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1.
J Nurs Scholarsh ; 47(3): 200-10, 2015 May.
Artigo em Inglês | MEDLINE | ID: mdl-25808828

RESUMO

PURPOSE: Genomics is increasingly relevant to health care, necessitating support for nurses to incorporate genomic competencies into practice. The primary aim of this project was to develop, implement, and evaluate a year-long genomic education intervention that trained, supported, and supervised institutional administrator and educator champion dyads to increase nursing capacity to integrate genomics through assessments of program satisfaction and institutional achieved outcomes. DESIGN: Longitudinal study of 23 Magnet Recognition Program® Hospitals (21 intervention, 2 controls) participating in a 1-year new competency integration effort aimed at increasing genomic nursing competency and overcoming barriers to genomics integration in practice. METHODS: Champion dyads underwent genomic training consisting of one in-person kick-off training meeting followed by monthly education webinars. Champion dyads designed institution-specific action plans detailing objectives, methods or strategies used to engage and educate nursing staff, timeline for implementation, and outcomes achieved. Action plans focused on a minimum of seven genomic priority areas: champion dyad personal development; practice assessment; policy content assessment; staff knowledge needs assessment; staff development; plans for integration; and anticipated obstacles and challenges. Action plans were updated quarterly, outlining progress made as well as inclusion of new methods or strategies. Progress was validated through virtual site visits with the champion dyads and chief nursing officers. Descriptive data were collected on all strategies or methods utilized, and timeline for achievement. Descriptive data were analyzed using content analysis. FINDINGS: The complexity of the competency content and the uniqueness of social systems and infrastructure resulted in a significant variation of champion dyad interventions. CONCLUSIONS: Nursing champions can facilitate change in genomic nursing capacity through varied strategies but require substantial training in order to design and implement interventions. CLINICAL RELEVANCE: Genomics is critical to the practice of all nurses. There is a great opportunity and interest to address genomic knowledge deficits in the practicing nurse workforce as a strategy to improve patient outcomes. Exemplars of champion dyad interventions designed to increase nursing capacity focus on improving education, policy, and healthcare services.


Assuntos
Competência Clínica/normas , Educação Continuada em Enfermagem/métodos , Genômica/educação , Desenvolvimento de Pessoal/métodos , Atitude do Pessoal de Saúde , Educação Continuada em Enfermagem/organização & administração , Humanos , Liderança , Estudos Longitudinais
2.
J Hand Surg Am ; 33(9): 1478-81, 2008 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-18984326

RESUMO

PURPOSE: The purpose of this study was to evaluate the biomechanical effect of core decompression of the distal radius for the treatment of Kienböck's disease. METHODS: In 7 fresh cadaver upper extremities, axial loads were applied and the pressure in the radiocarpal joint measured using pressure-sensitive film before and after core decompression of the distal radius. RESULTS: Biomechanically, the stiffness of the distal forearm statistically decreased significantly from 229.4 N/mm to 198.6 N/mm after core decompression. No or minimal changes in the distribution of the force in each radiocarpal fossa and ulnocarpal fossa, the area of contact in each fossa, and the location of the centroid of force were observed. CONCLUSIONS: Core decompression of the distal radius in the setting of Kienböck's disease has been documented good clinical outcomes, yet the biomechanical analysis of this surgical technique does not demonstrate obvious unloading of the lunate.


Assuntos
Descompressão Cirúrgica , Osteonecrose/fisiopatologia , Osteonecrose/cirurgia , Rádio (Anatomia)/cirurgia , Articulação do Punho/fisiopatologia , Idoso , Fenômenos Biomecânicos , Cadáver , Feminino , Antebraço/fisiopatologia , Humanos , Osso Semilunar/fisiopatologia , Masculino , Pessoa de Meia-Idade , Rádio (Anatomia)/fisiopatologia , Suporte de Carga/fisiologia , Articulação do Punho/cirurgia
4.
J Biomech ; 37(5): 757-62, 2004 May.
Artigo em Inglês | MEDLINE | ID: mdl-15047005

RESUMO

The objectives of this study were to (a). create 3D reconstructions of two carpal bones from single CT data sets and animate these bones with experimental in vitro motion data collected during dynamic loading of the wrist joint, (b). develop a technique to calculate the minimum interbone distance between the two carpal bones, and (c). validate the interbone distance calculation process. This method utilized commercial software to create the animations and an in-house program to interface with three-dimensional CAD software to calculate the minimum distance between the irregular geometries of the bones. This interbone minimum distance provides quantitative information regarding the motion of the bones studied and may help to understand and quantify the effects of ligamentous injury.


Assuntos
Ossos do Carpo/diagnóstico por imagem , Ossos do Carpo/fisiologia , Imageamento Tridimensional/métodos , Modelos Biológicos , Movimento/fisiologia , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Interface Usuário-Computador , Gráficos por Computador , Simulação por Computador , Apresentação de Dados , Humanos , Técnicas In Vitro , Sistemas On-Line , Fatores Sexuais , Articulação do Punho/fisiologia
5.
Clin Orthop Relat Res ; (419): 232-7, 2004 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-15021160

RESUMO

Defects from curettage for giant cell tumors of bone frequently have been reconstructed with bone cement with or without reinforcement pins. The biomechanical basis for the addition of reinforcement pins was examined using a model of a contained defect in the proximal tibia. Fifty-four cadaveric proximal tibia in matched pairs were divided into five test groups: intact tibia, medial metaphyseal contained defect, defect reconstructed with cement alone, defect reconstructed with cement and pins inserted within the medullary canal, and defect reconstructed with cement and pins inserted through the cortex. Specimens were tested to failure during one cycle of compressive loading. Defect specimens were significantly weaker and less stiff than intact specimens, establishing the validity of the model-contained defects. For the reconstructions, there was no statistically significant difference in load to failure, stiffness, energy to failure, or displacement for the polymethylmethacrylate treatment alone when compared with matched specimen receiving polymethylmethacrylate and pins treatment. Similarly, there was no statistical difference in biomechanical properties in comparing matched specimens treated with polymethylmethacrylate alone or polymethylmethacrylate/pins (cortex). For contained defects of the proximal tibia that are typical after curettage for giant cell tumor, there appears to be no biomechanical advantage to use of reinforcement pins in the cement.


Assuntos
Força Compressiva , Procedimentos Ortopédicos/instrumentação , Polimetil Metacrilato , Tíbia/patologia , Tíbia/cirurgia , Fenômenos Biomecânicos , Cimentos Ósseos , Pinos Ortopédicos , Neoplasias Ósseas/patologia , Neoplasias Ósseas/cirurgia , Cadáver , Materiais Revestidos Biocompatíveis , Feminino , Tumores de Células Gigantes/patologia , Tumores de Células Gigantes/cirurgia , Humanos , Masculino , Teste de Materiais , Procedimentos Ortopédicos/métodos , Probabilidade , Valores de Referência , Sensibilidade e Especificidade , Estresse Mecânico
6.
J Hand Surg Am ; 27(1): 68-76, 2002 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-11810617

RESUMO

The role of the dorsal radiocarpal wrist ligament has been the subject of several investigations. Several biomechanical studies have used sensors inserted dorsally into the wrist joint to evaluate its pressure distribution. The purpose of this study was to evaluate whether a dorsal capsulotomy that sections the dorsal radiocarpal ligament or insertion of a flexible pressure sensor alters scaphoid or lunate kinematics. Eight cadaver upper extremities were instrumented with motion sensors and placed in a wrist joint simulator. Each arm was moved through continual cycles of wrist flexion/extension and radial/ulnar deviation. Motion data were obtained in the intact state, after a capsulotomy, and after insertion of the sensor. We found that either a dorsal capsulotomy sectioning the dorsal radiocarpal ligament or insertion of the pressure sensor alters scaphoid and lunate kinematics during dynamic wrist motion. This study supports the clinical belief that this dorsal wrist ligament should be spared during surgical approaches to the carpus.


Assuntos
Ossos do Carpo/fisiopatologia , Ossos do Carpo/cirurgia , Ligamentos Articulares/fisiopatologia , Ligamentos Articulares/cirurgia , Osso Semilunar/fisiopatologia , Rádio (Anatomia)/fisiopatologia , Rádio (Anatomia)/cirurgia , Osso Escafoide/fisiopatologia , Transdutores de Pressão , Traumatismos do Punho/fisiopatologia , Traumatismos do Punho/cirurgia , Articulação do Punho/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Fenômenos Biomecânicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Movimento/fisiologia , Pressão , Amplitude de Movimento Articular/fisiologia
7.
Clin Orthop Relat Res ; (396): 231-9, 2002 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-11859248

RESUMO

With disseminated malignancies, segmental defects of the humeral diaphysis may occur from surgical resection or as a complication of failed prior internal fixation. This study directly compared the biomechanical properties of a second generation titanium modular intercalary humeral spacer (segmental defect replacement prosthesis) with those of a modern locked humeral nail combined with methylmethacrylate (intramedullary nail) or with an intercalary allograft spacer (allograft nail composite) for fixation of segmental defects of the humeral diaphysis. Eighteen matched pairs (36 specimens) of fresh-frozen humeri were prepared in a standard fashion to create a 5-cm middiaphyseal defect and were divided randomly into three groups of 12 specimens each, using three different reconstructive methods. Specimens were tested in external torsion to failure on a Materials Testing System machine. The segmental defect replacement specimens had statistically greater peak torque (mean, 41.4 N-m) and stiffness (mean, 2.1 N-m/ degrees) than the intramedullary nail specimens (mean peak torque, 23.1 N-m) (mean stiffness, 1.6 N-m/ degrees) or the allograft nail composite specimens (mean peak torque, 12.4 N-m) (mean stiffness, 0.6 N-m/ degrees). The intramedullary nail specimens also had a statistically greater peak torque at failure and stiffness than the allograft nail composite specimens. For segmental defects of the humeral diaphysis, reconstruction with a cemented metallic intercalary spacer provides significantly greater immediate stability than interlocked intramedullary nail fixation supplemented with segmental methylmethacrylate or intercalary allograft reconstruction.


Assuntos
Úmero/fisiopatologia , Úmero/cirurgia , Implantação de Prótese , Fenômenos Biomecânicos , Pinos Ortopédicos , Neoplasias Ósseas/cirurgia , Cimentação , Falha de Equipamento , Humanos , Úmero/diagnóstico por imagem , Técnicas In Vitro , Fixadores Internos , Metilmetacrilato , Radiografia , Titânio , Torque
8.
J Hand Surg Am ; 27(1): 49-56, 2002 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-11810614

RESUMO

The ulnar styloid (US) architecture was examined radiologically and directly by dissection in 13 cadaver wrists to examine a potential relationship between US shape and US abutment syndrome and to determine an optimal radiographic view that could be used to detect US fractures. A higher incidence of US abutment syndrome in the radially deviated US type was observed by dissection. Radiographs taken at varying shoulder abduction angles suggested that the base of the US and ulnar head are not round. To best evaluate the fovea and the US for possible US fractures, radiographs should be taken with the glenohumeral joint abducted 45 degrees, the elbow flexed 90 degrees, the forearm in neutral rotation, and the x-ray beam directed through the wrist perpendicular to the floor.


Assuntos
Fraturas da Ulna/diagnóstico por imagem , Ulna/diagnóstico por imagem , Dissecação , Humanos , Imageamento Tridimensional , Postura , Tomografia Computadorizada por Raios X , Ulna/patologia , Fraturas da Ulna/patologia , Traumatismos do Punho/diagnóstico por imagem , Traumatismos do Punho/patologia , Articulação do Punho/diagnóstico por imagem , Articulação do Punho/patologia
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