Latarjet as a primary and revision procedure for anterior shoulder instability - A comparative study of survivorship, complications and functional outcomes in the medium to long-term.

BACKGROUND: This retrospective study aims to compare the outcome of the Latarjet procedure when used as a primary or revision procedure for recurrent anterior gleno-humeral instability. METHODS: One hundred and ninety-seven patients underwent 205 open Latarjet procedures during the period 2006-2015 (mean follow-up 5.6 years). Sixty shoulders had failure of a previous stabilisation requiring revision to the Latarjet procedure. Outcomes were measured using the Western Ontario Shoulder Instability Index and Quick Disabilities of the Arm, Shoulder and Hand score. Survival analyses were performed using Kaplan-Meier curves, and multiple linear regression modelling was utilised to identify predictors of functional outcome (p < 0.05). RESULTS: Two shoulders had recurrent dislocations in the cohort of 205 (1.0%). Six shoulders underwent further surgery for non-instability complications (2.9%). There were no significant differences in the clinical or functional outcome between patients undergoing a primary Latarjet procedure and those who required revision of a failed soft-tissue stabilisation. Ninety-two per cent of patients were satisfied with their shoulder following surgery. Patient-reported instability and satisfaction was significantly associated with poorer functional scores. DISCUSSION: The Latarjet procedure successfully prevents recurrent anterior instability and is associated with high levels of satisfaction. Patient-reported outcome measures suggest no difference between primary and revision procedures.

The connection between neurosciences and dialysis: a quick neurological assessment for hemodialysis nurses.

Stroke is a significant medical emergency and occurs frequently in patients receiving renal replacement therapy. In 2005, the Registered Nurses Association of Ontario (RNAO) published Nursing Best Practice Guidelines for Stroke, highlighting the necessity and expectation that all nurses, regardless of specialty, are able to perform an abbreviated neurological assessment, identify the symptoms of stroke, and respond to these as a medical emergency. This article highlights the significance of neurovascular disease in persons who receive renal replacement therapy, and serves as an educational review for dialysis nurses to increase their neurological functional assessment skills. The outlined abbreviated neurological assessment parallels the Canadian Neurological Scale, and is based on the practice recommendations published in the RNAO Nursing Best Practice Guidelines in 2005.

The influence of between-needle cannulation distance on the efficacy of hemodialysis treatments.

There is a belief that there should be a minimum of 5 cm between two cannulating needles of an arteriovenous fistula. This study examined the effect of reduction of space between needles from 5 cm to 2.5 cm on access recirculation, the measurement of access blood flow rate (by indicator dilution technology), and dialysis efficiency (by effective ionic dialysance). Twelve patients were studied, with half having their dialysis needles placed 2.5 cm apart for five consecutive dialysis treatments followed by placing needles 5 cm apart for a further five consecutive treatments. The other half initiated with 5 cm followed by 2.5 cm distance for a similar number of treatments. All 120 dialyses had successful cannulations with access recirculation excluded. Access blood flow (Qa mL/min) measurement was attempted for each patient twice, with each of the two needle positions. The Qa with needles 2.5 cm apart was 1310.95 ± 525.7 mL/min (M ± SD, n = 21) and was 1001.0 ± 240.4 mL/min when 5 cm apart (n = 22) (p = 0.014). There was a correlation between these two sets of Qa values (r = 0.554; p = 0.011). The effective ionic dialysance values obtained with needles 2.5 cm or 5 cm apart were similar and correlated strongly (r = 0.71; p = 0.000). Hemodialysis treatments using arteriovenous fistulae and two needles as close as 2.5 cm apart are possible without access recirculation and impairment of clearance. Indicator dilution access blood flow measurements are not recommended under these circumstances.