Validity and Applicability of Clinical Ladder System Model for Nurses / 임상간호연구

PURPOSE: The purpose of this study was to verify the validity and applicability of the Clinical Ladder System(CLS) Model for nurses and to suggest a model for nurses in general hospitals as well as tertiary hospitals. METHODS: After refining questionnaires through focus group participation, a survey was carried out with 50 nurse managers and 500 staff nurses from 6 tertiary hospitals and 4 general hospitals. S-CVI and i-CVI for validity and applicability were calculated. Differences in validity and applicability by the type of hospitals and characteristics of respondents were analyzed using t-test and ANOVA. RESULTS: S-CVI for validity and applicability of the CLS model were over 0.8 in two types of hospitals and the validity and applicability of the CLS model were confirmed. No differences were found in the total score for validity between the 2 types of hospitals, but in applicability, general hospitals had significantly lower applicability than tertiary hospitals. Some items showed difference according to characteristics of the respondents. CLS models were postulated based on the study results. CONCLUSION: The CLS model refined through this study can be used for nurses. In application, modifications are needed according to the conditions of each hospital.

Does simulated training improve medical students’ knowledge on cardiac life support? A study comparing simulated versus traditional teaching at the International Medical University

Background: At the International Medical University (IMU), a half day cardiac life support teaching session was provided to fourth year medical students which included training on the use of the defibrillator machine, how to handle cardiac or respiratory arrest and drugs used for resuscitation. A new CLS (cardiac life support) training session was introduced and increased to a oneday course where students were given practical training first, which included 5 stations (airway equipment, mega codes, drugs for resuscitation, defibrillator use and cardiac rhythm identification) , MCQ (multiple choice questions) test and a mega code (practical)assessment. Objective: To evaluate the students’ knowledge on cardiac resuscitation after a change in the delivery of the cardiac life support training (CLS). Methodology: Group I, consisted of 82 students taught using the traditional teaching and Group II consisted of 77 students taught using hands on simulation. The students in both groups had an online manual to read prior to the session, were given an identical written exam six months after the CLS training. Group II, however, had an online pre-test. Results: There was a statistical difference in the final mean marks between the two groups with group II scoring higher (67.3) than group 1 (62.1). No significant marks difference was noted between male and female students for both the cohorts. Conclusion: There is a significant difference in medical students’ knowledge when cardiac life support is taught using simulation. IMU has adopted the new teaching method with simulated training for the cardiac life support courses with plans to implement higher fidelity and technology to the existing simulated teaching in other areas of medicine.

Long-term Follow-up Results after Hip Arthroplasty using a Cementless Spotorno (CLS) Femoral Stem / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to evaluate the long-term clinical and radiological findings in patients who underwent total hip arthroplasty using a CLS femoral stem. MATERIALS AND METHODS: We evaluated 40 patients (47 hips) who underwent total hip arthroplasty using a CLS femoral stem between 1988 and 1992. The average patient age at the time of operation was 45.3 years, and the average duration of follow-up was 17 years 3 months (range, 15 years to 19 years 10 months). RESULTS: No femoral stem revisions were performed. The average Harris hip score improved from 51.9 preoperatively to 94.9 at final follow-up. Radiographically, small osteolytic lesions were found in 17 cases (36.2%), and endosteal bone formations were found in 44 cases (93.6%). Acetabular cup loosening occurred in 3 cases, and acetabular cup revisions were performed. Additionally, a liner change was performed in 1 case. One periprosthetic fracture and one dislocation were noted. CONCLUSION: Fifteen-to-twenty-year follow-up results after total hip arthroplasty using a CLS femoral stem were excellent, with no patients requiring femoral stem revision.

Breakage of Metal Shell in Total Hip Replacement using CLS Expansion Press-Fit Cup: A Case Report

Acetabular metal shell breakage is very rare after a total hip replacement. We encountered one case of metal shell breakage at approximately 8 years after the total hip replacement arthroplasty using a CLS expansion cup without a trauma history. Breakage of the metal shell was confirmed during revision surgery. We report this rare case with a review of the relevant literature.

A case of Coffin-Lowry syndrome

Coffin-Lowry syndrome (CLS) is a rare X-linked hereditary disorder characterized by moderate to severe mental retardation, facial dysmorphism, tapering fingers, and skeletal deformity. A 12-month-old boy was referred to our pediatric clinic for his developmental delay and seizure with fever. The boy exhibited a coarse facial appearance characterized by prominent, high-arched eyebrow, broad nose, downward palpebral fissure, high arched palate, hypodontia. The boy also showed finger tapering and puffy hand. Hypotonia, hyperextensible fingers and hypermobility of the joint were seen. Based on these findings, he was diagnosed as having Coffin-Lowry syndrome. We report a case of Coffin-Lowry syndrome with reference.

Learning Curve for Laparoscopic Colorectal Surgery: Hand Assisted Laparoscopic Surgery (HALS) versus Conventional Laparoscopic Surgery (CLS)

Purpose: Laparoscopic colorectal surgery is technically demanding and needs a longer learning curve than open surgery. HALS (hand-assisted laparoscopic surgery) is a useful alternative to conventional laparoscopic surgery (CLS) because of its palpability and hand dissection. We compared the learning curves between HALS and CLS for colorectal surgery. Methods: A prospective study without randomization was conducted with the participation of two colorectal surgeons who had not experienced a laparoscopic colorectal operation. The collected data included operative features, oncologic outcomes, and early clinical outcomes. Fifty patients were enrolled in each group, the HALS group and the CLS group. Results: None of the operations converted to open surgery. The operative time was significantly shorter in the HALS group than in the CLS group (149.6+/-34.6 minutes versus 179.1+/-36.5 minutes, P<0.001). On a subgroup analysis of the operative time in the anterior resection, the operative time was consistent after the 13th operation in HALS group. However, in CLS group, there was a continuous fluctuation of the operative time until 25 cases. In regard to the oncologic outcome, the numbers of total harvested lymph nodes and the proximal and the distal margins in the anterior resection showed no statistical differences (P=0.400, P=0.908, and P=0.073, respectively). The early clinical results were similar in both groups. Conclusions: In the learning curve study, the HALS group had a shorter operative time and reached a learning curve plateau earlier than the CLS group. Other parameters, such as the oncologic results and the early postoperative clinical outcomes, showed no differences between the two groups.

The Effect of Stem Alignment on Clinical and Radiographic Results of a Tapered CLS Stem / 대한정형외과학회잡지

PURPOSE: To examine the effects of the stem alignment on the clinical and radiographic results of a tapered wedge femoral prosthesis. MATERIALS AND METHODS: Ninety-one consecutive primary total hip arthroplasties were performed with an implantation of a CLS cementless femoral prosthesis between 1995 and 1998. Among them, 75 hips were retrospectively examined after a minimum duration of five years. The hips were divided into three groups based on the stem alignment; neutral stem alignment in 50 hips (67%), valgus in 15 hips (20%), and varus in 10 hips (13%). The clinical and radiographic results of the three groups were compared. RESULTS: There were no differences in the Harris hip scores and the incidence of thigh pain between the groups. Radiographic analysis revealed no difference in the fixation status at the latest follow up, nor was there any difference in the level of endosteal bone formation, the incidence of radiolucent lines, stressshielding, or osteolytic lesions. No loosening of the femoral stems was observed in any of the cases. CONCLUSION: Stem alignment of a tapered CLS femoral component does not compromise the clinical and radiographic results after a minimum follow-up of five years.

Hydroxyapatite Coated CLS Femoral Stem in Patients with Rheumatoid Arthritis: Minimum 5 Year Results / 대한정형외과학회잡지

PURPOSE: The study was undertaken in order to characterize the clinical and radiological results of total hip arthroplasty using a fully rough blasted stem with proximal hydroxyapatite coating in rheumatoid arthritis patients. MATERIALS AND METHODS: Twenty three total hip arthroplasties were performed using CLS stems in rheumatoid arthritis patients. Mean patient age of the patients and follow-up period were 53 and 6.8 years, respectively. Both clinical and radiographical parameters were evaluated. RESULTS: Chronological change of Harris hip score showed good results after 1 year. Harris hip score and the incidence of thigh pain at the last follow-up were 94 and one case, respectively. The mean time weight bearing without support was 12.5 weeks. Most endosteal bone formations around the stem appeared in the first 3 to 6 months. This was present in more than 80% of cases in zones 1, 2, 6, 7 and from 50 to 70% of cases even in zones 3, 4, 5 at the final follow-up. Loosening or implant failure was not found. Incomplete calcar fracture occurred in three cases, liner fracture around the femoral stem in one, heterotrophic ossification in one and superficial infection in one. CONCLUSION: The total hip arthroplasty using a CLS stem with a proximal HA coating may be a good choice in rheumatoid arthritis patients requiring hip arthroplasty.

10-15 Year Follow-up Results of Total Hip Arthroplasty Using a CLS (Cementless Spotorno) Stem for Osteonecrosis of the Femoral Head / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to evaluate the 10-15 year follow-up results of total hip arthroplasty using a CLS (Cementless Spotorno)stem for osteonecrosis of the femoral head. MATERIALS AND METHODS: Out of a series of 67 CLS stems implanted in patients with osteonecrosis of the femoral head from February 1988 to February 1993, 33 hips of 29 patients were studied for 10 to 15 years postoperatively. The average age at the operation was 46.8 years and the average duration of follow up was 12.3 (10-15 years) years. RESULTS: The average Harris hip score improved from 54.6 preoperatively to 95.8 postoperatively. Although one case showed radiologic stem loosening, no revision was performed because symptoms were not severe. Endosteal bone formation was observed in 29 (87.8%) casesand heterotophic ossification in 5. Acetabular cup loosening occurred in 1 case, and the acetabular revision was performed. Acetabularcup migration was not noted, though loosening was observed in the single case. CONCLUSION: Ten to fifteen year follow-up results of total hip arthroplasty using CLS stem for the osteonecrosis of the femoral head showedan excellent results with good osseointegration of the components. Therefore, we believe that CLS stem design and surface treatment is effective in terms of the longevity and produces good results.

Primary Total Hip Arthroplasty with a CLS Expansion Acetabular Component: Mid Term Follow-Up Study / 대한정형외과학회잡지

PURPOSE: To evaluate the results of total hip arthroplasty (THA) with a CLS expansion acetabular cup using press-fit technique. MATERIALS AND METHODS: One hundred and nineteen primary THA in 102 patients with a CLS expansion cup by press-fit technique were performed consecutively. Eighty-four hips were evaluated for clinical analysis by Harris hip score (HHS) , and 70 hips were evaluated for radiographic analysis, including stability (cup migration and change of position) , remodelling (change of polar gap and trabecular pattern) , and early wear rate of polyethylene after a mean follow up of 4 years and 9 months. RESULTS: Mean HHS was improved from 44.9 points preoperatively to 90.4 points at the most recent follow up. Initial adequate contact fit was found in 64 hips (91%) . Radiolographically, optimal stabilities of acetabular cup at the most recent follow up were found in all hips. Polar gap in 38 hips (78%) of 48 hips at postoperative radiographs disappeared at most recent follow up. Periacetabular trabecular patterns were maintained or improved in all cases. CONCLUSION: CLS expansion acetabular cup fixation by press-fit technique guaranteed an excellent implant stability.

Changes of Bone Mineral Density after Cementless Total Hip Arthroplasty: A quantitative comparison of two different implant designs / 대한정형외과학회잡지

PURPOSE: To compare the mineral density of periprosthetic bone around the two collarless stems, CLS and Alloclassic, which were same in composition and coating, but different in their shape and fit. It is known that the CLS stem is designed for metaphyseal fit and the Alloclassic stem is for upper diaphyseal fit. MATERIALS AND METHODS: In this matched cohort study, we performed DEXA scan using Hologic QDR-1000 on 20 patients, 9 of whom had CLS (Sulzer, Switzerland) femoral stem (group A), and 11 had Alloclassic (Sulzer, Switzerland) femoral stem (group B). BMD was obtained for seven zones of Gruen, and the difference was compared between the two groups. RESULTS: In group A, there was a significant decrease (P<0.05) of mean BMD in Gruen zones 1, 2 and 7 compared to normal side. In group B, there was a significant decrease (P<0.05) of mean BMD in Gruen zones 1, 2, 3, 4, 6 and 7 compared to normal side. Comparing the percent decreases of BMD, the only significant difference was observed in Gruen zone 1, in which group B showed more than 10% decrease than group A (P<0.05). CONCLUSION: Our findings suggest that the design of stem affects postoperative changes of BMD, and that the stem with more proximal fit would behave better in terms of stress shielding.

Radiographic Analysis of CLS Expansion Acetabular Cup in Total Hip Arthroplasty: Preliminary Report / 대한정형외과학회잡지

Since the use of Charnley hip prosthesis, total hip arthroplasty has been used for the treatment of coxarthrosis. However, aseptic lossening of the acetabular cup component in total hip arthroplasty remains the most common cause of failure and most serious complication. Cementless acetabular cup fixation in total hip arthroplasty is increasingly popular because of the high failure rates of cemented components, particularly in younger and more active patients. We have experienced 62 cases of CLS expansion acetabular cup developed by L. Spontorno, from January 1992 to January 1994. We analysed 41 CLS expansion acetabular cup components in 38 patients performed at the Department of Orthopedic Surgery, Kang Nam General Hospital with minimum follow up lyear(average 17.3 months). The object of this study is to evaluate the radiographic change of the cup inclination, horizontal and vertical migration of the CLS expansion acetabular cup by methods of Engh et al, and Callagham et al. The results were as follows: 1. The initial adequate contact fit were 39 hips and inadequate fit in 2 hips. 2. The initial acetabular inclination between 35 degrees and 55 degrees were 38 hips. 3. Vertical and/or horizontal migration was not occurred, except 2 hips which were complicated by deep infection. 4. Change of acetabular cup inclination than 5 degrees were not occurred. 5. Radiolucent line wider than 2mm was not found. 6. In final follow up of out 41 hips optimal stability was obtained in 39 hips, suboptimal stability was obtained in 2 hips, and definite instability was not found.