Recommendations of the OARSI FDA Osteoarthritis Devices Working Group.

Osteoarthritis (OA) is the most common type of arthritis and a major cause of chronic musculoskeletal pain and functional disability. While both pharmacologic and non-pharmacologic modalities are recommended in the management of OA, when patients with hip or knee OA do not obtain adequate pain relief and/or functional improvement, joint replacement surgery or other surgical interventions should be considered. Total joint arthroplasties are reliable and cost-effective treatments for patients with significant OA of the hip and knee. Evidence from cohort and observational studies has confirmed substantial improvements in pain relief with cumulative revision rates at 10 years following total hip (THA) and total knee arthroplasties (TKA) at 7% and 10%, respectively. Joint replacements have been used in most every synovial joint, although results for joints other than hip and knee replacement have not been as successful. The evolution of new device designs and surgical techniques highlights the need to better understand the risk to benefit ratio for different joint replacements and to identify the appropriate methodology for evaluating the efficacy and optimal outcomes of these new devices, designed to treat OA joints.

Analyzing participant produced photographs from an ethnographic study of fatherhood and smoking.

As part of an ongoing ethnographic study, we examined the photographs and narratives that new fathers produced to ascertain how they created social, psychological, and relational space for continued smoking. A four-part process for analyzing the photographs consisting of preview, review, cross-photo comparison, and theorizing revealed how visual data analyses can be used to develop insights into men's health behaviors and beliefs. There is ongoing epistemological debate and methodological uncertainty about how photographic data should be treated in health sciences research. By conducting formal layered analyses, researchers can expand and extend both what is said about, and interpreted through, photographs.

Coordinating integrated services: a pilot study with participants of a co-ordinators course.

The aim of this study was to explore developments in integrative practice in cancer care. Views were drawn from a small focus group (n=4), with students from a coordinators course. The role of a coordinator or team leader has been suggested as pivotal to service integration and organisation [National guidelines for the use of complementary therapies in supportive and palliative care. The Prince of Wales's foundation for Integrated Health & The National Council for Hospice and Specialist Palliative Care Services London POWFIH, 2003; Mackereth, European Journal of Oncology Nursing 8 (2004) 1]. The participants suggested that there are areas which need to be developed to achieve this goal, including evidence based practice, standardisation of training, and ongoing support, and personal development.

Safety indices associated with the use of contingent restraint procedures.

The safety of four general classes of contingent restraint was evaluated in a sample of 231 institutionalized mentally retarded persons. The use of mechanical restraints resulted in a significantly lower injury rate than did personal restraint. The use of restraint in emergency situations was found to be more dangerous than the planned use of such procedures.

Externally stented polytetrafluoroethylene valved conduits for right heart reconstruction. An experimental comparison with Dacron valved conduits.

Valve-containing conduits have made possible the repair of many congenital anomalies that involve right ventricular-pulmonary arterial discontinuity. The distressing problem of neointimal peel formation with eventual conduit obstruction in patients with Dacron valved conduits has led to the need for premature replacement in many patients. Externally stented polytetrafluorethylene has demonstrated superior patency in the venous system experimentally and clinically and was believed to have potential advantages over Dacron for conduit construction. This study compares the transconduit resistance and the thickness of the neointimal peel in right ventricular-pulmonary arterial conduits constructed of externally stented polytetrafluoroethylene with those of woven Dacron. The 19 mm externally stented polytetrafluoroethylene conduits (Impra, Inc.) containing a Hancock porcine valve (Extracorporeal Inc.) were implanted in six adult mongrel dogs followed by proximal occlusion of the pulmonary artery. In six additional animals, a Dacron valved conduit of similar size and length was inserted. Cardiac output, transconduit gradient, and resistance were measured at operation and at 3 months. All conduits were subsequently explanted, opened longitudinally, and the thickness of the neointimal peel (excluding suture lines) measured. No hemodynamic differences were noted during the 3 month follow-up. However, the thickness of the neointimal peel was fourfold greater in Dacron conduits (609 +/- 144 mu) than in the conduits constructed of externally stented polytetrafluoroethylene (156 +/- 50 mu) (p less than 0.01). The thick peel in Dacron conduits extended into the outflow portion of the porcine valve cusps and prevented their full excision. The neointima in externally stented polytetrafluoroethylene conduits was thin and uniform and did not extend onto the leaflets or limit their mobility. This study demonstrated that the early hemodynamic performance of externally stented polytetrafluoroethylene conduits was comparable to that of Dacron conduits; Dacron conduits were subject to an accelerated rate of peel formation that affected leaflet mobility and may be a factor in early valve degeneration; a thin neointima formed in externally stented polytetrafluoroethylene conduits and valve leaflet motion was preserved. This study showed that externally stented polytetrafluoroethylene conduits offer advantages over Dacron valved conduits and warrant clinical application.

Selected functionality changes of beta-lactoglobulin upon esterification of side-chain carboxyl groups.

Free carboxyl groups of bovine beta-lactoglobulin were esterified with methanol, ethanol, and n-butanol. The modified proteins showed increased positive charge as the number of ionizable carboxyl groups was reduced. The methyl, ethyl, and butyl esters of beta-lactoglobulin showed enhanced surface activity, determined with surface and interfacial tension measurements at an air/water and oil/water interface, respectively. The methyl ester showed the largest enhancement in surface activity relative to the native protein. The ethyl and butyl esters were less effective in lowering the surface and interfacial tension but were more surface active than the native protein. The hydrophobic probe, 1,8-anilinonaphthalene sulfonate, showed enhanced fluorescence in the presence of native and modified beta-lactoglobulin. The largest enhancement in fluorescence of the hydrophobic probe was noted in the presence of the methyl ester of beta-lactoglobulin. The ethyl ester also effectively enhanced the fluorescence of the probe. The slopes of the curves of the fluorescent response for the native and modified proteins were graphically related to the interfacial tension at an oil/water interface for the corresponding protein. A large positive correlation was noted between the effectiveness of the proteins in reducing the interfacial tension and the enhancement in fluorescence of ANS with hydrophobic binding by the proteins. A general method to quantify carboxyl groups of proteins, employing the formation of a colored hydroxamate-ferric ion chelate, was also developed. Modification of the reaction for proteins in general, and carboxyl-modified proteins in particular, appears to have potential. Use of the hydroxamic acid reaction made it possible to estimate the apparent extent of carboxyl modification of beta-lactoglobulin through esterification with methanol, ethanol, and n-butanol.

Use of air entrainment masks during eye surgery.

Plastic drapes over the patient's face during eye surgery are necessary to maintain a sterile surgical field. We found that providing the patient with adequate inspiratory gas under these surgical drapes was a problem. We now use air entrainment oxygen masks to provide this surgical patient with a high flow gas source, nearer to peak inspiratory flows than the previously used nasal cannula. The mask is powered with compressed air or, if necessary, compressed oxygen. This practice has helped eliminate restlessness, smothering sensations, coughing, and sudden movements, which can result in disastrous complications during ophthalmic microsurgical procedures. Respiratory therapists can play a key role in explaining and adapting this system for eye surgery.

Use of venturi entrainment mask for high-flow ventilation of patients submitting to ophthalmic surgery under local anesthesia.

The venturi entrainment mask is an inexpensive, disposable item readily available from the respiratory therapy department of most hospitals, which can be used with the patients submitting to ophthalmic surgery under local anesthesia to provide low oxygen concentration, high-flow ventilation at nearly room temperature and humidity. Four liters of oxygen will entrain an additional 101 liters of room air using the 24% uptake valve. This high-flow ventilation system eliminates hypercarbia since the patient never rebreathes. The mask elevates the drapes comfortably off the patient's face without dislodging and reduces the danger of flash fire with the use of thermal electrocautery.