Total Talar Prosthesis, Learning from Experience, Two Reports of Total Talar Prosthesis after Talar Extrusion and Literature Review.

Recently, total talar prosthesis has been proposed to substitute the talus during the management of complex talar lesions such as talar extrusion, comminuted talar fractures, or avascular necrosis. Herein, we report two cases of talar extrusion treated with total talar replacement after a high-intensity trauma. Both cases subsequently required revision surgery due to degenerative changes of the tibial plafond (arthrodesis in the first case, conversion to a total ankle prosthesis in the latter). We report and analyze the literature concerning total talar replacement to discuss strategies that could help improve prosthesis survival and reduce the incidence of osteoarthritis.

Nurse educational activity on non-prescription therapies in patients with chronic heart failure.

BACKGROUND: Notwithstanding the polypharmacy required for heart failure therapy, many patients use non-prescription therapies, including alternative medicines, herbal remedies, integrators and over-the-counter (OTC) drugs. AIMS: Non-prescription therapies could interfere with heart failure therapy, both promoting non-compliance and through pharmacological interferences. Heart failure nurses, in order to plan their educational activity, need to known about the use of therapies other than prescription. METHODS: The use of non-prescription therapies was assessed by a structured interview in 153 chronic patients with heart failure. RESULTS: Only 15.7% patients exclusively used medicines prescribed by their physicians. Alternative medicine use was not frequent (5.8%), herbal remedies (21.3%) and integrators (20.9%) were more used; OTC drugs were most common, with 75.8% use. Patients were often unaware of possible interaction with heart failure therapies, and seldom informed physician of use. CONCLUSIONS: Advice about drugs avoidance is emphasized by heart failure guidelines, and is part of the nurse educational activity. More attention should be paid to OTC drug assessment and education since their use is common.