The causes of total knee arthroplasty failure: Avoiding your next revision

This article is a personal retrospective of the author׳s more than 35 years of experience as an arthroplasty surgeon and specifically addresses how to avoid revision total knee arthroplasty.

• 1.Avoid revision surgery if the patient is satisfied, unless imminent danger of prosthetic failure appears.
• 2.Use proper technique at the primary arthroplasty to avoid the problems of aseptic loosening, instability, malalignment, and infection that force most revisions. Scrupulous attention to detail in patient selection and operative technique at the primary surgery will help avert revision surgery.
• 3.Remember that surgical technique is prosthesis specific. Understanding the design and insertion philosophy of each implant is crucial to success; every implant system is different.
• 4.Strive to understand the underlying reason that an arthroplasty has failed to make a patient satisfied and fix the problem at revision. If the reason for revision is unclear, it is unlikely that surgery will make the patient better.
• 5.Avoid revision surgery if the problem is pain with no identifiable, surgically correctable problem.
• 6.Maintain strict selection criteria for obese patients, who have higher prevalence of problems that can lead to total knee revision. Surgeons who operate on obese patients likely will have more revision cases. Often, however, obese patients have gratifying results in terms of pain relief and improved function.

     

The Effect of Radiation on Complication Rates and Patient Satisfaction in Breast Reconstruction using Temporary Tissue Expanders and Permanent Implants

The optimal method of reconstruction following mastectomy for breast cancer patients receiving radiation therapy (RT) is controversial. This study evaluated patient satisfaction and complication rates among patients who received implant‐based breast reconstruction. The specific treatment algorithm analyzed included patients receiving mastectomy and immediate temporary tissue expander (TE), followed by placement of a permanent breast implant (PI). If indicated, RT was delivered to the fully expanded TE. Records of 218 consecutive patients with 222 invasive (85%) or in situ (15%) breast lesions from the Salt Lake City region treated between 1998 and 2009 were retrospectively reviewed, 28% of whom received RT. Median RT dose was 50.4 Gy, and 41% received a scar boost at a median dose of 10 Gy. Kaplan–Meier analyses were performed to evaluate the cumulative incidence of surgical complications, including permanent PI removal. Risk factors associated with surgical events were analyzed. To evaluate cosmetic results and patient satisfaction, an anonymous survey was administered. Mean follow‐up was 44 months (range 6–144). Actuarial 5‐year PI removal rates for non‐RT and RT patients were 4% and 22%, respectively. On multivariate analysis (MVA), the only factor associated with PI removal was RT (p = 0.009). Surveys were returned describing the outcomes of 149 breasts. For the non‐RT and RT groups, those who rated their breast appearance as good or better were 63% versus 62%, respectively. Under 1/3 of each group was dissatisfied with their reconstruction. RT did not significantly affect patient satisfaction scores, but on MVA RT was the only factor associated with increased PI removal. This reconstruction technique may be considered an acceptable option even if RT is needed, but the increased complication risk with RT must be recognized.     

A Three‐wave Study of Antecedents of Work–Family Enrichment: The Roles of Social Resources and Affect

On the basis of conservation of resources theory (Hobfoll, 1989 ) and the resource‐gain‐development perspective (Wayne, Grzywacz, Carlson, & Kacmar, 2007 ), this paper examines the differential impact of specific social resources (supervisory support and family support) on specific types of affect (job satisfaction and family satisfaction, respectively), which, in turn, influence work‐to‐family enrichment and family‐to‐work enrichment, respectively. A sample of 276 Chinese workers completed questionnaires in a three‐wave survey. The model was tested with structural equation modelling. Job satisfaction at time 2 partially mediated the relationship between time 1 supervisory support and time 3 work‐to‐family enrichment (capital), and the effect of supervisory support on work‐to‐family enrichment (affect) was fully mediated by job satisfaction. Family satisfaction at time 2 fully mediated the relationship between time 1 family support and time 3 family‐to‐work enrichment (affect, efficiency). Implications for theory, practice and future research are discussed. Copyright © 2013 John Wiley & Sons, Ltd.     

药物结合心理干预对高血压患者血压、抑郁情绪和生活满意度的影响

目的：探讨心理干预对高血压患者治疗效果的影响。方法：将不同程度抑郁状态的70例高血压患者随机分为对照组和干预组,两组均接受常规药物治疗,干预组在药物治疗的基础上进行5周综合心理干预;比较两组患者汉密尔顿抑郁量表（ HAmD ）评分和生活满意度量表（ SWLS）评分,并测定治疗前后的血压,分析心理干预对高血压患者抑郁情绪、生活满意度以及血压的影响。结果：治疗5周后,干预组HAmD评分由（24.14±8.08）分下降至（12.91±4.27）分,与对照组比较,差异有统计学意义（P<0.01）;干预组SWLS评分由（15.88±4.27）分提高到（26.15±2.95）分,与对照组比较,差异有统计学意义（ P<0.01）;治疗后干预组平均收缩压及舒张压分别下降（21.08±14.38）mmHg和（12.88±8.77）mmHg,对照组平均收缩压及舒张压分别下降（2.42±8.92）mmHg和（2.31± 8.17）mmHg,干预组下降幅度明显大于对照组（ P<0.01）。结论：药物结合心理干预治疗能有效缓解高血压患者的抑郁情绪,可有效控制血压,提高患者生活满意度。     

The effect of hospital infection control policy on the prevalence of surgical site infection in a tertiary hospital in South-South Nigeria

Background:

Surgical site infections (SSIs) are a significant cause of morbidity, emotional stress and financial cost to the affected patients and health care institutions; and infection control policy has been shown to reduce the burden of SSIs in several health care institutions. This study assessed the effects of the implementation of the policy on the prevalence of SSI in the University of Port Harcourt Teaching Hospital, Nigeria.

Patients and Methods:

A review of the records of all Caesarean sections carried out in the hospital, before and 2 years after the implementation of the infection control policy was conducted. Data collected include the number and characteristics of the patients that had Caesarean section in the hospital during the period and those that developed SSI while on admission.

Results:

The proportion of patients with SSI decreased from 13.33% to 10.34%, 2 years after the implementation of the policy (P-value = 0.18). The implementation of the policy did not also result in any statistically significant change in the nature of the wound infection (P-value = 0.230), in the schedule of the operations (P-value = 0.93) and in the other predisposing factors of the infections (P-value = 0.72); except for the significant decrease in the infection rate among the un-booked patients (P-value = 0.032).

Conclusion:

The implementation of the policy led to a small decrease in SSI, due to the non-implementation of some important aspects of the WHO policy. The introduction of surveillance activities, continuous practice reinforcing communications and environmental sanitation are recommended to further decrease the prevalence of SSI in the hospital.     

目标导向教学法在窝沟封闭技术实验课教学中的应用

目的 探讨目标导向教学法在口腔预防医学窝沟封闭技术实验室教学过程中的应用效果.方法 将昆明医科大学口腔医学院2008级本科学生68人中随机抽20为实验组,在窝沟封闭技术的实验室教学中采用目标导向教学法教学,20人为对照组,采用传统教学方法进行,在两种教学方法后进行窝沟封闭技术实验室操作和相关窝沟封闭技术问卷调查的比较.结果 实验组学生在窝沟封闭技术实验室操作和相关窝沟封闭技术问卷调查对结果优于对照组(P＜ 0.05,检验有差异性).结论 目标导向教学法在口腔医学临床技能实验室教学中可巩固口腔医学生的理论基础,同时与临床技能有机结合,起到教学相长的效果     

人文关怀护理模式在提高乳腺癌患者生活质量和护理满意度中的应用

目的:探讨人文关怀护理模式在提高乳腺癌患者生活质量和护理满意度中的应用。方法:将46例乳腺癌患者随机分为研究组和对照组各23例,对照组采用常规护理模式,包括环境护理、生活护理、药物护理等,研究组在此基础上实施人文关怀护理模式。比较两组干预前后生活质量和护理满意度情况。结果:研究组干预后生活质量评分、护理满意度明显高于对照组,差异有统计学意义(P0.05)。结论:人文关怀护理模式能提高乳腺癌患者生活质量和护理满意度,值得临床推广应用。     

研讨式带教模式在手术室护生临床教学中的应用

目的：探讨研讨式带教模式在手术室护生临床教学中的应用方法及效果。方法：将112名手术室实习护生随机分为实验组和对照组各56名,对照组采用传统的带教方法,实验组在对照组基础上采用研讨式带教模式,比较两组教学效果。结果：实验组护生考核成绩高于对照组（P ＜0.05）,实验组临床科研能力、临床教学能力、临床管理能力优于对照组（P ＜0.05）,实验组教学满意度高于对照组（P ＜0.05）。结论：研讨式带教模式能有效提高手术室护生的实习效果,提高临床教学质量。     

“教学做”一体化模式在康复治疗技术专业中的教学实践与成效评估

目的 探讨“教学做”一体化教学模式在康复治疗技术专业中的教学效果及实践成效。方法 以2012级康复专业学生共71人作为实验组,针对康复专业基础课和康复专业课中的八门主干课程实施“教学做”一体化教学模式;以2010级康复专业学生共88人作为对照组,采用传统以讲授为主的教学模式。将两组学生主干课程考核成绩、实习期综合实践能力调研反馈信息进行统计学分析。结果 实验组康复生主干课程测试成绩均高于对照组(P<0.05);综合实践能力反馈结果显示实验组与对照组学生在主动服务意识、沟通交流能力、专业技术技能、应急应变能力等方面有显著差异(P<0.05)结论“教学做”一体化教学模式突显学生学习的主体性,提高知识及技能的“迁移”能力,适时培养学生的创新意识,实现以适应岗位需求为目标的课程教学模式成效显著。