Tibial tray fracture in a modern prosthesis with retrieval analysis.

Fracture of the tibial tray is a rarely observed complication of total knee arthroplasty (TKA), predominately in implants placed greater than a decade ago. This case highlights a case of baseplate fracture in a contemporary prosthesis. The patient presented 1 year after TKA with medial knee pain consistent with pes bursitis. The implant-cement-bone construct was intact and she was managed with corticosteroids. She had persistent pain, acutely developed new varus deformity, and presented with a tibial tray fracture. Retrieval analysis suggested fatigue fracture as the likely mechanism. At time of revision, necrotic bone was found at the medial plateau, which likely caused cantilever bending relative to the well-supported portion of the tray and resultant failure. The patient continues to do well 5 years after revision TKA.

Hispanic physicians' tobacco intervention practices: a cross-sectional survey study.

BACKGROUND: U.S. Hispanic physicians constitute a considerable professional collective, and they may be most suited to attend to the health education needs of the growing U.S. Hispanic population. These educational needs include tobacco use prevention and smoking cessation. However, there is a lack of information on Hispanic physicians' tobacco intervention practices, their level of awareness and use of cessation protocols, and the type of programs that would best address their tobacco training needs. The purpose of this study was to assess the tobacco intervention practices and training needs of Hispanic physicians. METHODS: Data was collected through a validated survey instrument among a cross-sectional sample of self-reported Hispanic physicians. Data analyses included frequencies, descriptive statistics, and factorial analyses of variance. RESULTS: The response rate was 55.5%. The majority of respondents (73.3%) were middle-age males. Less than half of respondents routinely performed the most basic intervention: asking patients about smoking status (44.4%) and advising smoking patients to quit (42.2%). Twenty-five percent assisted smoking patients by talking to them about the health risks of smoking, providing education materials or referring them to cessation programs. Only 4.4% routinely arranged follow-up visits or phone calls for smoking patients. The majority of respondents (64.4%) indicated that they prescribe cessation treatments to less than 20% of smoking patients. A few (4.4%) routinely used behavioral change techniques or programs. A minority (15.6%) indicated that they routinely ask their patients about exposure to tobacco smoke, and 6.7% assisted patients exposed to secondhand smoke in understanding the health risks associated with environmental tobacco smoke (ETS). The most frequently encountered barriers preventing respondents from intervening with patients who smoke included: time, lack of training, lack of receptivity by patients, and lack of reimbursement by third party payers. There was no significant main effect of type of physician, nor was there an interaction effect (gender by type of physician), on tobacco-related practices. CONCLUSION: The results indicate that Hispanic physicians, similarly to U.S. physicians in general, do not meet the level of intervention recommended by health care agencies. The results presented will assist in the development of tobacco training initiatives for Hispanic physicians.

Health education and multimedia learning: educational psychology and health behavior theory (Part 1).

When health education researchers began to investigate how individuals make decisions related to health and the factors that influence health behaviors, they referred to frameworks shared by educational and learning research. Health education adopted the basic principles of the cognitive revolution, which were instrumental in advancing the field. There is currently a new challenge to confront: the widespread use of new technologies for health education. To better overcome this challenge, educational psychology and instructional technology theory should be considered. Unfortunately, the passion to incorporate new technologies too often overshadows how people learn or, in particular, how people learn through computer technologies. This two-part article explains how educational theory contributed to the early development of health behavior theory, describes the most relevant multimedia learning theories and constructs, and provides recommendations for developing multimedia health education programs and connecting theory and practice.

Health education and multimedia learning: connecting theory and practice (Part 2).

Part 1 of this article reviewed the contributions of educational psychology to the early development of health behavior theory and the difficulties faced by health education in adopting some of the perspectives that today guide multimedia learning. Whereas Part 1 involved discussion at the theoretical level, the purpose of Part 2 is to connect theory and practice by describing the most relevant multimedia learning theories and by providing recommendations for developing multimedia health education programs. It also provides practitioners with specific examples of the features that may make computer-based interventions more attractive to their particular audiences.