Caring for Dying Patients: Attitude of Nursing Students and Effects of Education

Background:

Education about caring for dying patients could be effective in changing nursing students’ attitude toward caring for dying patients.

Aim:

The aim of the present study was to examine the nursing students’ attitude toward caring for dying patients and effects of education on their attitude.

Materials and Methods:

The present study enjoys a quasi-experimental method with using one-group pre-test/post-test design conducted in Bam in southeast of Iran. The attitude of nursing students was measured using Frommelt Attitude Toward Care of the Dying (FATCOD) scale before and after an educational intervention. Data were analyzed using non-parametric tests in Statistical Package for the Social Sciences (SPSS) 18 software.

Results:

Of 32 students, 30 participated in this study (response rate of 94%). Only 20% of the students reported previous experience of dying patients in their clinical courses. Students showed moderately negative to neutral attitudes toward caring for dying patients. Education has improved students’ attitude significantly (mean score of FATCOD before study were 3.5 ± 0.43 and after intervention were 4.7 ± 0.33) (P < 0.001).

Conclusion:

Educational programs about death and caring for dying patients should be added to undergraduate nursing curricula. Further research recommended examining nursing students’ knowledge about caring for dying patients and the effect of education on their knowledge.     

Displacement of the Hip Center of Rotation After Arthroplasty of Crowe III and IV Dysplasia: A Radiological and Biomechanical Study

To study the direction and biomechanical consequences of hip center of rotation (HCOR) migration in Crowe type III and VI hips after total hip arthroplasty, post-operative radiographs and CT scans of several unilaterally affected hips were evaluated. Using a three-dimensional model of the human hip, the HCOR was moved in all directions, and joint reaction force (JRF) and abductor muscle force (AMF) were calculated for single-leg stance configuration. Comparing to the normal side, HCOR had displaced medially and inferiorly by an average of 23.4% and 20.8%, respectively, of the normal femoral head diameter. Significant decreases in JRF (13%) and AMF (46.13%) were observed in a presumptive case with that amount of displacement. Isolated inferior displacement had a small, increasing effect on these forces. In Crowe type III and IV hips, the HCOR migrates inferiorly and medially after THA, resulting in a decrease in JRF, AMF, and abductor muscle contraction force.     

The results of two-stage revision TKA using Ceftazidime–Vancomycin-impregnated cement articulating spacers in Tsukayama Type II periprosthetic joint infections

Purpose

This study examined the success and factors associated with failure, of using cement spacers impregnated with high-dose Ceftazidime and Vancomycin when performing two-stage revision for infected total knee arthroplasty (TKA).

Methods

A retrospective analysis was performed using a prospectively collected database of 82 patients (median age 68 years, range 39–87) with a confirmed deep TKA infection treated with a two-stage revision. All cement spacers were impregnated with high-dose Ceftazidime and Vancomycin. The rate of success was recorded—an association between failure of treatment, and patient factors, previous surgical treatment, and microbial characteristics was sought.

Results

The mean time to infection from index arthroplasty was 45 months (range 3–240). The initial two-stage revision was successful in 70/82 patients (85.4 %), who remained free of infection at average follow-up of 36.2 months (range 24–85). A second two-stage revision for infection was required in 12/82 patients (14.6 %), which was successful in 4/12 (33 %). A third two-stage revision was performed in three patients, all of whom had a polymicrobial infection of which only one patient had successful eradication of infection. Recurrent infection was correlated with irrigation and debridement with implant retention prior to initial two-stage revision (p < 0.01), polymicrobial infections (p = 0.035), and infections presenting <6 months after index surgery (p = 0.031). No correlation was seen with age, BMI, type of organism, diabetes mellitus, or Charlson Comorbidity Index.

Conclusion

The findings of this study suggest that the combination of Ceftazidime and Vancomycin in cement spacers is as efficacious as other published single or combined antibiotic mixtures, which is clinically relevant to clinicians treating this difficult problem in the setting of patients with compromised renal function.

     

Acetabular Cup Revision Combined With Tensor Facia Lata Reconstruction for Management of Massive Abductor Avulsion After Failed Total Hip Arthroplasty

We report on 17 patients with massive abductor avulsions after total hip arthroplasty (THA) treated with medialization of the acetabular component and tensor fascia lata (TFL) reconstruction. All patients had severe limp, positive Trendelenburg sign, and avulsion of the abductor insertion confirmed on MRI. Mean age was 69 years (range, 50–83 years), and mean follow-up period was 36 months (range, 18–78 months). After surgery, 9 patients had no limp (47%), 8 patients had a mild limp, and abductor power improved from mean 2.5/5 to mean 3.8 (P < 0.0001). At latest follow-up, the Harris Hip Score was excellent in 6 hips (37%), good in 7 (43%) hips, and fair or poor in 3 (23%). Two patients with mild limp were not satisfied with their procedure.     

Nineteen Year Results of THA Using Modular 9 mm S-ROM Femoral Component in Patients With Small Femoral Canals

A retrospective analysis was undertaken of 30 consecutive THA performed in 25 patients with hypoplastic proximal femurs, who had received a 9-mm uncemented modular S-ROM stem. The mean patient age was 42 years (17–69 years), mean height was 152.5cm (130–170.5 cm), mean weight was 63 kg (39–90 kg), and mean follow-up period was 19 years (range, 12–23 years). Subsidence was seen in 2 hips, with asymptomatic femoral osteolysis present in 11 hips; overall survival of the femoral stem was 93.3%, with two revisions of the femoral component required for aseptic loosening. After a mean follow-up of 19 years, the use of the S-ROM 9 mm femoral stem in the patient with the small femur was associated with a low revision rate due to aseptic loosening of the stem.     

Patient's Height and Hip Medial Offset Are the Main Determinants of the Valgus Cut Angle During Total Knee Arthroplasty

Background

Valgus cut angle (VCA), defined as the angle between the anatomical and the mechanical axes of femur, is an important parameter upon which a critical step of knee arthroplasty is based. Some variables have been proposed to affect the magnitude of this cut. However, little information is available regarding whether a generic value can be used, or if a patient-specific value from a long leg X-ray, or factors that can be determined preoperatively, is necessary to accurately set the VCA.

Scapulothoracic arthrodesis for winged scapula due to facioscapulohumeral dystrophy (a new technique)

We introduced a new scapulothoracic arthrodesis technique in 6 patients (2 bilaterally) with winging of the scapula due to facioscapulohumeral muscular dystrophy from 1984 to 2000. The procedure involved a combination of plating and wiring techniques. The indications were symptomatic winging, limitation of active shoulder motion, pain, and impaired daily living activity. Our objective was to improve motion, strength, and performance of activities of daily living, as well as to provide pain relief. As a result of the technique, active motion improved in all patients, flexion improved from 64 degrees to 104 degrees, and abduction improved from 67.5 degrees to 112.5 degrees. The only complication was a hemothorax in a bilateral case that was easily treated. The length of follow-up averaged 32.5 months (14-55 months), and results did not change with time.     

Effect of Patellar Thickness on Knee Flexion in Total Knee Arthroplasty: A Biomechanical and Experimental Study

A biomechanical computer-based model was developed to simulate the influence of patellar thickness on passive knee flexion after arthroplasty. Using the computer model of a single-radius, PCL-sacrificing knee prosthesis, a range of patella–implant composite thicknesses was simulated. The biomechanical model was then replicated using two cadaveric knees. A patellar-thickness range of 15 mm was applied to each of the knees. Knee flexion was found to decrease exponentially with increased patellar thickness in both the biomechanical and experimental studies. Importantly, this flexion loss followed an exponential pattern with higher patellar thicknesses in both studies. In order to avoid adverse biomechanical and functional consequences, it is recommended to restore patellar thickness to that of the native knee during total knee arthroplasty.