Do degree of coronal plane deformity and patient related factors affect union and outcome of Arthroscopic versus Open Ankle Arthrodesis?

BACKGROUND: This study aimed to analyse if union and outcome of Arthroscopic Ankle Arthrodesis (AAA) versus Open Ankle Arthrodesis (OAA) were influenced by the extent of coronal plane deformity and to report if patient related factors influence union. METHODS: A total of 122 ankle arthrodesis procedures were included in the study. These were divided into two groups; Group A (n = 99) with deformity less than 15° and Group B (n = 23) with deformity greater than or equal to 15°. Data was collected on patient demographics, medical comorbidities (smoking, diabetes, obesity) and time to union. Patient reported outcome measures (PROMs) evaluated were Manchester Oxford Foot Questionnaire, EuroQol-5D and EuroQol visual analogue health thermometer (EQ-VAS). RESULTS: The mean follow-up in Group A and B was 74.87 and 89.17 months respectively. The average deformity in Group A was 4.9° for AAA and 5.8° for OAA. In Group B it was 18.9° (maximum 28° varus) for AAA and 22.1° (maximum 41° valgus) for OAA. The overall union rate was 95% in Group A (AAA-94%; OAA-100%; [p = 0.20]) and 87% in Group B (AAA-100%; OAA-67%; [p = 0.02]). Mean time to union was 13.2 weeks in Group A (AAA-13.3 weeks; OAA-12.8 weeks; [p = 0.73]) compared to 12.4 weeks for Group B (AAA-12.9 weeks; OAA-11.8 weeks; [p = 0.56]). Irrespective of the extent of deformity and type of surgery, smokers had a 10 times higher likelihood of non-union (p = 0.03). In Group A, none of the PROMs showed significant difference between AAA and OAA. In Group B, EQ-VAS score reached statistical significance (p = 0.03) in favour of AAA whereas other PROMs showed no difference. CONCLUSION: AAA is reproducible in achieving union in end stage ankle arthritis and good PROMs can be expected even in ankles with larger deformities. Regardless of the type of surgery and extent of deformity, smoking is a significant risk factor for non-union. LEVEL OF EVIDENCE: Level III, retrospective comparative series.

Educational Revolution: Integrating Concept-Based Curriculum and Active Learning for Mental Health Nursing Students.

OBJECTIVE: To disseminate knowledge to mental health nurse educators regarding a course that is successfully preparing registered nurse (RN) students to pass the psychosocial integrity portion of the National Council Licensing Exam for Registered Nurses (NCLEX-RN). METHOD: Following the implementation of a new concept-based nursing program curricular design, faculty teaching in a psychiatric mental health nursing course embarked on converting lecture-based, content-saturated teaching strategies into active learning strategies. In this article, the overall conceptual framework for the course and specific examples of active learning teaching strategies related to nursing concepts in mental health are described. Information on objectives, clinical placements, testing, class organization, and curricular content are provided. Outcomes are shared revealing success in helping students pass the psychosocial integrity section of the NCLEX-RN. RESULTS: Predictive scores on the HESI RN Psychiatric Mental Health Specialty Exam have been consistently higher than the national average for the United States, and the NCLEX-RN pass rate for the cohort of 90 students was 97%. The majority of student evaluations of the course were positive. CONCLUSIONS: Results suggest that the integration of conceptual and active learning in a psychiatric mental health nursing course may increase the likelihood of student success.

Vitamin D levels in 577 consecutive elective foot & ankle surgery patients.

BACKGROUND: Vitamin D deficiency is a global concern impacting upon large communities and certain disease populations. It can adversely affect the outcome of orthopaedic operations. We aimed to perform an audit of the Vitamin D status of patients in two centres in the United Kingdom undergoing elective foot and ankle surgery. METHODS: Serum 25-hydroxyvitamin-D (vitamin D) levels were obtained prospectively in 577 consecutive elective patients undergoing elective foot and ankle surgery between October 2014 and March 2017 (29 months). Variables including age, gender, ethnicity, location, season, month and procedure type were recorded. RESULTS: 577 patients were included over the study period. 62.0% were female. Mean age was 53.2 (median 54.5, range 16.7-86.6). 300 patients were treated in Northampton and 277 in Leicester. The serum 25-hydroxyvitamin-D levels for the patient group were normally distributed. The mean was 52.3nmol/L (SD 28.0; range 7.5-175) and the median 47.5nmol/L. 21.7% were grossly deficient, 31.9% deficient, 28.9% insufficient and 17.5% within normal range. Age, gender and procedure type did not statistically affect vitamin D levels (p=0.5, t-test). Ethnicity, location and Winter season did affect Vitamin D levels (p<0.05). August was the most significant month with levels significantly higher than January, February, March, April, June, November and December (p<0.05, one-way ANOVA). CONCLUSIONS: Only 1 in 5.7 patients had a normal Vitamin D level and 1 in 4.6 were grossly deficient. Ethnicity and patient location significantly affected Vitamin D results. Summer months were noted to demonstrate significantly the highest levels and August the highest. We did not find that age or gender affected Vitamin D levels in our cohort.

Effects of Space Flight on Mouse Liver versus Kidney: Gene Pathway Analyses.

Understanding genome wide, tissue-specific, and spaceflight-induced changes in gene expression is critical to develop effective countermeasures. Transcriptome analysis has been performed on diverse tissues harvested from animals flown in space, but not the kidney. We determined the genome wide gene expression using a gene array analysis of kidney and liver tissue from mice flown in space for 12 days versus ground based control animals. By comparing the transcriptome of liver and kidney from animals flown in space versus ground control animals, we tested a unique hypothesis: Are there common gene expression pathways activated in multiple tissue types in response to spaceflight stimuli? Although there were tissue-specific changes, both liver and kidney overexpressed genes in the same four areas: (a) cellular responses to peptides, hormones, and nitrogen/organonitrogen compounds; (b) apoptosis and cell death; (c) fat cell differentiation and (d) negative regulation of protein kinase.

Physical Forces Modulate Oxidative Status and Stress Defense Meditated Metabolic Adaptation of Yeast Colonies: Spaceflight and Microgravity Simulations.

Baker's yeast (Saccharomyces cerevisiae) has broad genetic homology to human cells. Although typically grown as 1-2mm diameter colonies under certain conditions yeast can form very large (10 + mm in diameter) or 'giant' colonies on agar. Giant yeast colonies have been used to study diverse biomedical processes such as cell survival, aging, and the response to cancer pharmacogenomics. Such colonies evolve dynamically into complex stratified structures that respond differentially to environmental cues. Ammonia production, gravity driven ammonia convection, and shear defense responses are key differentiation signals for cell death and reactive oxygen system pathways in these colonies. The response to these signals can be modulated by experimental interventions such as agar composition, gene deletion and application of pharmaceuticals. In this study we used physical factors including colony rotation and microgravity to modify ammonia convection and shear stress as environmental cues and observed differences in the responses of both ammonia dependent and stress response dependent pathways We found that the effects of random positioning are distinct from rotation. Furthermore, both true and simulated microgravity exacerbated both cellular redox responses and apoptosis. These changes were largely shear-response dependent but each model had a unique response signature as measured by shear stress genes and the promoter set which regulates them These physical techniques permitted a graded manipulation of both convection and ammonia signaling and are primed to substantially contribute to our understanding of the mechanisms of drug action, cell aging, and colony differentiation.

Addressing the Cost, Value, And Student Debt in Nursing Education.

The current initiatives to improve the academic preparation of nurses have added emphasis to the presence or prediction of thousands of dollars of debt, which may influence personal decisions about returning to school. In this study, nearly 40% of survey respondents reported less than $25,000 in college debt and 23.5% reported greater than $25,000 of prior college debt. Slightly less than a third of respondents reported no plans to return to school for more education but of those who did have an educational plan, the influence of prior college debt on their plans for academic progression was significant. Debt and the influence of debt on education planning for nurses was confirmed as a concern that will impede achievement of the baccalaureate education benchmark for nurses unless steps are taken to address prior college debt and the cost of further education. Nurse executives should take nurses' debt load into account when planning academic advancement initiatives.

Is There a Space-Based Technology Solution to Problems with Preclinical Drug Toxicity Testing?

Even the finest state-of-the art preclinical drug testing, usually in primary hepatocytes, remains an imperfect science. Drugs continue to be withdrawn from the market due to unforeseen toxicity, side effects, and drug interactions. The space program may be able to provide a lifeline. Best known for rockets, space shuttles, astronauts and engineering, the space program has also delivered some serious medical science. Optimized suspension culture in NASA's specialized suspension culture devices, known as rotating wall vessels, uniquely maintains Phase I and Phase II drug metabolizing pathways in hepatocytes for weeks in cell culture. Previously prohibitively expensive, new materials and 3D printing techniques have the potential to make the NASA rotating wall vessel available inexpensively on an industrial scale. Here we address the tradeoffs inherent in the rotating wall vessel, limitations of alternative approaches for drug metabolism studies, and the market to be addressed. Better pre-clinical drug testing has the potential to significantly reduce the morbidity and mortality of one of the most common problems in modern medicine: adverse events related to pharmaceuticals.

A disease-specific metabolic brain network associated with corticobasal degeneration.

Corticobasal degeneration is an uncommon parkinsonian variant condition that is diagnosed mainly on clinical examination. To facilitate the differential diagnosis of this disorder, we used metabolic brain imaging to characterize a specific network that can be used to discriminate corticobasal degeneration from other atypical parkinsonian syndromes. Ten non-demented patients (eight females/two males; age 73.9 ± 5.7 years) underwent metabolic brain imaging with (18)F-fluorodeoxyglucose positron emission tomography for atypical parkinsonism. These individuals were diagnosed clinically with probable corticobasal degeneration. This diagnosis was confirmed in the three subjects who additionally underwent post-mortem examination. Ten age-matched healthy subjects (five females/five males; age 71.7 ± 6.7 years) served as controls for the imaging studies. Spatial covariance analysis was applied to scan data from the combined group to identify a significant corticobasal degeneration-related metabolic pattern that discriminated (P < 0.001) the patients from the healthy control group. This pattern was characterized by bilateral, asymmetric metabolic reductions involving frontal and parietal cortex, thalamus, and caudate nucleus. These pattern-related changes were greater in magnitude in the cerebral hemisphere opposite the more clinically affected body side. The presence of this corticobasal degeneration-related metabolic topography was confirmed in two independent testing sets of patient and control scans, with elevated pattern expression (P < 0.001) in both disease groups relative to corresponding normal values. We next determined whether prospectively computed expression values for this pattern accurately discriminated corticobasal degeneration from multiple system atrophy and progressive supranuclear palsy (the two most common atypical parkinsonian syndromes) on a single case basis. Based upon this measure, corticobasal degeneration was successfully distinguished from multiple system atrophy (P < 0.001) but not progressive supranuclear palsy, presumably because of the overlap (∼ 24%) that existed between the corticobasal degeneration- and the progressive supranuclear palsy-related metabolic topographies. Nonetheless, excellent discrimination between these disease entities was achieved by computing hemispheric asymmetry scores for the corticobasal degeneration-related pattern on a prospective single scan basis. Indeed, a logistic algorithm based on the asymmetry scores combined with separately computed expression values for a previously validated progressive supranuclear palsy-related pattern provided excellent specificity (corticobasal degeneration: 92.7%; progressive supranuclear palsy: 94.1%) in classifying 58 testing subjects. In conclusion, corticobasal degeneration is associated with a reproducible disease-related metabolic covariance pattern that may help to distinguish this disorder from other atypical parkinsonian syndromes.

Preparing staff to care for veterans in a way they need and deserve.

More than 2.5 million military veterans have been deployed for service in Iraq and/or Afghanistan, whereas another 20 million veterans currently reside in the United States. For various reasons, increasing numbers of military and associated personnel from various wars could go to civilian population-based care facilities for their rest-of-life health care. Therefore, educational activities are important to prepare nursing staff for the culturally sensitive care that veterans, their dependents, and civilian contractor personnel need. This article (a) provides rationale for veterans' admissions, (b) summarizes some common health situations that veterans are likely to encounter, (c) stresses major educational goals, and (d) emphasizes the use of the universal assessment question: Have you ever served in the military? Several educational implications and challenges are discussed, including war zone physiology, reintegration, military culture and pride, ethical challenges, educational speakers, simulation, veteran individuality, and compassion fatigue. Available resources to accompany this content are provided.

Gluten-Related Disorders: Celiac Disease, Gluten Allergy, Non-Celiac Gluten Sensitivity.

Gluten is a protein complex found in the endosperm portion of wheat, rye, and barley. "Gluten-related disorder" is a term used to describe conditions related to ingestion of gluten-containing foods. Gluten has been implicated as the cause of a variety of gastrointestinal (GI) and extraintestinal symptoms. These symptoms are often non-specific and variable, making it difficult for the primary care provider to diagnose the cause and develop a management plan. Recently, gluten-related disorders have received much attention in the popular press, and the sale of gluten-free foods has become a multi-billion dollar business. It is important for pediatric primary care providers to understand the potential role of gluten in GI health and symptomatology so appropriate screening, diagnostic testing, and management can be provided.

Screening for autism spectrum disorders in infants before 18 months of age.

Autism spectrum disorders (ASDs) are a group of developmental disabilities that can cause significant social, communication, and behavioral challenges for children and families. An estimated one in 88 children in the United States are affected by an ASD. Early identification and intervention have been shown to improve outcomes for these children, and the routine well-child visit is a critical opportunity for pediatric health care providers to obtain developmental information relating to ASD identification. Although current recommendations suggest ASD screening at 18 and 24 months of age, research suggests that ASD-specific behaviors and delays emerge earlier in infancy. The purpose of this article is to identify key developmental tasks that can be assessed by pediatric primary care providers to determine increased risk for ASD in infants at nine, 12, and 15 months prior to formal screening for ASD at 18 and 24 months.

Creating innovative programs for the future.

Although several major national mandates advocate for a better educated workforce, this push comes at a time when the competition for faculty, financial resources, advanced technology, and students remains strong. If nurse educators are seriously considering creating a new nurse program at their school, some key points are essential during the development stage. Using the innovation frameworks from the Institute of Healthcare Improvement, from the global design firm IDEO, and from Gladwell's The Tipping Point: How Little Things Can Make a Big Difference, this article examines the informal, formal, internal, and external work needed during program conceptualization, initial program exploration, resource infrastructure, support, and evaluation for an effective and innovative plan.

Veterans' health care considerations for today's nursing curricula.

Although there have been several wars and conflicts since World War I, the escalating numbers of veterans since that time is now evident. Extraordinary survival results have evolved from effective triage, trauma treatment, and recovery maneuvers during Operation Iraqi Freedom and Operation New Dawn (OIF) in Iraq and Operation Enduring Freedom (OEF) in Afghanistan. Yet even with those results, the number of physical and mentally wounded individuals exceeded 32,000 from OIF and 16,000 from OEF. How will we help these service men and women meet the special challenges they may face after discharge from the military? This article presents a rationale for content integration, health concerns, and realistic educational suggestions for faculty as they prepare professional nurses to care for these veterans and their families. Future nurses need to be prepared to care for this patient population in community health care systems.

Best practices to identify gay, lesbian, bisexual, or questioning youth in primary care.

Compared to heterosexual youth, gay, lesbian, bisexual, and questioning (GLBQ) adolescents engage disproportionately in a variety of health risk behaviors and are at risk for numerous negative health outcomes. Adolescents reporting same-sex sexual attraction, romantic relationships, and sexual experience are also at increased risk, regardless of self-identified sexual orientation. While adolescents feel it is important to discuss sexuality with primary care providers, they are unlikely to initiate discussion about sexuality or to openly disclose GLBQ sexual orientation to their providers. Primary care providers should identify GLBQ youth to increase delivery of targeted preventive health services to this at-risk population. However, providers do not routinely address sexual orientation in their clinical encounters with adolescents, and the majority of GLBQ youth are not identified in the primary care setting. To better serve the needs of this population, providers should initiate open, sensitive, nonjudgmental, and confidential discussion of sexuality with all adolescents. Providers should inquire about sexual orientation, sexual attraction, romantic relationships, and sexual partners.

Health risks associated with late-preterm infants: implications for newborn primary care.

This integrative literature review focuses on the health risks associated with late-preterm infants (34 to 36 and 6/7 weeks gestation) and the implications for newborn primary care providers and pediatric nurses. Common morbidities in the late-term population included hyperbilirubinemia, respiratory compromise, hyperglycemia and poor feeding, temperature instability, and infection. Primary care providers should be aware of these morbidities to be sure risk-focused evaluation is performed during and after the birth hospitalization, and treatment is administered when necessary.

Recommendations After an Objective Structured Clinical Examination Program Evaluation.

BACKGROUND: The use of objective structured clinical examinations (OSCEs) is a well-established method of clinical assessment in the medical profession, and these are currently being integrated into advanced practice nursing curricula. METHOD: A program assessment was conducted at a current family nurse practitioner track within a southwestern U.S. university using the OSCE evaluative strategy. The logic model from the Centers for Disease Control and Prevention framework was incorporated. Both focus group and the de-identified faculty-scored student rubrics during the fall, spring, and summer semesters of one cohort of students (N = 73) were examined. RESULTS: Strengths and challenges were found in the areas of student preparation, scoring/grading with variations of inter-rater reliability, and debriefing. CONCLUSION: Establishing a specific OSCE center with a dedicated director could support adequate attainment of formative and summative competencies for nurse practitioners and provide faculty education and standardized student preparation, while adhering to the multiple guidelines and standards related to nurse practitioner competency evaluation with simulation. [J Contin Educ Nurs. 2023;54(4):169-175.].

Creating and launching. Innovative nursing education programs: perils and pearls.

Nursing's future depends on continuing to seek, create, and launch innovative nursing programs. Successful innovation can improve nursing education delivery and make optimal use of available resources while tapping into the imagination and creativity of faculty and students; in addition, it can create an optimistic environment and encourage beneficial change with the faculty and staff. Innovation has been described as an art, a process of diffusion, and a process of transforming ideas into real value. The purpose of this article is to explore the concepts surrounding innovation, steps in development of an innovation, and share pearls, perils, and lessons learned so that others can explore the process within their nursing education programs.

Barriers to advanced practice registered nurse scope of practice: issue analysis.

Advanced practice registered nurses (APRNs) have the unique potential to affect the changing needs of health care in the United States, but are restricted in care provision by varying state regulations and reimbursement policies. Although research shows APRN care to be safe, cost-effective, and of high quality, most medical professional organizations continue to oppose the removal of scope-of-practice barriers, citing patient safety concerns. Nursing organizations at the state and national levels have already begun to invest the time and resources needed for policy change. However, empirical evidence of APRN quality of care must be shared with policymakers, funding entities, and the public. Additionally, support must be garnered from the public and other health care disciplines. Scope-of-practice policy change will occur through the emergence of strong individuals within nursing professional organizations and the joining together of organizations to form one voice.

The impact of maternal depression on children with asthma.

This integrative literature review focuses on the impact of maternal depression on children with asthma. Maternal depression has a negative impact on a child's growth, development, behavior, mental health, safety, and health care utilization. Mothers of children with chronic conditions such as asthma have higher rates of depression compared to mothers of children without a chronic condition. Research has shown that maternal depression has the potential to increase asthma morbidity and health care utilization. In addition, mothers with depressive symptoms report lower self-efficacy in their ability to care for their children with asthma, which can affect their ability to manage their child's asthma with the prescribed medication regimen. To provide optimal care for children with asthma and their families, pediatric care providers must perform periodic depression screening to mothers or caregivers. Depressed mothers or caregivers of children with asthma require care coordination and management that consists of increased education on asthma and depression, and more frequent follow up than families without maternal/caregiver depression. These additional care measures have numerous positive benefits, including enhancing the quality of life in both the child and caregiver by improving asthma management in the child and depressive symptoms in the mother, as well as decreasing costs imposed on the economy through reduced emergency department visits, hospitalizations, missed work days, and missed school days.