Made available in DSpace on 2016-08-10T10:53:35Z (GMT). No. of bitstreams: 1 LUCIANO LUCINDO DA SILVA.pdf: 762537 bytes, checksum: fc611b5b537940fa8236781a4cf03333 (MD5) Previous issue date: 2012-03-20 / OBJECTIVE: To analyze, based on scientific literature, the cost of infection related to health care (IRAS) in orthopaedic surgery. METHODS: We conducted a study of integrative review of publications on infection in orthopaedic surgery from January 1990 to December 2011. Sixteen papers were considered in its entirety. The indexing databases were used to search PubMed and the Latin American and Caribbean Health Sciences (LILACS). RESULTS: We found in the databases searched 21,490 publications on cost of infections, considering several sites and etiologies. Only 16 of these articles refer to the cost of surgical site infection in orthopaedic. The surgical sites were most commonly studied hip and knee, making a total of 14 publications. The infection rate in knee arthroplasty is 0.92%, while the hip is 0.88%. The growing cost of surgical site infection in orthopaedic is 1.5 to five times and the hospitalization may represent more than half of these costs. Mortality increases in cases of infection related to large procedures, reaching a rate of 15.4% in hip surgery. CONCLUSIONS: Infection in orthopaedic surgery increases the length of stay, mortality and costs. Patients undergoing arthroplasty have higher costs. Pathogens resistant to antimicrobial have higher costs when compared to infections by sensitive germs. / OBJETIVO: Analisar, com base na literatura científica, o custo das infecções relacionadas à assistência à saúde (IRAS) em cirurgias ortopédicas. METODOLOGIA: Foi realizado um estudo de revisão integrativa de publicações sobre infecção em cirurgia ortopédica no período de janeiro de 1990 a dezembro de 2011. Foram considerados 16 artigos científicos. As bases indexadoras utilizadas para pesquisa foram PubMed e Literatura Latino- Americana e do Caribe em Ciências da Saúde (LILACS). RESULTADOS: Foram encontrados nas bases de dados pesquisadas 21.490 publicações sobre custo de infecções, considerando vários sítios e etiologias. Desses somente 16 artigos referem-se a custo de infecção em sítio cirúrgico ortopédico. Os sítios cirúrgicos mais comumente estudados foram quadril e joelho, perfazendo um total de 14 publicações. A taxa de infecção em artroplastia de joelho é de 0,92%, ao passo que no quadril é de 0,88%. O aumento do custo da infecção em sítio cirúrgico ortopédico é de 1,5 a cinco vezes, em que a hospitalização pode representar mais da metade desses custos. A mortalidade aumenta nos casos de infecção relacionada a procedimentos de grande porte, podendo chegar a uma taxa de 15,4% nas cirurgias de quadril. CONCLUSÕES: Infecção em cirurgia ortopédica aumenta o tempo de internação, mortalidade e custos. Pacientes submetidos a artroplastias cursam com maiores gastos. Patógenos resistentes aos antimicrobianos geram maior custo quando comparado a infecções por germes sensíveis.

Foi feita a caracterização eletroquímica do aço inoxidável austenítico UNS S31254 em meio de NaCl 0,11 mol L-1 na ausência e presença de soro albumina bovina (BSA) visando seu emprego em implantes ortopédicos. Foram empregadas como técnicas: medidas de potencial de circuito aberto, curvas de polarização, cronoamperometria, EIE, XPS, MEV, EDS e EEO. O comportamento eletroquímico do aço 254 foi comparado com o de outros aços empregados em implantes ortopédicos (ISO 5832-9, ASTM F138, e AISI 316L) na ausência e presença de BSA. O aço 254 se mostrou semelhante ao ISO 5832-9: encontra-se passivado desde o potencial de corrosão até o de transpassivação; a presença de inclusões de óxidos de cálcio e alumínio no aço 254 foi considerada a responsável por um potencial de transpassivação 100 mV menos positivo do que o observado com o aço ISO 5832-9. Foi detectada. além de óxido de Cr(III), a presença de Mo na forma Mo(VI) no filme passivo do aço 254. A ação da BSA, ora passivante ora catalisadora, depende de sua concentração, da natureza do substrato metálico, e do potencial na interfase metal-solução. A BSA modifica o mecanismo de oxidação do aço 254 e inibe seletivamente a dissolução dos seus elementos constituintes, em particular, níquel e cromo. / The electrochemical characterization of UNS S31254 has been made in 0.11 mol L-1 NaCl medium in the absence and presence of bovine serum albumin (BSA) in order to propose its application in orthopaedic implants. The techniques employed were: open circuit potential measurements, polarization curves, chronoamperometry, EIS, XPS, SEM, EDS and EEO. The electrochemical behavior of 254 SS was compared to that observed for ISO 5832-9, ASTM F138 and AISI 316L stainless steels, used in orthopedic implants, in the absence and presence of BSA. 254 SS is similar to ISO 5832-9 SS: it is passivated on the potential range between the corrosion and the transpassivation potentials; the presence of calcium and aluminum oxides can be responsible for the shift of about 100 mV to less positive potentials on the transpassivation potential when compared to ISO 5832-9 SS. The presence of Mo(VI) was detected beside Cr(III) as passivating film for 254 SS. BSA action depends on its concentration, the nature of the metallic substract and on the potential in the metal-solution interphase. BSA changes the oxidation mechanism of 254 SS and promotes the selective dissolution of the elements particularly nickel and chromium.

Arbetet handlar om hur man som höft och knäopererad patient känner sig bemött på en ortopedisk vårdavdelning efter att ha fått en protes inopererad. Dessa operationer kan i efterförloppet vara mycket smärtsamma och behöver i regel lång rehabilitering, vilket ställer stora krav på personalens sätt att vårda och bemöta patienter i postoperativt skede.Syftet är att beskriva hur patienter efter höft och knäprotesoperationer upplever personalens bemötande på ortopedisk vårdavdelning.En litteraturstudie är gjord utifrån kvalitativa artiklar som har bearbetats och analyserats enligt Evans metod som utgångspunkt för ett deskriptivt resultat.Resultatet presenteras utifrån tre teman; Att känna sig bemött som en unik individ: som skildrar patienters upplevelser av hur personalen tillgodoser varje enskild patients behov. Att känna sig professionellt omhändertagen: beskriver hur patienter känner när de blir väl omhändertagna under sin postoperativa tid på avdelningen. Att känna sig förbisedd: beskriver att patienter känner sig försummade och negligerade under sin postoperativa tid på vårdavdelningen. För att patienter med höft och knäproteser skall uppleva vården som positiv diskuteras vikten av att sjuksköterskan ger god information till patienten, att hon får fortlöpande utbildning och att vårdpersonalen arbetar med etiska reflektioner. / Program: Sjuksköterskeutbildning

Ledproteskirurgi av höft- eller knäled är idag en av de vanligaste operationerna i Sverige. Den vanligaste orsaken till ledproteskirurgi i höft och knä är artros som orsakar kronisk nedbrytning av leder. I den postoperativa vården är patienter utsatta och behöver hjälp av vårdpersonal med rehabiliteringen och smärta. Under denna vårdtid utvecklas en vårdrelation mellan patienterna och personalen, som påverkar patientens livskvalité. Syftet med studien är att belysa patienters upplevelse av personalens bemötande i samband med postoperativ vård efter operation av höft- eller knäprotes. Metoden är en litteraturstudie, där sex kvalitativa artiklar med vårdvetenskaplig ansats används. Det finns få artiklar och forskning gjord i ämnet. Fribergs (2006) modell om evidensbaserad omvårdnad och Evans (2002) modell om innehållsanalys ligger till grund för studiens metod. Resultatet presenteras utifrån fyra kategorier som är; Omvårdnaden upplevs som bra, Personalen är engagerad, Jag vågar inte ställa frågor och får heller inget veta och Jag blir inte respekterad. I varje kategori beskrivs hur patienter upplever personalens bemötande. Resultatet visar patienters både positiva och negativa upplevelser av hur personalen bemöter dem. I diskussionen diskuteras patienters vårdupplevelser under vårdtiden. Det patienter uppskattar är att vården sker genom professionella handlingar och att sjuksköterskan är vänlig, glad och lugn. / Program: Sjuksköterskeutbildning

In 2005, over 200,000 Americans underwent a hip arthroplasty, the replacement of a hip joint with an artificial prosthesis. Of these arthroplasties, metal-on-metal type implants represent an increasing usage percentage. Metal-on-metal implants are selected largely for their low volumetric wear rate, durability, and resistance to corrosion. In spite of these advantages, little is known concerning the long-term consequences of heavy metal alloy use in the body, although early research indicates potentially carcinogenic results. This thesis is a preliminary investigation into these long term effects and their root causes. An improved comprehension of the corrosion kinetics and the rate of ion production from the high surface energy wear debris released by implant articulation can assist in illustrating the relative clinical significance of exposure to these metallic bodies over time. This thesis primarily focuses on developing a test methodology for the detection and analysis of ion dissociation in simulated body fluids. In order to validate this test methodology, the ion dissociation rates and surface characteristics of several predetermined diameters of cobalt chromium alloy spherical particles were analyzed. The effect of changing particle diameter, and thus surface area to volume ratio, on ion dissociation rate was determined to be significant when not affected by localized agglomeration. Additionally, preferential corrosion of cobalt within individual grains was observed and correlated to elevated cobalt concentrations in the electrolyte. These results suggest that ion dissociation kinetics for true wear particles can be determined through the refinement and application of the methodology developed.

Nitric oxide is a small free radical generated by family of enzymes, the nitric oxide synthases. In a series of experiments performed over the last 15 years we showed that nitric oxide is induced by all three isoforms of nitric oxide synthase during tendon healing and that it plays a crucial beneficial role in restoring tendon function. In normal tendon we found very little nitric oxide synthase activity while in injured rat and human tendons nitric oxide synthase activity was expressed in healing fibroblasts in a temporal fashion. In healing rat Achilles tendon fibroblasts the first isoform to be expressed was endothelial nitric oxide synthase (eNOS), followed by inducible nitric oxide synthase (iNOS), and then brain or neuronal nitric oxide synthase (bNOS). Systemic inhibition of nitric oxide synthase activity decreased the cross sectional area and mechanical properties of the healing rodent Achilles tendons. Addition of nitric oxide via NO-flurbiprofen or NO-paracetamol enhanced rat Achilles tendon healing. Addition of nitric oxide to cultured human tendon cells via chemical means and via adenoviral transfection enhanced collagen synthesis, suggesting that one mechanism for the beneficial of nitric oxide on tendon healing might be via matrix synthesis. The final part of the work involved three randomized, double-blind clinical trials which evaluated the efficacy of nitric oxide donation via a patch in the management of the tendinopathy. In all three clinical trials there was a significant positive beneficial effect of nitric oxide donation to the clinical symptoms and function of patients with Achilles tendinopathy, tennis elbow and Achilles tendonitis.

This is an interdisciplinary research project in which the methods of Industrial and Product Design Engineering are focused upon a problem in Orthopaedics. One of the most controversial areas in Orthopaedics is the reconstruction of the anterior cruciate ligament (ACL). The current twin-instrument method for locating the ACL is difficult for surgeons with fewer than 500 surgical experiences. This was clearly demonstrated by Kohn, Busche and Cans (1995), and confirmed by Sommer, Friederich and Muller (2000), Sudhahar, Glasgow and Donell (2004), and Kuga, Yasuda, Hata et al. (2004). The above research indicates that the problem is not only one of anatomical location, but of how the operation takes place. The aim of the research was, therefore, to develop a new and improved surgical instrument and technique for locating the ACL anatomical landmarks. The research described in this thesis employs a number of design methods that can be used separately or in combination (hybrid process). They form the theory base that guides the design process. This allows the designer to engage in a flexible process that is effective in finding design solutions to the problem. Within this process, iterative case studies were employed in order to design a new surgical device for ACL reconstruction. The thesis describes a series of designed devices (case studies) that were iteratively developed and surgically tested, leading to a penultimate device. This latter device was tested via a number of surgical operations. The device provides a new method for externally locating the internal ACL attachment points. The research has resulted in a commercial association with Smith and Nephew Surgical Australia and BrainLAB AG Germany for the commercialisation of this technique. At the time of writing, the next stage of research and development is under way. This is using a frameless computer-aided image guidance system in the place of X-ray.

There is no common understanding on what constitutes good sick-listing, a frequent and problematic task for many physicians, especially general practitioners (GPs) and orthopaedic surgeons. Aiming to achieve a deeper understanding of sick-listing practices, 19 GPs (I, III) and 18 orthopaedic surgeons (II) in four counties were interviewed, and data analysed qualitatively for views on good sickness certification and barriers to desired practice. Data from a survey of all 7665 physicians in two counties on emotionally straining problems in sickness certification (IV) was analysed quantitatively. Some GPs exposed narrow views of sick-listing, where their responsibility was limited to issuing a certificate, while GPs with the most inclusive view had a perspective of the patient’s total life-situation and aimed to help patients shoulder their own responsibility (I). The orthopaedic surgeons´ perceptions of good sick-listing were mainly related to their views on their role in the health-care system. Some perceived their responsibility as confined to the orthopaedic clinic only, while others had the ultimate goal of helping the patient to become well functioning in life with regained work capacity – by means of surgery and proper management of sick-listing (II). Difficulty handling conflicting opinions was a barrier to good sickness certification for GPs (III), and problematic for about 50% of all physicians and about 80% of GPs (IV). Orthopaedic surgeons’ handling of such situations varied from being directed by the patient, via compromising, to being directed by professional judgement (II). Other barriers included poor stakeholder collaboration (III). GPs with a workplace-policy on sickness certification reported fewer conflicts and less worry of getting reported to the disciplinary board in relation to sick-listing (IV). Understanding physicians’ underlying views on and barriers to practicing “good sick-listing” can inform efforts to change physician practice. Communications skills training in handling sick-listing situations with conflicting opinions is recommended.

Bakgrund: Teorier i omvårdnad har beskrivits av många omvårdnadsforskare. Sjuksköterskeprofessionen är tvärvetenskaplig. Huvudämnet i sjuksköterskeutbildningen är omvårdnad och stödämnen i professionen kan vara biomedicin och folkhälsa. Det akademiska ämnet omvårdnad är professionsneutralt. En vanlig uppfattning bland sjuksköterskor är att jämställa professionen med ämnet. Detta mångvetenskapliga perspektiv har lett till att det inte finns någon klar definition om vad som är kärnan i ämnet omvårdnad. Syfte: Syftet med examensarbetet var att studera hur sjuksköterskor på en ortopedavdelning beskriver god omvårdnad. Metod: Studien gjordes på en ortopedavdelning i Sverige under 2008. Åtta sjuksköterskor deltog i studien. En kvalitativ intervju genomfördes på en ortopedavdelning. Data transkriberades och analyserades med hjälp av kvalitativ innehållsanalys. Resultat: Sjuksköterskornas beskrivning av god omvårdnad sammanfattades i sju teman; smärtlindring, sjuksköterskans ansvarsområde, kommunikation, glädje, tid, teamwork och etiskt förhållningssätt. Konklusion: När sjuksköterskorna beskrev god omvårdnad utgick de ifrån deras arbetsuppgifter i sjuksköterskeprofessionen. De särskiljde inte omvårdnadskunskap från kunskaper inom stödämnen. Teorier i omvårdnad och centrala begrepp i omvårdnad var inte självklara för sjuksköterskorna. Däremot har de beskrivit delar av kärnan i omvårdnadsämnet utan att relatera till teorier i omvårdnad. / Background: Theories in nursing care has been described by several researchers. The profession is multidisciplinary. The major subject in the education for nurses is nursing care and other subjects in the profession can be biomedicine and public health. The academic subject nursing care is not bounded to the nurses’ profession. A common idea among the nurses is to see the profession as equal to the academic subject nursing care. Because of many perspectives, there is no clear definition that describes the essence of nursing care. Aim: The aim of this dissertation was to study how nurses´ describe good nursing care at an orthopaedic unit. Methods: The study was carried out in one orthopaedic unit in Sweden in 2008. Eight nurses’ took part in the study. A qualitative interview with was performed at the orthopaedic unit. Data were transcribed and analysed using qualitative content analysis. Findings: The nurses’ description of good nursing care was summarized in seven themes; pain management, a nurse responsibility, communication, joy, time, teamwork and ethical attitude. Conclusions: When the nurses´ described god nursing care they assumed from their tasks in the profession. They did not distinguished nursing care from the knowledge of subjects included in a nurse profession. Theories in nursing care and central concepts were not obvious for the nurses´. Although the parts of the core in nursing care has been described without relating to theories.

There have been many advances in surgical residency education and similar interest exists in fellowship education. This study evaluated perceptions among spine surgeons about the specific competencies required for successful spine surgical fellowship training, and then compared these perceptions to clinical practice. Firstly, a questionnaire was administered to spine fellow trainees and academic spine surgeons across Canada in order to identify the cognitive and technical skills required for successful spine fellowship training. Fellowship trainees and supervisors had similar perceptions on the relative importance of specific cognitive and technical competencies. Differences in perceptions were found when comparing surgeons based on background residency specialty training (orthopaedic surgical or neurosurgical). Secondly, using administrative data, a retrospective study assessed volumes, surgeon characteristics, and outcomes for surgery of the degenerative lumbar spine in Ontario between 1995 and 2001. Neurosurgeons were found to perform more decompressions, and more total procedures, than orthopaedic surgeons with similar outcomes.