Submitted by Marcos Anselmo (marcos.anselmo@unipampa.edu.br) on 2016-05-03T19:44:16Z No. of bitstreams: 1 LEANDRO ZIEMER CARNEIRO.pdf: 5141284 bytes, checksum: 967ea86595423b1d3aa3442bdec2b570 (MD5) / Approved for entry into archive by Marcos Anselmo (marcos.anselmo@unipampa.edu.br) on 2016-05-03T19:45:34Z (GMT) No. of bitstreams: 1 LEANDRO ZIEMER CARNEIRO.pdf: 5141284 bytes, checksum: 967ea86595423b1d3aa3442bdec2b570 (MD5) / Made available in DSpace on 2016-05-03T19:45:34Z (GMT). No. of bitstreams: 1 LEANDRO ZIEMER CARNEIRO.pdf: 5141284 bytes, checksum: 967ea86595423b1d3aa3442bdec2b570 (MD5) Previous issue date: 2015-03-31 / Osteotomia intertrocantérica varizante (OIV) objetiva diminuir o ângulo de inclinação de cabeça e colo femoral, comumente aumentado em animais displásicos. Pode ser estabilizada por diferentes métodos, sendo a placa de compressão e parafusos o método mais tradicional. Embora a haste intramedular bloqueada (HIB) ainda não tenha sido relatada em estabilizações pós OIV, sabe-se que em fraturas femorais este método é considerado mais eficiente que as placas compressivas, além de permitir tempo cirúrgico menor. Deste modo, objetivou-se avaliar a aplicabilidade da HIB como método de fixação pós OIV em comparação com a placa compressiva. Foram utilizados dez cadáveres caninos com peso superior a 15 kg, com ambos os fêmures intactos. Nos fêmures esquerdos foram realizadas as OIVs, com remoção de cunha óssea de 20o na face medial e fixação por meio de HIB. Os fêmures contralaterais foram utilizados como controle e, após a realização da mesma técnica cirúrgica, fixou-se os segmentos ósseos por meio de placas de compressão e parafusos. As articulações coxofemorais foram radiografadas em projeção ventrodorsal e os ângulos de Norberg e de inclinação de cabeça e colo femoral comparados antes e após o procedimento cirúrgico entre os métodos de fixação. Também foi comparado o tempo dispendido para a colocação dos implantes. Os resultados demonstraram aumento do ângulo de Norberg em relação ao ângulo pré-operatório (passando de 106,84±5.55o para 111.22o ± 3.89) apenas no grupo HIB; ambos os grupos apresentaram redução do ângulo de ICF, mas sem diferença entre eles; e o tempo de colocação de cada implante também não diferiu entre os dois grupos. Assim, o uso da HIB na estabilização pós OIV foi factível em cadáveres, produzindo resultados similares à placa em relação ao tempo de execução e redução do ângulo ICF, além de permitir aumento o ângulo de Norberg. / Intertrochanteric varus osteotomy (IVO) aims to decrease the angle of head and femoral neck, commonly increased in dysplastic animals. It can be stabilized by different methods, and the compression plate and screws is the most commonly applied. The application of locked intramedullary nail (IN) in femoral fractures has been more efficient and faster than the compressive plates. However, is not known if the IN would be effective in stabilization post IVO. Thus, this study aimed to compare the application of the IN post IVO with compression plate. For this, were used ten canine cadavers weighing more than 15 kg, with both intact femurs. In the left femur were performed IVO, with bone wedge removal of 20o on the medial side and fixation with IN. The contralateral femurs were used as control and, after performing the same surgical technique, the bone segments were fixed with compression plates and screws. The hip joints were radiographed in Ventrodorsal projection, and compared the angles of Norberg and inclination of the head and femoral neck (IHF), obtained before and after surgery. The time spent for the placement of implants as compared too. IHF between the fixing methods before and after surgery. Finally, there was an increase of Norberg angle (from 106.84 ± 5.55o to 111.22o ± 3.89) only in the IN group; Similar results between the two groups were obtained with regard to reducing the IHF angle and the implant placement time compared to the compression plate. Thus, the use of IN post IVO stabilization was feasible in cadavers, producing similar results to the plate in relation to the execution time and reducing the angle IHF, and increasing the Norberg angle.

The opioid epidemic in the United States continues to be a national health crisis affecting all populations. From 1999 to 2016, more than half a million people died from drug overdose. Nonpharmacological therapies are underused in nursing practice due to the gap in nurses' baseline knowledge and confidence related to nonpharmacological techniques for pain management. The purpose of this scholarly project was to develop and implement an expert-reviewed, evidence-based education program focused on nonpharmacological techniques for pain management. Participants included 18 registered nurses (RNs) from an orthopedic unit in a large academic medical center. A 45-minute educational session was conducted for RNs. A pre/postquestionnaire, including a 5-point Likert scale on nurses' self-perceived knowledge and confidence in using selected nonpharmacological techniques, was the method of data collection. Descriptive statistics were used to analyze the data. The results indicated an increase in nurses' self-perceived knowledge in all nonpharmacological techniques. The most significant increase in knowledge posteducation intervention was guided imagery with an increase of 72% in terms of the response Good. The data analysis indicates that the nurses self-perceived confidence posteducation intervention increased in terms of the response Good by 50 % and response Excellent by 33% demonstrating the efficacy of an evidence- based education program on nonpharmacological techniques. The implications of this project for social change include the empowerment of nurses to provide holistic patient-centered care, opioid sparing in keeping in alignment with patient safety, and the development of an evidence-based program that can be replicated in other settings.

Osteoarthritis is a chronic, deleterious disease of the joints. It currently affects nearly 25 million Americans. Clinically, osteoarthritis presents as joint pain and verified by radiographic evidence of joint space narrowing. Unfortunately, symptomatic osteoarthritis describes the later stages of disease, at which point irreversible cartilage and bone damage has occurred. Cross-sectional imaging modalities offer the promise of visualizing early features of disease, enabling the development and evaluation of interventions to forestall or prevent degenerative change. Modalities of clinical interest include magnetic resonance imaging (MRI) and multi-detector computed tomography (MDCT). The following work describes the efficacy of MRI-derived measures for the identification and accurate quantification of local and whole joint changes in articular cartilage thickness changes in vivo. This was performed as part of a study investigating the diagnostic potential of clinical morphometric and compositional MRI to identify early features of osteoarthritis in a large animal model of traumatic knee joint injury. Surgically induced trauma consisted of a partial medial meniscectomy and blunt impact of either 0 J, 0.6 J, or 1.2 J to the weight-bearing cartilage of the medial femur. The study was six months in duration. To evaluate the accuracy of MRI-derived measures of cartilage thickness, imaging acquired at time of euthanasia was compared to high-resolution contrast-enhanced micro-computed tomography (micro CT). 3-dimensional multimodal analysis demonstrated that morphometric MRI imaging is sensitive to sub-voxel changes in cartilage thickness. Therefore, MRI is a clinically relevant modality to quantify subtle cartilage damage, thereby presenting an opportunity to identify patients earlier in the disease process.

No description available.

Femoroacetabular impingement (FAI) has been increasingly recognized as a cause of early hip osteoarthritis. FAI is characterized by pathologic contact between the femur and acetabular rim during hip join movement, caused by morphological abnormalities. Arthroscopic technique has become increasingly popular for FAI surgical treatment because of its minimal invasiveness. However, it involves cumbersome procedures and over- or under-resection are likely to occur. To tackle this issue, robot-assisted FAI arthroscopy is a well suited approach because it results in high accuracy and reproducible surgical outcomes. This dissertation provides new approaches and methods for the current challenges in the development of robot-assisted FAI arthroscopy. The study has three objectives: 1) to develop a robust calibration method for the A-mode ultrasound probe used for noninvasive bone registration, 2) to develop a bone registration simulator for verifying the registration accuracy and consistency for any given registration point-pattern, and 3) to develop a hip range of motion simulation system that returns the virtual range of motion and determines the bone resection volume. Carefully designed calibration procedures and simulation experiments have been conducted during the study of this research. From the experimental results, the developed ultrasound calibration method successfully reduces the registration errors and is proved to be robust. The results from the registration simulator indicate that the pattern with widely distributed points lead to better registration accuracy and consistency. The hip range of motion simulation system results in acceptable accuracy and successfully generates the resection volume. With further modifications, the ultrasound probe can be successfully calibrated with the developed method, and will be applied for noninvasive bone registration. The registration simulator can also be served as a useful tool for determining the optimized registration point-pattern, which can lead to reduced surgical trauma and registration time. Finally, the developed range of motion simulation system can allow the surgeon to evaluate the surgical outcome and to determine the resection volume even before the surgery begins. To conclude, this dissertation provides useful approaches, methods, and software for developing robot-assisted FAI arthroscopy.

Postoperative urinary retention (PUR) is a common problem seen after surgery, particularly after orthopedic surgery. There has been a great deal of research done surrounding the causes of PUR and the optimal treatment for PUR, all with conflicting results. Little research has been done with orthopedic nurses to find out how they actually treat PUR, and on what information they base those treatment decisions. Evidence-based practice has been gaining popularity recently and highlights the need for nurses to make treatment decisions based on sound research, patient preferences, clinical expertise, and taking into consideration health care resources and the clinical setting (DiCenso, Ciliska, & Guyatt, 2005). This study investigated nurses' views on the definition of PUR, how they assessed for PUR, how they treated PUR and what they based their treatment decisions on. Ten nurses who worked on orthopedic units were interviewed using a semi-structured format consisting of four questions. The interviews were recorded and then transcribed verbatim by the student researcher. Qualitative description, as described by Sandelowski (2000), was used to analyze data. All nurses defined PUR fairly similarly. Various contributing factors for PUR were mentioned, some that were studied in the literature, and some that were not. Each nurse had a slightly different way of treating PUR, and 'ward routine' was also described differently. Study results point to a need for more research and education in the area of PUR so that all nurses are treating PUR in the same manner based on the same sound knowledge base.

Several outcome tools have been developed to measure physical functioning in pediatric orthopedic patients. One such tool, the Activities Scale for Kids (ASK), allows assessment of physical functioning in the community in 5-to 15-year-olds. Previous validation of the ASK showed a significant difference in scores according to global ratings of disability. In this study, the ASK was administered to children without musculoskeletal disability to determine how normal respondents scored. ASK questionnaires were distributed to 137 children and 122 (89%) were returned. Normal children scored quite high, with a mean summary score of 93.12 (SD 6.45). This score differs significantly from the mean summary score for children with mild disabilities as determined in previous studies of disability (P = 0.005). / Study conducted at the Children’s Hospital of Eastern Ontario, Universityof Ottawa, Ottawa, Ontario, Canada. / Dr. Plint is supported in part by a Junior Clinical Investigator Award from the Children’s Hospital of Eastern Ontario Research Institute.

Postoperative urinary retention (PUR) is a common problem seen after surgery, particularly after orthopedic surgery. There has been a great deal of research done surrounding the causes of PUR and the optimal treatment for PUR, all with conflicting results. Little research has been done with orthopedic nurses to find out how they actually treat PUR, and on what information they base those treatment decisions. Evidence-based practice has been gaining popularity recently and highlights the need for nurses to make treatment decisions based on sound research, patient preferences, clinical expertise, and taking into consideration health care resources and the clinical setting (DiCenso, Ciliska, & Guyatt, 2005). This study investigated nurses' views on the definition of PUR, how they assessed for PUR, how they treated PUR and what they based their treatment decisions on. Ten nurses who worked on orthopedic units were interviewed using a semi-structured format consisting of four questions. The interviews were recorded and then transcribed verbatim by the student researcher. Qualitative description, as described by Sandelowski (2000), was used to analyze data. All nurses defined PUR fairly similarly. Various contributing factors for PUR were mentioned, some that were studied in the literature, and some that were not. Each nurse had a slightly different way of treating PUR, and 'ward routine' was also described differently. Study results point to a need for more research and education in the area of PUR so that all nurses are treating PUR in the same manner based on the same sound knowledge base.

The purpose of this thesis was to explore the use of cost effectiveness for interventions in orthopaedics. This was done through three cost effectiveness articles that have been published by the author. In each of these articles, similar methodologies were used. Decision models were constructed for cost-effectiveness analyses of competing orthopaedic interventions. Outcome probabilities and effectiveness values were derived from the literature. Effectiveness was expressed in quality adjusted life years gained. Cost data were compiled and verified from either hospital cost data or from Medicare data. Costs and utilities were discounted in accord with the United States Panel on Cost Effectiveness in Health and Medicine. Principal outcome measures were average incremental costs, incremental effectiveness, incremental quality-adjusted life years, and, in the case of one article, net health benefits. In particular the articles compared the following: 1. Core decompression versus conservative management for osteonecrosis of the hip as a way to delay hip replacement; 2. Total knee arthroplasty versus unicompartmental knee arthroplasty; and 3. Periacetabular osteotomy versus total hip arthroplasty for a young adult with developmental dysplasia of the hip. The more cost effective intervention was identified in each case, along with implications of the results for clinical and operative decision-making. Cost effectiveness was found to be a useful tool in orthopaedic surgery under limited circumstances of either scarce data on new interventions or the need to use more resources to achieve greater effectiveness. It also can provide excellent insight into ways to direct future clinical research.

Thesis (Ph. D.)--University of California, San Diego, and San Diego State University, 2004. / Vita. Includes bibliographical references (leaves 104-107).