Intraoperative Psoas Compartment Block vs Preoperative Fascia Iliaca Block for Pain Control After Direct Anterior Total Hip Arthroplasty: A Randomized Controlled Trial

Background

Modern joint arthroplasty protocols place an emphasis on minimizing patient-reported postoperative pain while minimizing opioid consumption. The use of multimodal pain management protocols has been reported to improve patient outcomes and satisfaction after total hip arthroplasty.

Impact of Femoral Stem Design on Failure After Anterior Approach Total Hip Arthroplasty

Background

An increased rate of complications related to femoral component failure has been described with less invasive total hip arthroplasty (THA). This study evaluated the incidence of femoral complications associated with the direct anterior approach for THA.

A useful alternative surgical technique to reconstructing large defects following excision of recurrent pilonidal sinus disease in the intergluteal region: An operative approach for the transverse lumbar artery perforator flap

The reconstruction of defects in the intergluteal region following pilonidal sinus excision is challenging due to its anatomical location, close proximity to the anus, and being a high‐tension area prone to wound‐healing problems. Excision and primary closure is known to carry a higher risk of recurrence and subsequent complications compared with using nearby local healthy tissue, such as a flap, to reconstruct defect. Extra due diligence should be given to patient selection and flap choice when deciding the reconstruction of a defect. The senior author, who has briefly reviewed complication rates in previous published literature, prefers the transverse lumbar artery perforator (TLAP) flap for reconstruction following pilonidal sinus excision in the intergluteal region. This paper illustrates the operative approach used by the senior author when raising a TLAP flap.     

Management Strategies for Pain in Breast Carcinoma Patients: Current Opinions and Future Perspectives

Breast cancer is the most frequently encountered carcinoma in women worldwide. Pain is the most distressing symptom in patients with breast carcinoma and can occur at all stages of the disease due to the cancer per se as well as due to various diagnostic and treatment modalities. A proper pain assessment helps in identification of pain syndromes and guides in formulating analgesic strategies. Primary therapies of breast carcinoma like surgery, chemotherapy, and radiotherapy for bony metastases can cause substantial pain relief. However, multimodal analgesic approaches incorporating pharmacological, interventional as well as non-conventional techniques should be employed prior to, in conjunction with, and after primary therapies of breast cancer. The prevalence of chronic neuropathic pain following breast cancer surgery may exceed 50% by current estimates, and with the increase in life expectancy of these patients, providing adequate pain relief is of paramount importance to improve their quality of life. In this review, we discuss prevailing methods of evaluation and management of pain in patients of breast carcinoma and the new techniques that may become the mainstay of pain management protocols in future.     

Lead insertion by supraclavicular approach of the subclavian vein puncture

Total occlusion of the left subclavian vein was diagnosed in a 76-year-old patient, 6 years after implantation of an ICD with VVI pacing backup. Replacement of the ICD included upgrading of the ICD system because of the presence of pacemaker syndrome when the patient was VVI paced. Insertion of an atrial lead through the ipsilateral vein system was made possible by using the supraclavicular approach of the subclavian, enabling puncturing of the left subclavian vein medially to the obstruction.     

"以问题为基础"教学法在康复治疗学专业运动疗法方向教学中的应用分析

作者通过对“以问题为基础”（PBL）教学法与传统教学方法的比较，分析在康复治疗学专业教学中应用PBL教学法的必要性，并探讨对课程的选择以及对教师和学生的具体要求、实施PBL教学方法的具体方案及其应用意义。     

Examining health visiting expertise: combining simulation, interview and observation

BACKGROUND: Resource constraints and the drive towards evidence-based practice are currently prompting the review of health visiting services, which are a costly element of community health services in the United Kingdom. There is a shortage of evidence about effective domiciliary health visiting practice that can inform local and national decisions about developing and reforming this service. AIMS: This paper is based on a study which aimed to articulate the health visiting expertise involved in recognizing and responding to client need during home visits. The paper describes the innovative, multi-method approach used to articulate this expertise, and presents the rationale for this unusual approach. DISCUSSION: The study used the complementary methods of a 20-minute simulated visit to an actress-client, a postsimulation focused interview and subsequent observation of actual home visits with 15 study participants. Data-gathering took place between 2001 and 2002. The rationale, strengths and limitations of the methodology are discussed, and recommendations made for further development based on the work. CONCLUSIONS: The findings confirmed the utility of this unusual combination of methods, with their blend of control and naturalism, for articulating the knowledge and expertise which underpins assessment practice. Further research using a similar approach is recommended for the systematic examination of professional expertise in nursing and multi-disciplinary contexts.     

离断式肾盂成形术手术入路的临床探讨

目的 :探讨经腹入路肾盂成形术的优点及适应证。方法 :对 2 6例 30侧经腹入路及 2 2例 2 4侧经腰入路两种离断式肾盂成形术围手术期临床指标及疗效进行对比观察。结果 :经腹入路手术切口时间、术中输血量、术后 2 4h肾周引流量及胃肠功能恢复时间等方面均优于经腰入路手术。结论 :对未合并肾脏畸形、肾周感染、结石及输尿管远端狭窄的单纯性肾盂输尿管连接部梗阻病人 ,经腹入路肾盂成形术优于经腰入路肾盂成形术     

两种不同入路在人工耳蜗植入术中的比较

目的:比较上鼓室径路和后鼓室径路进行人工耳蜗埴入术的异同,便于选择更合适的方法完成该手术。方法:在手术中分别使用两种方法对6例患者进行人工耳蜗植入术。结果:两种方法均能达到植入人工耳蜗的目的,比较起来上鼓室径路手术困难和风险相对较小。结论:上鼓室径路避免了对鼓索神经和面神经的损害,使手术更为简便易行。