The Effect of Patient-Engaged Bedside Handoffs Protocol in Comprehensive Care Units / 임상간호연구

Purpose@#The purpose of this study was to apply patient-engaged bedside handoffs in comprehensive care units, and to evaluate the effects of bedsides to nurses and patients. @*Methods@#This study employed a cluster randomized cross-over design.Electrical Medical Record (EMR)-based handoffs and patient-engaged bedside handoffs were alternatively applied to 104 patients, who were assigned to a total of 30 clusters (nursing handoff teams) in 4 comprehensive care units at the S medical center in Seoul, and the patients evaluated each type of handoffs. A total of 139 nurses were also participated in the same units and evaluated each type of handoffs. Data were analyzed using t-test, Wilcoxon rank sum test, ANOVA, and Kruskal-Walls test. @*Results@#The patient's satisfaction of the patient-engaged bedside handoffs was higher than that of the EMR-based handoffs (Z=-5.16, p<.001). On the other hand, the nurse's satisfaction of the patient-engaged bedside handoffs was significantly lower than that of the EMR-based handoffs (t=13.21, p<.001). There were no differences in length of the reporting time between two types of handoffs (t=-0.48, p=.634). @*Conclusion@#Patient satisfaction with the patient-engaged bedside handoffs was higher than that of EMR-based handoffs, and nurses' satisfaction with the patient-engaged bedside handoffs was significantly lower than that of EMR-based handoffs. Future studies are needed regarding the impacts of patient-engaged bedside handoffs on the quality of healthcare by identifying the benefits of the handoffs.

Effectiveness of caries-preventing agents on initial carious lesions within the scope of orthodontic therapy / 대한치과교정학회지

OBJECTIVE@#To evaluate the effectiveness of three different caries-preventing agents on artificial caries in a Streptococcus mutans-based caries model.@*METHODS@#Sixty-five caries-free human molar enamel blocks were treated with a demineralization solution and a remineralization solution. The specimens were assigned to the following groups according to the caries-protective product applied: group A, chlorhexidine varnish; group B, fluoride-releasing chemically cured sealant; group C, fluoride-releasing lightcured sealant; group D, positive control (specimens that were subjected to de- and remineralization cycles without treatment with any caries-protective agents); and group E, negative control (specimens that were not subjected to de- and remineralization cycles). Samples in groups A–D were stored in demineralization solution with S. mutans and thereafter in artificial saliva. This procedure was performed for 30 days. Average fluorescence loss (ΔF) and surface size of the lesions were measured using quantitative light-induced fluorescence at baseline and on the 7th, 14th, and 30th days.@*RESULTS@#After 30 days, group A demonstrated a significant increase in ΔF and the surface size of the lesions, no significant difference in comparison with the positive control group, and a significant difference in comparison with the negative control group. Group B showed no significant changes in both parameters at any of the measurement points. While group C showed increased ΔF after 14 days, no significant fluorescence change was observed after 30 days.@*CONCLUSIONS@#Both fluoride-releasing sealants (chemically or light-cured) show anti-cariogenic effects, but the use of chlorhexidine varnish for the purpose of caries protection needs to be reconsidered.

Subsidence of Polyetheretherketone Cage after Anterior Cervical Fusion / 대한정형외과학회잡지

PURPOSE: The purpose of this study is to evaluate the rate and direction of subsidence that occurred after anterior cervical discectomy and fusion using the polyetheretherketone (PEEK) cage and to analyze the risk factors of subsidence. MATERIALS AND METHODS: Thirty two patients (36 segments) who underwent anterior cervical discectomy and fusion using the PEEK cage and autologous cancellous iliac bone graft from July 2003 to November 2011 were enrolled in this study. anterior segmental height (ASH), posterior segmental height (PSH) and cage corner distance (CCD) were measured on plain radiographs. Subsidence was defined as > or =2 mm decrease in the average of ASH and PSH at the final follow up compared to that measured in the immediate postoperative period. A decrease of more than 3 mm was defined as severe subsidence for further statistical analysis. RESULTS: Subsidence of more than 2 mm was observed in 14 segments (38.9%) and severe subsidence (> or =3 mm) was observed in seven segments (19.4%). The direction of subsidence was examined by comparison of means of decreased ASH and PSH and anterior subsidence outweighed posterior subsidence (p<0.001). Examination of CCD showed that inferior subsidence was more frequent than superior subsidence (p<0.001, p=0.047). Among the suspicious risk factors for subsidence, intraoperative disc space distraction (anterior distraction: p=0.031, posterior distraction: p=0.007) and height of inserted cage (p=0.032) showed statistical significance. CONCLUSION: Considerable incidence of subsidence was observed after use of the cage. Using a cage of appropriate height and prevention of intraoperative over-distraction of disc space will be helpful to prevention of subsidence of the cage after anterior cervical discectomy and fusion using the PEEK cage.

Periacetabular Osteotomy for Treating Dysplastic Hips That Were Misdiagnosed as Having Acetabular Bone Tumor: Report of Two Cases

The incidence of primary bone tumor of the acetabulum is 1-2% of all the bone tumors. Degenerative cystic change can occur in patients with hip dysplasia and this can be misdiagnosed as primary bone tumor. We have experienced 2 patients with painful dysplastic hips that were treated with curettage and autogenous bone graft for a cystic lesion that was originally misdiagnosed as primary bone tumor. The patients'hip pain and limitation of motion recurred, and so Bernese periacetabular osteotomy was performed for the dysplastic hips. At over one year follow-up, the corrected hips showed a painless and good range of motion.

Bilateral Wrist Fracture-Dislocation by Fall from Height : A Case Report

Wrist fracture-dislocation including perilunar injury is an uncommon high energy trauma, especially cases occurred simultaneously on bilateral wrist have been quite rarely reported in the orthopaedics literature. We encountered a case of open transtriquetral dorsal perilunar dislocation on right wrist and transstyloid dorsal dislocation on left wrist by fall from height. We performed open reduction and percutaneous K-wire fixation with interosseous ligament repair for both wrist. On the left wrist, flexion-extension arc, radio-ulnar deviation arc, grip strength were recovered satisfactorily at 1 year after the injury. On the radiographs, there were no intercarpal instabilities and scapholunate angles were within normal range. But clinical results on right wrist were dissatisfied by septic arthritis sequelae, and patient complained discomfort at motion. We report this unusual pattern of injury with review of the relevant literature

Incomplete Compressive Neuropathy of Posterior Interosseous Nerve Caused by Ganglion : A Case Report

Ganglion is a common benign tumor and is likely to cause paralysis of posterior interosseous nerve by compressiononce occurred in proximal radial area. A 25- year old female patient, who was suffering from forearm pain and trouble with extending her fingers after intramuscular stimulation, visited this hospital. We diagnosed as the common extensor muscle rupture by physical examination. But, on the basis of preoperative MRI, she was diagnosed with incomplete posterior interosseous nerve paralysis caused by ganglion of the proximal radius. We performed the surgical excision and obtained a satisfactory result without any evidence of recurrence at the 1 year follow-up after surgery. Incomplete compressive neuropathy of posterior interosseous nerve sometimes confused with spontaneous rupture of the common extensor muscle, which can lead to inappropriate surgical treatment. Careful preoperative examination is essential to avoid misdiagnosis. We report this case with review of the relevant literature, because of rarity of incomplete compressive neuropathy of posterior interosseous nerve by ganglion.

Calcific Amyloidoma of Tibialis Anterior Muscle: Case Report / 대한정형외과학회잡지

Calcific amyloidoma of the soft tissue is quite rare and it is difficult to make a differential diagnosis from other lesions such as osteomyelitis or bone tumor. We encountered a case of a calcified amyloidoma found in the anterior tibial muscle that occurred more than 20 years after a proximal tibial fracture adjacent to the origin of the muscle. The features of the lesion resembled osteomyelitis. Satisfactory result was obtained by a thorough mass excision. We report this case with review of the relevant literature.

Shape and Motion of Each Lumbar Segment in Normal Korean Adults / 대한정형외과학회잡지

PURPOSE: By achieving informations about sagittal shape and motion of each lumbar segment in normal subjects, we tried to get the standards useful in management of spinal disorders and fractures. MATERIALS AND METHODS: Thirty normal adults without any disorder on their back were adopted. L3 centered thoracolumbar (T-L) X-ray's including standing lateral, AP's in righ-tleft bending, and flexion- extension lateral were checked for each person. Cobb angles of each segment were measured. Statistical analysis was done for comparison by gender and correlation of each factors. RESULTS: Body shape of upper lumbar vertebrae was kyphotic but caudal bodies are changed into lordotic gradually. Disc angle was lordotic in all the discs. Segmetal motion in sagittal plane was greatest at L4-L5 (18.6degrees). However, segmental motion at coronal plane was largest at L3-L4 (12.6degrees). CONCLUSION: We achieved Korean standard of shape and motion of each lumbar segment. Proportion of each factor contributing to total lumbar lordosis was evaluated also.

Early Isolated Loosening of Patellar Component after Primary Total Knee Arthroplasty: A Case Report

The early loosening after total knee arthroplasty is one of the most serious complications. For the purpose of prevention against the complication, many researches were carried out in implant's quality, design and operative technique, etc. The mechanism of the loosening after arthroplasty is considered that micromotion makes a gap between implant and bone, the subsidence of implant and osteolysis around the implant. The authors found one case of the early isolated loosening of patellar component in a patient who had undergone primary total knee arthroplasty for osteoarthritis thirteen month ago. We tried to elucidate the mechanism of the early loosening by clinical and radiologic assessment of this case.

Comparative Study of the Clinical Results between Arthroscopic Multiple Drilling and Autologous Osteochondral Grafting for Osteochondral Lesions of the Talus / 대한정형외과학회잡지

PURPOSE: We compared the clinical results between arthroscopic multiple drilling and autologous osteochondral grafting for osteochondral lesions of the talus. MATERIALS AND METHODS: Twelve patients underwent arthroscopic multiple drilling that left the remaining cartilage at the lesions, and ten patients underwent autologous osteochondral grafting for detached cartilage lesions. We performed a modified Brostrom procedure for 9 of the cases with combined lateral ankle instability in both groups. The average follow-up period was 12.4 months. The mean ages were 31 and 28 years old, respectively. The results were compared between the two groups by assessing the AOFAS scores and patient satisfaction, based on subjective symptoms. RESULTS: The mean pre-operative AOFAS scores were 70 in the arthroscopic multiple drilling group and 70.3 in the autologous osteochondral grafting group. The post-operative AOFAS scores were 78.8 in the arthroscopic multiple drilling group and 93.5 in the autologous osteochondral grafting group (p<0.05). Patient satisfaction after multiple drilling was good in 3 cases, fair in 4 cases, poor in 5 cases, and pre-operative symptoms were not improved at all in 4 cases. After autologous osteochondral grafting, 7 cases were good and 3 were fair. CONCLUSION: The study demonstrated that in the treatment of osteochondral lesions of the talar dome, the results of autologous osteochondral grafting were superior to those of arthroscopic multiple drilling.

A Case of Periprosthetic Fracture of Acetabulum Associated with Osteolysis / 대한정형외과학회잡지

Periprosthetic acetabular fracture after total hip arthroplasty is relatively uncommon but can occur in high-energy trauma or in patients with bone loss secondary to osteolysis. We encountered a periprosthetic acetabular fracture after minor trauma. The fracture was minimally displaced, and was treated conservatively. After eight-weeks non-weight-bearing, the fracture was healed but the acetabular cup had migrated. Acetabular revision was performed with morcellized allograft and non-cemented acetabular cup. At the one-year follow-up, the injured hip showed good range of motion with a stable acetabular component.

Disengagement of the Lag Screw from Side plate in a Subtrochanteric Fracture of the Femur treated with Compression Hip Screw: A Case Report

Subtrochanteric fractures of the femur can be treated by sliding hip screw devices. We encountered a subtrochanteric fracture in a 43 years old male. Open reduction and fixation with a sliding hip screw and plate were performed. One week later, the sliding screw disengaged from the side plate. In the operating room, the side plate was changed to the long barrel type and a compression screw was inserted. At two year follow-up, the fracture was united with good function.

Differential Expression of System L Amino Acid Transporters in Wound Healing Process of Rat Skin / 체질인류학회지

The continuous growth and proliferation of cells are essential for the wound healing process, and the amino acid transporters plays an important role in the continuous growing and proliferating cells. Among the amino acid transport systems, the amino acid transport system L, which is a Na+/-independent neutral amino acid transport system, is a major route for providing living cells including tumor cells with neutral amino acids including several essential amino acids. In the present study, to elucidate the role of amino acid transport system L in the wound healing process, we investigated the expression pattern of LAT1 and LAT2 in the healing process after inflicting the wound on skin of rat. The expression of LAT1 was increased at 12 hours after inflicting the wound and was similar to the control group getting closer to 7 days. The expression of LAT2 was increased at 1 day and 3 days after inflicting the wound and was similar to the control group getting closer to 7 days. These results suggest that the LAT1 and LAT2 play important roles at the early stage and at the middle stage getting closer to normal skin in the wound healing process after inflicting the wound, respectively.

Implantation of Femoral Stem of Total Hip Arthroplasty Using a Mini-Robot / 대한정형외과연구학회지

PURPOSE: To evaluate the feasibility and accuracy of the simple robotic surgical system to rasp the femoral canal in total hip arthroplasty, we investagated the fitness error and alignment error. MATERIALS AND METHODS: Femoral canals of six human cadaveric bones, 12 pig bones, and 18 sawbones were reamed using the author's robot system. Radiographs and axial CT images were obtained after the operation. The fitness error(gap between the femoral stem and the surface of the femoral canal) and the alignment error(the angle between the longitudinal axis of femoral canal and the distal part of the stem) were measured. The anteversion was measured in axial view of CT scan. RESULTS: The errors were measured at 3 levels; level A, in the upper third, level B, in the middle third and level C, in the lower third of the proximal part of the stem. The mean value of fitness error was 0.12 mm at level A, 0.20 mm at level B, and 0.29 mm at level C. In cadaveric femurs, the average alignment errors were 0.02 degrees in anteversion, 0.98 degrees of valgus in coronal plane, and 0.51 degrees of flexion in sagittal plane. The errors were -0.03 degrees, 0.31 degrees, and -0.36 degrees respectively in pig bones. The errors were 0.13 degrees, 0.14 degrees, and -0.27 degrees respectively in sawbones. CONCLUSIONS: This robot system is relatively simple and cheap compared with ROBODOC system. It can be utilized for the rasping of the femoral canal during total hip arthroplasty.

Neglected Traumatic Posterior Hip Dislocation in a Crutch-walking Patient: A Case Report

Traumatic posterior hip dislocation should be reduced emergently, but diagnosis could be delayed in a patient with head trauma or in developing countries. We have experienced neglected posterior hip dislocation for three months in a crutch-walking patient who had ipsilateral tibia fracture and alert mentality. Open reduction followed by six-weeks skeletal traction was performed. At one year follow-up, the reduced hip showed good range of motion with no evidence of avascular necrosis.

Differences of Fracture Types and Associated Injuries in Thoracolumbar Fractures Caused by Fall from Height and by In-Car Accident

PURPOSE: To evaluate the differences of associated factors in thoracolumbar fractures according to the mechanism of injury, level and type of the fracture, associated injuries were investigated for comparison between injuries by fall from height and by in-car accident injury. MATERIALS AND METHODS: Medical records and X-ray findings of 249 patients with fractures of thoracolumbar spine were reviewed retrospectively. Among them, 169 patients were injured by the two main causes. McAfee classification was adopted to determine the type of fracture. Associated injuries were classified as head and neck, chest and abdomen, pelvis, proximal and distal extremity, and neurologic deficit. Statistical analysis using Chi-square method was used for comparison between the two groups. RESULTS: In overall patients, the most common cause of thoracolumbar fracture was fall from height (44.6%) followed by in-car accident (23.3%) and fall down (16.9%). In fall-from height gruoup, burst fracture was the most common (44.1%) while flexion-distraction injury was the most popular (39.7%) in in-car accident group (p=0.05). Comparison according to height of fall showed significant increase of multiple fractures (p=0.0326). Associated injuries of distal lower and upper extremities and pelvis were common in fall-from-height group, while injuries of head and neck, proximal part of upper extremity, chest and abdomen were common in in-car accident patients. CONCLUSION: Type of fracture and distribution of associated injuries were significantly different between the two main causes of thoracolumbar injury, which seemed to be useful for understanding the mechanical events of injury and detecting associated injuries in each victim.

Fat Embolism in a Patient with Multiple Fractures of Cancellous Bones: A Case Report

Fat embolism is a rare complication of multiple long bone fracture or extensive soft tissue injury. The pathogenesis of fat embolism has been poorly understood and definite pathogenesis and treatment were not fully established. Respiratory failure associated with fat embolism is a major cause of death, but is usually self-limited, and is responsive to intensive treatment. We have experienced fat embolism in cancellous bone fracture which occurred in spine, distal radius and talus. Patient's fractures were treated with conservative management. The patient was recovered from fat embolism with supportive treatment.

The Effect of Shoe Lift on Lumbar Scoliosis Associated with Pelvic Obliquity / 대한척추외과학회지

STUDY DESIGN: A retrospective study designed to evaluate the effect of a shoe lift on the lumbar scoliosis associated with pelvic obliquity. OBJECTIVES: To analyze the changes in pelvic height, Cobb angle and clinical manifestations after application of a shoe lift. SUMMARY OF LITERATURE REVIEW: The most common form of scoliosis in adolescence is idiopathic (85% of scoliosis), which is a form of structural scoliosis. Some non-structural scoliosis may be assessed as an idiopathic form, which can result in an unnecessary treatment, such as bracing. Pelvic obliquity may be a cause of non-structural scoliosis, and a shoe lift may be used for its correction. MATERIALS AND METHODS: Twelve cases of lumbar scoliosis associated with pelvic obliquity, between April, 1998 and October, 2002, were investigated for the changes in the pelvic height and Cobb angle. Standing T-L AP and standing pelvic AP for measuring the Cobb angle and pelvic obliquity, respectively, were checked before and after application of a shoe lift. The Bell-Thompson method was used for measuring the limb length discrepancy. The shoe lift was composed of a compact cork pad and soft sponge tissue. The extent of a shoe lift was determined with the use of the most comfortable wood block height on stand-ing still. The radiological and clinical outcomes of the shoe lift were investigated. RESULTS: After the introduction of the shoe lift, 9 cases (75%) achieved a leveled pelvis (height difference less than 0.3cm) 1 week post-shoe lift. The mean Cobb angle before treatment was 16degrees ranging from 9 to 26degrees which was reduced to 6.7degrees ranging from 0 to 23degrees due to the shoe lift 1 week post-shoe lift. The mean correction of the Cobb angle after the introduction of a shoe lift was 73.9%. Clinically, 2 cases with low back pain achieved an improvement in the pain, and most patients expressed that walk-ing and standing had become more comfortable. CONCLUSION: A shoe lift seems to be significantly effective in correcting the Cobb angle and pelvic height in lumbar scoliosis associated with pelvic obliquity.

Carotid Artery Stenting in Patients With Takayasu's Arteritis:Early and long-term follow-up results

Takayasu's arteritis is a chronic inflammatory disease of unknown etiology involving the aorta, major branches of aorta, and pulmonary arteries and leads either stenosis and occlusion of the involved artery or aneurysm formation or both. The clinical course and prognosis are variable according to two major prognostic factors, ie, complications and the pattern of the past clinical course, as well as by ESR. Though the aggressive medical and surgical treatment are required for patients with a major complication and a progressive course, surgical reconstruction entails a high incidence of suture line complications including stenosis or dilatation. Moreover all the vascular lesions are amenable for vascular surgery. Initial reports revealed excellent results of percutaneous transluminal angioplasty (PTA) in patients with Takayasu's arteritis. However the suboptimal results and restenosis have been the main limitations of the PTA. Stenting has some benefits for early elastic recoil of the fibrotic vessels and restenosis as in other large vessels in Takayasu's arteritis or atherosclerosis. We report early and long-term results of two cases of carotid stenting in patients with symptomatic carotid stenosis and Takayasu's arteritis, which revealed variable angiographic results according to clinical courses and recommend that stenting in Takayasu's arteritis may be another treatment modality in inactive Takayasu's arteritis.

Carotid artery stenting in patients with symptomatic coronary artery disease

Carotid artery stenting has been accepted as a potential alternative to carotid endarterectomy in patients with significant carotid artery stenosis. The objective of this study was to evaluate the feasibility, safety and long-term outcome of percutaneous stenting of carotid artery stenosis in patients with coexisting symptomatic coronary disease. Between May 1996 and May 1999, we performed carotid artery stenting at 48 lesions in 36 patients with carotid stenosis of 60% and symptomatic coronary artery stenosis. Twenty-one patients (58%) had neurologic symptoms. Carotid stenting was performed in 43 internal, 2 external and 3 common carotid lesions. We used Wallstent in 46 lesions, Palmaz stent in 2 lesions and Microstent II in 1 lesion. Staged or combined coronary intervention was performed in 18 patients (50%) and staged coronary artery bypass surgery was performed in 6 patients (17%). In the other 12 patients (33%), medical treatments were performed. Carotid stenting was successful in all lesions. Simultaneous bilateral carotid stenting was performed in 11 patients (31%). One major and 1 minor stroke developed during the procedure. There were no deaths during the procedures and within 30 days post-procedure. During the follow-up of 14 +/- 7 (3 to 40) months, there were no deaths or neurological events. On follow-up (6 +/- 1 months) angiography and/or duplex sonography of 44 eligible lesions in 32 patients, there were 2 cases of asymptomatic restenosis (4.5%) which developed in Palmaz stents implanted at the external carotid artery and the common carotid artery, respectively. In conclusion, carotid artery stenting in patients with coexistent carotid and coronary artery disease is feasible, safe and shows favorable follow-up outcomes.