot coagulation analysis in patients undergoing orthopedic operations.

OBJECTIVE: To assess the relationship between Sonoclot coagulation variables and age, gender, or platelet count in surgical patients without coagulation disorders. MATERIAL AND METHODS: This study included 136 patients undergoing orthopedic surgical procedures under spinal or epidural anesthesia. Whole blood was withdrawn preoperatively from each patient, and a Sonoclot analysis was performed within 2 minutes after the sample was obtained. The Sonoclot results were considered investigational and not used in the perioperative management of the patients. Variables from the Sonoclot graphs were analyzed statistically to determine any associations with age, gender, or platelet count. RESULTS: The Sonoclot baseline height was decreased in patients with lower hemoglobin levels, older age, and female gender. The upward slope from baseline to inflection (R1) was increased in female patients and older patients. In comparison with patients who had lower platelet counts, patients with higher platelet counts exhibited a shorter time to inflection, increased upward slope from inflection to peak (R2), shorter time to peak, increased downward slope from peak to plateau (R3), decreased time to plateau, and lower plateau height (P < or = 0.01 for all relationships). CONCLUSIONS: Sonoclot coagulation analysis reliably evaluates platelet count as an indicator of platelet function. Controlled studies are needed to examine the clinical usefulness of Sonoclot coagulation analysis in the diagnosis and treatment of perioperative coagulopathies and hemorrhagic complications.

Adult↗
PubMed2003

Investigations of the immunoglobulin subtype transformation of anti-heparin-platelet factor 4 antibodies during treatment with a low-molecular-weight heparin (clivarin) in orthopedic patients.

CONTEXT: It is now widely accepted that the pathophysiology of heparin-induced thrombocytopenia (HIT) syndrome is mediated by the generation of a wide array of functional and molecularly heterogeneous anti-heparin-platelet factor 4 (AHPF4) antibodies that may mediate platelet and/or endothelial cell activation/destruction. OBJECTIVE: We investigated the differential prevalence and functionality of AHPF4 immunoglobulin subtypes (IgA, IgG, and IgM) in plasmas obtained from orthopedic patients immobilized with Plaster-Cast and treated with clivarin (a low-molecular-weight heparin) in comparison to a placebo for the prophylaxis of deep-vein thrombosis. DESIGN AND METHODS: Clivarin was administered subcutaneously at a fixed daily dosage of 1750 U without any adjustment or loading dosage. Citrated plasmas were obtained at baseline, at 10 to 14 days, and at postbrace procedure (5-12 weeks). An enzyme-linked immunosorbent assay (ELISA) was used to quantitate the AHPF4 antibody titers. The functionality of the ELISA-positive samples was determined by a 14C-serotonin release assay (SRA). RESULTS: In the ELISA test, 16 of 1073 samples (1.5%; 6 in clivarin and 10 in placebo groups) were positive for AHPF4 antibodies (mean optical density [OD] = 0.46 +/- 0.02). None of the ELISA-positive samples for AHPF4 antibodies could mediate platelet activation responses as determined by the SRA (0%-3% serotonin release, P >.10, n = 16). Through differential immunoglobulin subtype analysis of the samples positive for (cumulative) AHPF4 antibodies, we determined that their relative prevalence in plasma were as follows: IgM (mean OD = 0.71 +/- 0.13) > IgG (0.31 +/- 0.08) > IgA (0.14 +/- 0.02). Although there was no significant difference in the total antibody titers between clivarin and placebo groups, the antibody subtyping data showed conversion trends (ie, IgA [clivarin to placebo], IgG [placebo to clivarin], and IgM [clivarin to placebo]). CONCLUSION: These observations indicate that even at reduced dosages, clivarin can shift the immunogenic up-regulation toward the IgG subpopulation; however, the IgG subtype is of a nonfunctional type of AHPF4 antibody and thus may not cause any HIT-related pathogenic responses.

Adolescent↗
PubMedDate not supplied

Analgesic efficacy of preoperative parecoxib sodium in an orthopedic pain model.

The efficacy and safety of preoperative intravenous administration of parecoxib sodium, a novel parenteral prodrug of a cyclooxygenase-2 selective inhibitor, in treating postoperative pain resulting from bunionectomy were evaluated in 50 patients who were part of a larger cohort of orthopedic and podiatric patients. Following bunionectomy, the median time to rescue medication (survival analysis) was 4 hours 18 min (95% confidence interval, 3 hours 4 min to 4 hours 37 min) in the placebo group, 7 hours 5 min (95% confidence interval, 3 hours 20 min to >24 hours) in the 20-mg parecoxib sodium group, and 10 hours 43 min (95% confidence interval, 4 hours 42 min to 14 hours 7 min) in the 40-mg parecoxib sodium group (significant for 40-mg parecoxib sodium versus placebo). Four or more hours after surgery, the mean pain-intensity (categorical) score was significantly lower in both parecoxib sodium groups than in the placebo group. Preoperative administration of parecoxib sodium was well tolerated and significantly reduced postoperative pain in patients who had undergone bunionectomy.

Adolescent↗
PubMed1999

[Vascular diseases in orthopedic practice].

From 1.4.1995 to 30.3.1997 1861 patients had been treated in orthopedic practice. In 52 cases deep vein thrombosis was detected. We found severe varicosis in 169 legs. A complete occlusion of the arteria femoralis superficialis or arteria popliteal was found in 16 legs, an aneurysm of the femoral or popliteal artery was seen in 5 legs.

Aneurysm↗
PubMed1998

[New methods on the subject of peroperative neurophysiological monitoring in vascular and orthopedic surgery].

The neurological and neuropsychological complications of vascular and orthopedic surgery can be prevented by the early detection of the ischemic penumbra, that is, the stage at which the ischemic nervous structures are no more functional, but still alive and salvageable by reperfusion. This can be achieved by intraoperative neuromonitoring of the electroencephalogram and evoked potentials. We illustrate how these techniques led to improvement of the surgical strategy and patient outcome in carotid endarterectomies, descending aorta surgery and surgery performed under deep hypothermic circulatory arrest.

Aorta, Thoracic↗
PubMed1992

Computer-assisted planning for orthopedic surgery.

Faced with challenging deformities and crippling arthritis, orthopedic surgeons frequently are called upon to perform increasingly complex reconstructive surgery. The desired goals of treatment include correction of deformities, relief of pain, and preservation or restoration of function.

Computer Simulation↗
PubMedDate not supplied

Analgesic efficacy and safety of two oral controlled-release morphine preparations in orthopedic postoperative pain.

This single-dose, double-blind, randomized, parallel-group study compared the analgesic efficacy and safety of MS Contin (MSC) and Oramorph SR (OSR), two controlled-release preparations of oral morphine sulfate, in patients following orthopedic surgery. One hundred patients received MSC 30 mg, MSC 60 mg, or OSR 60 mg (two 30-mg tablets) when postoperative pain became moderate or severe. Patients self-rated pain intensity and relief on categorical (CAT) and visual analogue scales (VAS) hourly for up to 12 hours. MSC 60 mg produced the greatest peak analgesic effect and was more efficacious than OSR 60 mg through the sixth hour, with statistical significance achieved at 1, 2, and 3 hours postdosage. Compared with OSR 60 mg, both MSC dosages provided significantly more rapid times to peak effect by CAT and VAS ratings. The OSR group experienced almost twice as many adverse events as did the two MSC groups and also reported somnolence and dizziness more frequently. MSC 60 mg provided more rapid and greater peak analgesia with fewer adverse effects than did OSR 60 mg.

Administration, Oral↗
PubMed1996

Capitation and orthopedic services.

One method of regulating healthcare costs is through capitaiton--a per-member per-month reimbursement to the provider of services. While there are many different entities affected by the capitation process, this article focuses predominantly on the hospital side of the equation as it relates to the delivery of orthopedic services.

Capitation Fee↗
PubMed1997

Differences in costs of treatment for foot problems between podiatrists and orthopedic surgeons.

We examined charge data for health insurance claims paid in 1992 for persons under age 65 covered by a large California managed care plan. Charge and utilization comparisons between podiatrists and orthopedic surgeons were made for all foot care and for two specific foot problems, acquired toe deformities and bunions. Podiatrists provided over 59% of foot care services for this commercial population of 576,000 people. Podiatrists charged 12% less per individual service than orthopedists. However, podiatrists performed substantially more procedures per episode of care and treated patients for longer time periods, resulting in 43% higher total charges per episode. Hospitalization was infrequent for all providers, although podiatrists had the lowest rates. In a managed care setting in which all providers must adhere to a preestablished fee schedule, regardless of specialty, the higher utilization by podiatrists should lead to higher overall costs. In some cases, strong utilization controls could offset this effect. We do not know if the utilization difference is due to actual treatment or billing differences. Further, we were unable to determine from the claims data if one specialty had better outcomes than the other.

Blue Cross Blue Shield Insurance Plans↗
PubMed1999

Sequential irrigation with common detergents: a promising new method for decontaminating orthopedic wounds.

This investigation sought to determine the capacity of irrigation solutions in decontaminating orthopedic wounds challenged with a polymicrobial inoculum. Rats were divided into two groups, a control group and a treatment group. After creation of a dorsolumbar incision and placement of a wire through the spinous process, rats were inoculated with Staphylococcus aureus and Pseudomonas aeruginosa. Wounds were irrigated with control or treated solutions. At 2 weeks, cultures were obtained. There were statistically significant differences between groups regarding total number of culture positive sites (P < 0.001), culture-positive animals (P = 0.02), and quantitative cultures (P < 0.02). Sequential irrigation with surfactants lowers bacteria counts recovered from polymicrobial wounds.

Analysis of Variance↗
PubMed1999

Imaging techniques for evaluation of postoperative orthopedic infections.

Labeled leukocyte scintigraphy is the preferred imaging technique for the evaluation of suspected postoperative orthopedic infections. Labeled leukocyte localization returns to a normal pattern faster than MRI after bone trauma, surgical procedures, and treatment of osteomyelitis. 99mTc HMPAO labeled leukocyte scintigraphy is useful, particularly in children, because less peripheral blood volume is required for labeling. However, delayed 16-20 hour imaging is usually needed to detect low-grade osteomyelitis, and 111In WBC usually provides better images in adults. Combined 111In WBC/99mTc sulfur colloid marrow images improve the specificity for detection of osteomyelitis in regions containing active bone marrow. Simultaneous 111In leukocyte/99mTc bone SPECT imaging is usually necessary in regions such as the skull, spine, and hips, where there is overlapping bone, and soft tissues.

Bone and Bones↗
PubMed1999

[30 years of computer-based clinical documentation at the Heidelberg University Orthopedic Clinic. From basic documentation to medical controlling].

An overview of the 30 years history and development of documentation and information systems in the Orthopedic University Hospital Heidelberg is presented. Since the foundation in 1967 four developmental phases can be described: first initiatives of medical doctors, establishment of a basic documentation system for scientific purposes, strategic information system planning and realisation of information systems with the possibility of controlling in medical areas and thereby steering of the services. Planning and realisation were accomplished within the framework of the masterplans and concepts of the university clinics of the state of Baden-Württemberg.

Academic Medical Centers↗
PubMed1999

[Nicolas Andry (1658-1742) inventor of the term "orthopedics"].

Nicolas Andry was born in 1658 in Lyons, France, and had a long Parisian career. He wrote a book entitled "L'orthopédie ou l'art de prévenir et de corriger dans les enfants les difformités du corps" just before his death, which was the first to use the term orthopedics.

France↗
PubMed1999

Bone dysplasias in orthopedic practice.

The paper presents a review of rare but important orthopedic diseases--osteochondrodysplasias. The authors stress both the clinical and radiological variety of these deformations. Some kinds of osteochondrodysplasia are clearly defined clinical entities, while in other cases the clinical presentation is so variable that it is very difficult to make a diagnosis. Accurate diagnosis is very important in order to assess the inheritance pattern, clinical course and possible complications. Clinical and radiological examination are the cornerstones in making a diagnosis. The paper contains a list of radiograms necessary for a correct diagnosis. In many cases the diagnostic process must include highly specific biochemical and genetic tests.

Diagnosis, Differential↗
PubMed1999

[How great is the need for ambulatory rehabilitation in the orthopedics field?--Results of a multi-perspective approach].

Despite the necessity to expand the outpatient rehabilitation system in Germany the development up to now must be described as quite reluctant. As yet there is a considerable lack of information about the demand for such care in Germany. On the basis of a complex study design insurants, applicants for medical rehabilitation, physicians in a rehabilitation hospital and general practitioners were asked how they estimated the demand for outpatient orthopedic rehabilitation care. Resulting data unanimously show a substantial demand in roughly one third of insurants who desire rehabilitation, clearly exceeding the already realized outpatient care. The investigation also illustrated that physicians often are uncertain as to their decisions and that depending on the respective point of view (insurants or different groups of physicians) there are different preferences as to the kind of rehabilitative care for the benefit of one specific patient. The results stress not only the fact that there is a demand for information of insurants and their referring physicians regarding the new outpatient rehabilitation offer, but also reveal the demand for a development of differential indication criteria for outpatient and inpatient rehabilitation, as well as for definite procedural regulations which should be harmonized among all insurers.

Adult↗