11% complications rate after Latarjet procedure at up to 14 years follow-up.

PURPOSE: Evaluate complications in correlation with radiological findings after an open Latarjet procedure performed on 140 shoulders with recurrent anterior instability with follow-up from 8 to 174 months. METHODS: Retrospectively, 140 shoulders, diagnosed with recurrent anterior glenohumeral instability, which were surgically treated with the open Latarjet procedure in our hospital, between January 2004 and November 2017, had been analysed. Mean age of operated patients was 29.5 years. One hundred and twenty-three patients were male (88.5%) and 16 were female (11.5%). Average length of follow-up was 110 months. Radiographs and CT scans of 16 patients with complications had been evaluated and correlations between radiological findings and observed complications had been analysed. RESULTS: Complications occurred in 16 shoulders (11%). Rates of individual complications were: 1. persistent pain (9%), 2. limited ROM (7%), 3. recurrent instability (6%), 4. neurologic injury (2%), 5. persistent apprehension (2%), 6. reduced strength (2%), 7. hematoma (1%) and 8. intraoperative coracoid graft fracture (0.8%). Mean postoperative ASES score and ROWE score were statistically significantly lower in the group with complications, compared to the group without complications. Good or excellent results were reported by 87.9% patients. CONCLUSION: Open Latarjet procedure is an effective and safe method for the treatment of recurrent shoulder instability, resulting in good to excellent outcomes in 87.9% of our cases. However, it is related to a higher postoperative complication rate compared to some other treatment options. Overall, very good results with high level of patient satisfaction have been demonstrated.

Advanced health assessment in nurse practitioner programs.

The purpose of this study was to examine the content, teaching methodologies, depth, and placement of advanced health assessment courses within nurse practitioner programs. Survey research was conducted with 140 schools of nursing listed in the Public Health Service/National Health Service Corp Nurse Practitioner Faculty Network in the United States. The majority of the schools reported that health assessment was taught as a course over an entire semester or quarter in their respective programs. A statistically significant difference was found between private and public institutions in that public institutions used computer assisted instruction (CAI) more often than their private counterparts. Qualitative data revealed that many nursing faculty believe a graduate-level health assessment course should incorporate the concept of differential diagnosis and focus on abnormal findings. Faculty described a wide range of student preparedness and indicated a need to incorporate more CAI and independent learning strategies. A number of faculty mentioned scarce resources and limited time to develop and test new strategies including use of the Internet. Findings reveal commonalties of content, course placement, credit allocation, and teaching strategies, as well as the challenges of diverse student preparation and limited resources.

Skin tears in institutionalized elderly: an epidemiological study.

Skin tears in the elderly are a common alteration of aging skin integrity. Very little is found in the literature on the prevention, identification, and treatment of skin tears. During a six-month period, 154 skin tears were studied in a convenience sample of residents in a VA Nursing Home Care Unit and nine community nursing homes. Data were collected on demographics, medication use, laboratory tests, cognitive function, and activities of daily living (ADLs). Descriptive data on the skin tears were also collected and these tears were graded according to the Payne-Martin Classification System. Data analysis revealed an at-risk sample of very old, frail elderly who are predominantly women, dependent in ADLs, nutritionally compromised, and suffering from dementia. Risk factors associated with the occurrence of skin tears included stiffness and spasticity, sensory loss, limited mobility, poor appetite, polypharmacy, use of an assistive device, presence of ecchymosis, and a history of previous skin tears. Skin tears were small, occurred more frequently on the upper extremities, and half had no tissue loss. Most skin tears occurred in patient care bedrooms. The findings of this study provide an outline for the development of an at-risk profile, and establish the basis for educational programs for caregivers.

Gynecologic and reproductive services for women with developmental disabilities.

A two-phase study using mail-out questionnaires examined the availability and accessibility of gynecologic and reproductive services for women with developmental disabilities. First, 127 women with developmental disabilities responded to queries about the accessibility and type of available services, the providers of necessary care, and satisfaction with the services. The age range of the women was 18-80 years, with a mean age of 40 years. Of the women queried, 40% indicated that they had not received health education regarding gynecologic and reproductive needs, and 27% indicated that they disliked health education about such matters. In the second phase of the study, agencies that provide services to these women were queried about patterns of the providers, available services, and identified barriers, including financial problems, difficulty in finding a provider, family perceptions, and fear of and distaste for examinations. A surprising finding was that more than one-third of the reporting agencies indicated that questions about the identification and treatment of sexual abuse were not applicable to their agencies. The findings are discussed with an emphasis on identified barriers to care, available services, and the implications for nurse practitioner practice.

[Results of surgical synovectomy of the knee joint in patients with rheumatoid arthritis.]. / Výsledky chirurgickej synovektómie kolena u pacientov s reumatoidnou artritídou.

The authors evaluate the results of synovectomy of the knee in 216 patients (83 men and 133 women) with rheumatic arthritis (RA); 35 patients with juvenile chronic arthritis (JCA) in the evaluated group account for 16,2%. On average 2.3 years have elapsed since the operation. They evaluate the peroperative macroscopic appearance of the synovial membrane, the damage of intraarticular structures, the effect of surgery on the range of movements. Comprehensive evaluation according to Aidem -Baker revealed very good results in 52.8%, good results in 36.1%, satisfactory results in 7.4% and poor results in 3.7%. Key words: surgical synovectomy, synovectomy of the knee, rheumatoid arthritis (RA), juvenile chronic arthritis (JCA).

[Comparison of surgical and radioactive synovectomy in various disorders of the knee joint]. / Porovnanie chirurgickej a rádioaktívnej synovialektómie pri rôznych afekciách kolenného klbu.

The authors evaluate after an interval of 1-20 years the long-term results of surgical synovectomy in 454 patients and radioactive synoviorthesis in 528 patients performed at the First Orthopaedic Clinic, Medical Faculty, Comenius University and Faculty Hospital in Bratislava and at the Orthopaedic and Traumatological Clinic of the Medical Faculty in Martin in 1969-1991. The most frequent diagnosis in surgical synovectomy is rheumatic synovitis in radioactive synovectomy arthrotic synovitis (47.6% and 68.6%). The authors evaluate both methods of synovectomy according to Aidem-Baker and compare the results of the two methods. They found significantly more very good and good results after surgical synovectomy (54.8% and 33.5%) as compared with radioactive synoviorthesis (15.5% and 38.0%). Conversely they found significantly more satisfactory and poor results in radioactive synoviorthesis (29.1% and 17.4%) than after surgical synovectomy (8.8% and 2.9%) which comprise patients relatively satisfied with this procedure and who do not agree with other procedures.

The environment and its relationship to the Type A behavior pattern in middle and old age, a pilot study.

21 men and 76 women between the ages of 68.0 and 97.0 yr. were administered the Geriatric Scale of Recent Life Events, the Jenkins Activity Survey, the Framingham Type A Scale, and a measure designed to assess factors in the environment believed to contribute to the development and maintenance of the Type A Behavior Pattern. Differences were found between the environment of old age and the retrospective middle-age environment. Results support that Type A behavior emerges in response to environmental elicitors.