Two-stage reimplantation in periprosthetic knee infection.

OBJECTIVE: The increasing number of total knee arthroplasties performed yearly worldwide has resulted in a concomitant rise in bacterial infections. Two-stage reimplantation has been reported as the most successful method of treating periprosthetic knee infections. The purpose of this study was to describe all the phases of the two-stage reimplantation and to review the literature regarding the topic. MATERIALS AND METHODS: Most significant and recent papers about the management of periprosthetic knee infection through a two-stage reimplantation protocol were carefully analysed and reviewed. Our personal experience, previously published, with two-stage-reimplantation protocol was also briefly reported. RESULTS: Two-stage reimplantation has been reported as the most successful method of treating periprosthetic knee infections. The strategy of using an antibiotic-loaded cement spacer and intravenous antibiotics with delayed exchange arthroplasty is actually considered the state-of-the-art, with a reported success rate of 88-96%. The two-stage protocol has been reported as a viable option also for patients with a periprosthetic knee infection by multidrug-resistant organisms. On the other hand, open debridement with polyethylene exchange and single-stage reimplantation have been reported effective only in selective case series involving acute infections by low-virulence organisms. CONCLUSIONS: The strategy that involves the use of cement spacer, intravenous antibiotic therapy, and successive revision total knee implantation is nowadays considered the gold standard for the management of the periprosthetic knee infection. This treatment is actually considered the first choice not only for chronic but also for acute infections, especially in the presence of resistant bacteria.

LARS™ in ACL reconstruction: evaluation of 60 cases with 5-year minimum follow-up.

PURPOSE: The injury of anterior cruciate ligament (ACL) causes joint instability and, in the absence of adequate treatment, progressive joint deterioration, meniscal lesions and development of post-traumatic osteoarthritis. METHODS: The purpose of this study was to evaluate the clinical, functional and radiographic outcomes and complications in a consecutive case series of 60 patients with minimum follow-up of 5 years who underwent an arthroscopic surgery for ACL reconstruction using LARS™ ligament. Patients with concomitant meniscal or chondral lesions in the same knee were excluded. RESULTS: The subjective evaluation of the patients involved in the study (Lysholm score, IKDC score and Tegner activity level scale) shows good/excellent results. The range of movement is optimal in most patients, and pain symptoms are considered mild. A total of 31.25% of the patients did not change their lifestyle that they had before the injury. None of the patients underwent resurgery in the same knee. In 85.4% of cases, X-ray images showed no signs of osteoarthritis after ACL reconstruction. CONCLUSIONS: Comparable with other series showed in the literature, this study assesses that the use of LARS™ in reconstruction of ACL is an excellent option for treating >40-year-old patients requesting rapid return to daily activities/sports also at the first surgery. By restoring knee stability, articular degeneration at short and medium follow-up was avoided.

Biphasic bioresorbable scaffold (TruFit®) in knee osteochondral defects: 3-T MRI evaluation of osteointegration in patients with a 5-year minimum follow-up.

PURPOSE: The aim of this study is to follow morphological imaging characteristics and osteointegration of TruFit® bone graft substitute (BGS) plugs in cases of chondral and osteochondral defects of the articular surface of the knee joint, using high-quality cartilage-sensitive 3-T magnetic resonance imaging (MRI), linked to clinical outcomes. METHODS: The MRI was used to assess osteointegration and biological evolution of the TruFit® BGS plugs in cases with minimum 5-year follow-up: The TruFit® plug was used in 46 patients for a total of 47 cases with mean age of 57.89 (range 32-80). In this study, we reviewed only the cases with minimum follow-up of 5 years: 5 patients with mean age 64.4 years (minimum 38, maximum 80). The mean follow-up was 71 months (range 63-77). Patients were evaluated clinically, with Lysholm Knee Scoring Scale and MOCART Scale. RESULTS: 3-T MRI, which is preferable to 1.5 T for the better signal-to-noise ratio, contrast and the ability to acquire morphological images at higher spatial resolution, shows a satisfactory integration of bone scaffolds in studied cases for more than 5 years and a satisfactory restoration of the articular cartilage, with the exception of a case of which we still have to consider the factors age, type of lesion and the relationship between the plugs implanted. CONCLUSION: Clinical and radiological results significantly improve in a longer follow-up time.

Detecting and preventing adverse drug interactions: the potential contribution of computers in pharmacies.

For patients taking two or more medications concurrently, interactions among the drugs can cause undesirable effects or negate desired responses. In modern pharmacy practice, an important role of the pharmacist is to detect potentially harmful interactions and take appropriate action to prevent their occurrence. Pharmacy computer systems offer potential for improving pharmacists' effectiveness in the detection and followup of drug interactions. Based on a survey of southern Michigan pharmacists, relationships between computer use and pharmacists' attitudes and activities in drug interaction monitoring were investigated. Respondents included users of two major computer systems as well as pharmacists who do not use computers. Results suggest that general statements cannot be made about the effect of computer use on drug interaction detection. Users of one of the two computer systems detected and followed up on interactions more frequently and were more likely to report improved knowledge of drug interactions than non-users. Frequencies of drug interaction detection and other related measures reported by users of the second computer system were similar to those for pharmacists not using computers. Computer system characteristics which might lead to these differences are discussed.

Evaluation of a medication refill reminder system for a community pharmacy.

The problem of maintaining compliance in patients taking chronic medications is well established. One recommended approach to reducing this problem is to develop a system which identifies non-compliers in order that interventions can be devised to improve that behavior. A medication refill reminder system is an example of this approach. The refill behavior was observed for 102 cardiovascular patients who were patrons of one community pharmacy in order to assess the effects of a postcard/telephone reminder system. Patients who failed to refill their prescriptions on time were sent a postcard reminding them to have them refilled. A telephone call would follow if the patient failed to visit the pharmacy after the postcard. The study results showed that the average day s late for patients who failed to refill their prescription as expected decreased from 19.15 to 6.6 days after the reminder system was used (P less than 0.005). In addition, the percent of late refills of these patients was 13% less than controls. These findings provide strong evidence that a refill reminder system can be used successfully in a community pharmacy as part of a program to identify non-compliant patients and improve their compliance with chronic medication therapy.

Effect of innovation characteristics on pharmacists' use of written patient medication information.

There is increasing pressure on pharmacists to provide written medication information in patients. Unfortunately, recent evidence indicates that this practice has not yet been extensively adopted. Pharmacists' reluctance can be explained partially by Diffusion of Innovations Theory which states that the characteristics of an innovation (i.e. relative advantage, compatibility with needs, experience and values, complexity and trialability) can affect its rate of adoption within a community. This theory was tested in a group of Michigan community pharmacists who recently purchased medication information sheets developed by the Michigan Pharmacists Association. Results were compared with a randomly selected sample of similar pharmacists who had not yet purchased the kit. Study findings support the theory that the adoption of an innovation (i.e. use of written information) is affected by the adopters' perception of certain innovation characteristics. The most influential factor in the adoption of the written information sheets was the extent that they were compatible with the pharmacists' business needs, professional values, and past experiences with providing written information to patients. The most important deterrent to adoption of the sheets appeared to be the perceived complexity in implementation at the practice site.

A systematic approach to educating elderly patients about their medications.

The purpose of this study was to evaluate a pharmacist-initiated, total package, patient education program based on the concepts described in the PRECEDE model. This program was directed towards 94 therapeutically complex elderly patients and consisted of a medication history, therapeutic evaluation, patient education needs assessment, patient education session, and a patient feedback/satisfaction telephone interview. Pharmacists identified on average 5.6 medication-related problems and provided an average of 6.2 recommendations. Problems commonly identified involved inadequate drug knowledge (25.5%), noncompliance (22.7%), and inappropriate drug use (17.4%). Typical recommendations included altering drug use (35.9%), improving compliance behavior (18.1%), and improving communication with health professionals (18.1%). Patient satisfaction with the education session was overwhelmingly positive. Based on the findings of this study, it is apparent that a patient education program based on the PRECEDE model can be used successfully by pharmacists to prepare education plans that would benefit the therapeutically complex elderly patient.

Activities, functions, and structure of pharmacy and therapeutics committees in large teaching hospitals.

The results of a survey on the activities and functions of hospital-based pharmacy and therapeutics (P&T) committees are presented. Questionnaires were mailed to the pharmacy director or the person responsible for the pharmacy's drug information service at 267 teaching hospitals throughout the United States in 1994 and 1995. The survey questions covered P&T committee composition, functions, roles of members, policies and procedures, and formulary-maintenance activities. The overall response rate was 70%. The mean number of members on the P&T committees was 19.3, of whom 91% were allowed to vote. There was an average of 12.3 physicians on the committees. Each P&T committee had at least one pharmacist member, with an average of 3.2 pharmacist members; 69.5% of the institutions reported having a committee secretary, who was almost always a pharmacist. On almost all committees, pharmacists wrote the minutes, prepared the formulary review documents, and were responsible for monitoring formulary activities outside the meeting. The P&T committee functioned in a very formal manner. Most (87.7%) of the respondents reported that their institutions had a closed formulary. At all hospitals, the attending medical staff could request additions to the formulary, but at only 62.4% of the hospitals could pharmacy staff make a similar request. The committees were active in changing the formulary. P&T committees in large teaching hospitals are active in formulary management, are large and diverse, and consist mainly of physicians, although pharmacists play an important role in the meetings.

Relative efficacy of two token economy procedures for decreasing the disruptive classroom behavior of retarded children.

Numerous studies have demonstrated that disruptive classroom behavior can be decreased by delivering tokens contingent upon periods of time during which children do not engage in it or by removing tokens contingent upon its occurrence. To date, the best controlled of these studies have consistently reported the two procedures to be qually effective. However, in these studies, token the two procedures to be equally effective. However, in these studies, token contingencies have been combined with instructions regarding the contigencies. The present study compared these two procedures when no instructions were given regarding the token contingencies. Token delivery was not effective in decreasing disruptive behavior in any of the children, while a combination of token delivery and removal was effective for three of four children. The results token delivery and removal was effective for three of four children. The results suggest that the combined procedure may be effective with certain populations that are not readily controlled by instructions.

Sharing in preschool children: Facilitation, stimulus generalization, response generalization, and maintenance.

Three approaches to facilitating verbal and physical sharing and of the generalizability and durability of the behaviors that were trained were investigated. During a free play period, groups of preschool children were taught to share verbally, to share physically, or to share verbally and physically; another group was not trained. Immediately following free play, the children were observed in a different setting. Follow-up was conducted 4 weeks after training ended. Physical sharing that was durable and generalizable resulted only when children were taught to share verbally. Increases in physical sharing produced by training children to share only physically were not durable and did not generalize. Training both verbal and physical sharing produced results with a magnitude slightly greater than teaching just verbal sharing. Despite a lack of special programming, some of the treatment effects generalized to another setting and were maintained during the Follow-up. There was response generalization of the effects of training verbal sharing to physical sharing but not vice versa. Problems with the concept of response class, a methodological suggestion for studying response generalization, and possibilities concerning why generalization and maintenance occurred without specific programming are discussed.

The effects of prosocial and aggressive videogames on children's donating and helping.

We investigated the effects of a prosocial and an aggressive videogame on children's prosocial behavior. Third-, fourth-, seventh-, and eighth-grade boys and girls (N = 160) were randomly assigned to either a control condition or one of four treatment conditions. In two of the treatment conditions, children played a videogame with prosocial content either singly or cooperatively with another child. In the other two conditions, children played an aggressive videogame either singly or competitively. Subsequent levels of donating and helping were measured. A three-way analysis of variance indicated that older students donated significantly more than did younger students. Children who played either of the aggressive videogames donated significantly less than did those who played prosocial games by themselves. No significant effects were found for helping. Playing the prosocial videogame did not increase prosocial responding, but playing the aggressive videogame tended to suppress this behavior. The failure of the prosocial game to accelerate prosocial responding might be due to the relatively brief treatments used in this study and/or to the particular prosocial videogame utilized.

Gender differences in Piagetian visual-spatial representation of verticality and horizontality.

Visual-spatial representations of verticality and horizontality (V/H) were assessed by novel plumb-line and water-level tasks in a replication of Jamison and Signorella's (1980) study of sex role orientation differences in V/H performance. Comparisons between men and women classified as masculine, feminine, and androgynous revealed no significant effect for either sex role orientation or for interactions between orientation and sex on V/H performance. The main effect for sex was significant, favoring men.

Effects of a training program on teacher behavior and handicapped children's self-concepts.

The purpose of this research was to assess the effectiveness of the revised Utah State University Self-Concept Protocol Program in changing teacher behaviors presumed to be related to pupil self-concept. This program was focused on teachers with handicapped pupils in mainstreamed classrooms (grades 4 through 6). Ten volunteer teachers were trained in the self-concept behaviors as part of an inservice course. Eight additional volunteer teachers served as a no-treatment control group. Program-related teacher behaviors were observed and a pupil self-concept measure was administered before and after the inservice course. Results indicated that, although no changes occurred in program-related behaviors for the control group teachers, experimental group teachers showed significant increases on six of the 12 program-related behaviors. No gains in self-concept were made by handicapped children; however, there was some evidence for differential effectiveness of the program for learning disabled and emotionally handicapped children.

The effects of continuous nurturance and nurturance withdrawal on children's behavior: a partial replication.

This research replicates and extends a study by Hartrup (1958) of the effects of continuous nurturance and nurturance withdrawal on children's behavior. Kindergarten and second-grade children interacted with either a continuously nurturant adult or an adult who was initially nurturant and then withdrew nurturance. A questionnaire was administered to assess children's perceptions of thier experiences and their perceptions of the reasons for the adult's withdrawal. Sessions ended after an assessment of the adult's social reinforcer effectiveness. The results indicated that the adult's social reinforcer effectiveness was an interaction of the effects of sex, children's frequency of verbalization, and nurturance condition. The results partially replicated Hartrup's (1958) and are discussed in terms of suggestions for future research on less complex contrasts between adult interaction patterns.

Exploring the iceberg. Common symptoms and how people care for them.

Despite the importance of daily symptoms for people's quality of living, they are seldom studied (thus, the "iceberg of morbidity"). We begin by reviewing United States and British studies that have information on daily symptoms experienced by adults. The most common ones are respiratory (largely from colds) and musculoskeletal (largely from arthritis, injury, overexertion). Using health diaries kept for 6 weeks by a population-based sample of adults, we report the frequency of respiratory and musculoskeletal symptoms, their specific types and causes, and what factor urge people to take therapeutic actions for them. The most popular action for both is prescription or nonprescription drugs, followed by lay consultation, then restricted activity, and lastly seeking medical care. On Respiratory Days, how miserable a person feels is the main stimulus to action; other morbidity aspects of the day also rank high. Sociodemographic groups scarcely differ in their responses to respiratory symptoms. The situation is similar for Musculoskeletal Nondisease Days (injury/overexertion). But for Musculoskeletal Disease Days (arthritis), sociodemographic characteristics figure more strongly in care, and the day's degree of morbidity less. These results signal basic differences in how people approach chronic and acute health problems: For chronic ones, they devise strategies of care (determined partly by their roles, attitudes, and resources) over months and years, and apply them during flare-ups. For acute problems, decisions about care are made in the short run and hinge mostly on symptoms. Our analysis also considers how actions complement or substitute for each other: Self-care actions (nonprescription drug use and restricted activity) tend to co-occur, and so do actions based on medical care (prescription drug use and medical contact). The two domains substitute in one way (nonprescription drug use greatly reduces chances of prescription drug use) and join in another (restricted activity increases chances of medical contact).