Objective: The objective of this study was to add to the body of knowledge about the impact of music on postoperative pain and anxiety. The specific purpose of this research study was to determine if listening to music and/or having a quiet rest period just prior to and just after the first ambulation on postoperative day 1 can reduce pain and/or anxiety, or impact mean arterial pressure, heart rate, respiratory rate, and/or oxygen saturation in patients following a total knee arthroplasty. Methods: An experimental repeated measures design was used. Setting: A postoperative orthopedic unit in a 300-bed community hospital in the southeastern United States. Sample: Fifty-six patients having a total knee arthroplasty, randomly assigned to either a music intervention group or a quiet rest group. Measures: A visual analog scale was used to measure pain and anxiety. Physiological measures, including blood pressure, heart rate, oxygen saturation, and respiratory rate, were also obtained. Results: A repeated measures analysis of variance between and within groups was conducted for pain and anxiety. Statistical findings between groups indicated the music group's decrease in pain or anxiety was not significantly different from the comparison rest group's decrease in pain (F = 1.120, p = .337) or anxiety (F = 1.566, p = .206) at any measurement point. However, statistical findings within groups indicated that when the groups were combined, the sample had a statistically significant decrease in pain (F = 6.699, p = .001) and anxiety (F = 4.08, p = .013) over time. Post hoc analyses showed the significant decrease in pain was from time 1 (just prior to the initiation of music or rest) to time 2 (just after 20 minutes of music or rest) (t(55) = 4.751, p = .000). Post hoc analyses showed the significant decrease in anxiety was from time 1 (just prior to the initiation of music or rest) to time 2 (just after 20 minutes of music or rest) (t(55) = 2.86, p = .006). Additionally, anxiety decreased significantly from time 3 (just after physical therapy) and time 4 (after second period of 20 minutes of music or rest period) (t(55) = 2.222, p = .030). Implications: Results of this research provides evidence to support the use of music and/or a quiet rest period to decrease pain and anxiety when initiated just before and just after ambulation on postoperative day 1 following a total joint arthroplasty of the knee. The interventions pose no risks, and have the benefits of improved pain reports and decreased anxiety. It potentially could be opioid sparing in some individuals, limiting the negative effects from opioids. Nurses can offer music as an intervention to decrease pain and anxiety in this patient population with confidence, knowing there is evidence to support its efficacy.

The static strength and long-term performance of composite hip prostheses under complex mechanical and environmental loading conditions are studied through theoretical modelling and experimental investigations. Two static strength models, namely, a cantilever beam model and an elastic foundation model, were developed using a strength of materials approach, and were transformed into an operating computer code which can be used for stress analysis and engineering design of composite prostheses. The predictions of the two models are shown to be in very good agreement with experimental data. A dynamic, mechanistic cumulative damage model that is capable of predicting the residual strength and life of a composite prosthesis under cyclic loading was also developed, based on a 'Critical Element Model' and the static strength models, and was transformed into an operating computer code. The predictions by the dynamic model are, in general, within engineering accuracy when compared to the experimental data. A test fixture was designed to perform fatigue tests on the composite prostheses. A total of nine prostheses were fatigue tested. Several nondestructive evaluation (NDE) techniques were used to assess fatigue damage development in the specimens tested. Among all the NDE techniques used, x-ray radiography and a surface replication technique were shown to be most effective qualitatively. Destructive tests were also performed on selected specimens, the results are complimentary to the information obtained from the NOE tests. / Master of Science

No description available.

Thesis (M.S.)--Mississippi State University. Department of Agricultural and Biological Engineering. / Title from title screen. Includes bibliographical references.

The common manufacturing process of prosthetic sockets is usually a time- and labor consuming activity. This project’s purpose was to look for alternative manufacturing methods that could speed up the process and enhance the experience for the patient for example make some personal design or make the socket lighter. The main goal was to investigate which properties could be achieved by applying Electron Beam Melting as an alternative manufacturing process for prosthetic sockets by applying an earlier developed methodology. An investigation of earlier scientific works with the keywords (additive manufacturing, free form fabrication, orthopedic, prosthetic sockets and rapid manufacturing) was done as well as gathering knowledge how to operate and handle the machines necessary to carry out the project. An updated version of the methodology was developed where the design was verified using finite element analysis. With the updated version the methodology contained nine steps, which in short was as follows. First apprehend an inner socket from an orthopedic clinic with a pattern drawn up on it, the pattern is then transferred to a computer environment and manipulated to the desired shape and thickness. A compressive strength test, both virtual and experimental, was designed by a modified version of the ISO-10328 standard and the virtual design was verified before the socket was manufactured in the Electron Beam Melting machine. The manufactured socket was tested in the experimental set-up to verify the virtual one. The result was a personal designed socket of Ti6Al4V including the male pyramid for connection and a suspension system, which consisted of an inner socket and a one-way valve. It was concluded that Electron Beam Melting could be used as an alternative manufacturing process of prosthetic sockets.

Background. Accidental falls comprise a serious health concern in older adults. Partially accounting for the high incidence rates is postural instability. While customized foot orthotics can improve certain measures of functional stability, the purpose of this study was to explore the degree to which prefabricated orthotics benefit this population and to expand the evidence base to postural stability. Methods. Eighteen healthy older adults (72.7 ± 4.8 years) were evaluated with and without foot orthotics, and again following 2-3 weeks of use. Functional stability was evaluated via the Timed-Up-and-Go test and the Fullerton Advanced Balance scale. Computerized posturography was used to assess stability in altered sensory environments (Sensory Organization Test) and to assess overall stability limits (Limits of Stability test). A pressure analysis system assessed gait parameters and pressure distribution patterns. Results. Foot orthotics improved stability on the Timed-Up-and-Go (p=0.003) and the Fullerton Advanced Balance Scale (p<0.001) and decreased fall occurrence on the Sensory Organization Test. Times based changes of postural stability occurred for medio-lateral sway velocity and area when only the vestibular system providing accurate information (condition 5) (p=0.001, 0.05, respectively), and under sensory conflict (condition 6) for sway velocity (medio-lateral and antero-posterior), sway path length and sway area (p=0.015, 0.021, 0.015, 0.015, respectively). An interaction effect was found for maximum excursion composite score (p=0.001) on the Limits of Stability test, as well as a main effect of time for directional control in the ML direction and composite score (p=0.024.0.043). Contact area increase in the midfoot and rearfoot and peak force decreased in the rearfoot (p=0.001, 0.03, 0.027, respectively). Conclusions. Results indicate that foot orthotic use can improve functional measures of stability in older adults. It is unclear whether the time-based changes in postural stability are attributable to the orthotics or are a result of learning effects. Regardless, improvements in stability with prefabricated foot orthotics may help decrease the risk of falls in this population. / School of Physical Education, Sport, and Exercise Science

Severe ankle injuries can result in ligament rupture or a fracture. A major problem after such injuries is limitation in mobility. Weight bearing tasks, such as walking, become a problem because of pain, deficits in joint range of motion and muscle strength. This thesis studies a key dilemma in early rehabilitation, whether to immobilise the ankle or allow joint motion to improve mobility outcomes. Studies have focused on two scenarios, severe ligament rupture, and unstable fractures managed through open reduction and internal fixation (ORIF). The analysis of gait outcomes was an important component of this thesis and a novel analytical method was developed to normalise gait velocity in the estimation of speed-dependent gait outcomes. A systematic review and meta-analysis was conducted including evidence to July 2014. The reporting and design of trials was universally poor. In the 6 weeks of recovery following ankle ORIF surgery, there was insufficient evidence that early ankle movements offered a benefit to mobility recovery compared with immobilisation in a cast. Ankle movements compared with immobilisation reduced the risk of venous thrombosis/thromboembolism. However, compared with cast immobilisation, the risk of deep and superficial surgical site infection and fixation-related complications were higher when ankle movements were permitted. To investigate the role of ankle supports in rehabilitation of walking after ORIF, two randomised cross-over studies were completed. In healthy participants with non-pathological gait, a walker boot induced gait abnormalities when compared with Tubigrip (elasticated bandage). There were no important differences in gait between a stirrup brace and Tubigrip. In people who had undergone ankle ORIF 6 weeks previously, a walker boot and to a lesser extent a stirrup brace offered improvements in gait symmetry and lower pain scores when compared with Tubigrip. Finally, a secondary analysis of the Collaborative Ankle Support Trial cohort (n=584) was conducted, which concluded that, in comparison to Tubigrip, 10 days of cast immobilisation provided greater probability of recovery of a range of mobility outcomes 4 weeks following injury. This thesis contributes evidence favouring a role for ankle immobilisation in improving mobility following severe ankle injury in adults. Clinicians should be aware of the benefits and risk of harms outlined, as well as the limitations in the current evidence base.

Entre ici et ailleurs, entre pratiques et disciplines, entre patients, chirurgien et psychiste, cette thèse est l’effet de rencontres avec des enfants ayant subi un traumatisme orthopédique. Effraction, la fracture est traumatisme et fait trauma. Désubjectivation, parcellisation du corps, violence, douleur et souffrance sont alors le lot des enfants en chirurgie pédiatrique. Et quand le bout prévaut sur le tout du corps, le corps-je devient autre. D’Abidjan à Paris, quatre histoires cliniques d’enfant montrent que, sur fond d’effroi et de perte du regard, le dévisagement est à l’oeuvre en chirurgie pédiatrique quelle que soit la qualité ou le type de soin. Chez ces enfants, la représentation subjective de soi et le test des trois dessins ont permis d’appréhender les perturbations de l’image de soi et de visagéifier la souffrance ainsi que les autres problématiques en présence. Il est apparu que la réparation n’est pas toujours suivie d’une restauration. Médiateur thérapeutique et relationnel, le dessin s’est révélé outil de visagéification de l’effraction psychocorporelle et de revisagéification par sa fonction miroir. Dans le temps du soin, se rejoue alors le stade du miroir. Le regard maternant et étayant du psychiste, dans ce processus, favorisent une réédification du soi de l’enfant ayant pour effet de lui redonner une image unifiée de lui favorisant une réappropriation du corps. Se dégage ainsi une nouvelle fonction du psychiste en chirurgie pédiatrique, celle de « psy-chir », pour décrire les modalités d’une aide psychothérapeutique particulière, en appui sur le dessin et la visagéification, pour panser le corps. / Between here and elsewhere, between practices and disciplines, between patients, surgeons and psychiste, this thesis is the effect of meetings with children with orthopedic trauma suffered. Burglary, the fracture is orthopeadic trauma and made trauma. Desubjectivation, fragmentation of the body, violence, pain and suffering are then the lot of children in pediatric surgery. And when the end prevails over all the body, the body becomes other-I. From Abidjan to Paris, four clinical histories of children show that, amid terror and loss of the look, the face-losing is at work in pediatric surgery regardless of the quality or type of care. In these children, self-representation and subjective testing of three drawings helped to understand the disturbances in self-image and suffering taking’s face and other issues involved. It appeared that the repair is not always followed by restoration. Therapeutic and relational mediator, drawing has proven tool visage-ification of burglary and psycho revisage-ification its mirror function. In the time of care, then replays the mirror stage. The underpinning of mothering look and psychiste, in the process, promote rebuilding of the child's self whose effect is to give it a unified picture of him promoting a reappropriation of the body. Thus emerges a new function of psychiste in pediatric surgery, that of "psy-chir" to describe the terms of a particular psychotherapeutic assistance in support of the design and visage-ification, to heal the body.

As micobacterioses são doenças causadas por micobactérias não tuberculosas pertencentes ao gênero Mycobacterium. As infecções por micobactéria de crescimento rápido (MCR) estão fortemente relacionadas às falhas nos processos de limpeza, desinfecção e esterilização de produtos médicos. Objetiva-se, analisar a ocorrência de infecções de sítio cirúrgico, por MCR, em pacientes submetidos a procedimentos ortopédicos, por meio de revisão integrativa; caracterizar as infecções de sítio cirúrgico (ISC) por MCR; verificar a presença de fatores que possam explicar as infecções de sítio cirúrgico por MCR. Como método utilizou-se a revisão integrativa, a qual contém as seguintes etapas: elaboração da questão da pesquisa; estabelecimento de critérios de inclusão e exclusão; definição das informações a serem extraídas do estudo; avaliação dos estudos incluídos; interpretação dos resultados e apresentação da revisão. No resultado foram encontrados 21 artigos, a maioria publicada no idioma inglês, e dois em francês, variando quanto ao continente e país de origem de edição. O tempo entre a cirurgia e o início dos sintomas foi mencionado para os 34 (100%) pacientes, mas a análise foi feita para 33 pacientes, pois se considerou apenas o primeiro episódio de infecção por MCR. O tempo médio para o diagnóstico da ISC foi de 653,6 dias (93 semanas), desvio padrão ±1.343 dias (192 semanas), mediana de 80 dias (11,4 semanas) e moda de 90 dias (três meses). Quanto aos sinais e sintomas relatados pelos pacientes, os mais prevalentes foram: dor (61,8%), secreção (50,0%), edema (41,2%), febre (41,2%), eritema (26,5%), fístula (20,6%), calor (14,7%), tremor (5,9%), abscesso (5,9%) e hematoma (3,0%). Em relação às intervenções cirúrgicas efetuadas nos pacientes, após o diagnóstico de ISC, a mais frequente foi a antibioticoterapia (100%), remoção de prótese total (50,0%), drenagem (41,2%), debridamento cirúrgico (41,2%), irrigação (23,5%), revisão cirúrgica (17,6%) troca da prótese total (8,8%), remoção de componentes da prótese (8,8%) e reimplante da prótese (2,9%). A identificação do(s) agente(s) etiológico(s) da(s) ISCs não seguiu uma metodologia de rotina, o que pode influenciar na confiabilidade do resultado, principalmente quanto à espécie do agente etiológico. Quanto à espécie de MCR isoladas dos sítios de infecção constatamos que M.fortuitum foi a mais prevalente; tendo sido isolados também M.chelonae, M.abscessus, M.goodii, M.smegmatis, M.farcinogenes e M.wolinskyi. Em relação às fontes investigadas, tem-se: provavelmente de origem iatrogênica, hábito do médico residente de ortopedia, presente nas cirurgias, de utilizar a hidromassagem antes de operar; componentes líquidos ou pó do cimento metilmetacrilato ou a prótese metálica; injeções de cortisona por sinovite crônica, durante cinco anos, antes da cirurgia; sistema de ar condicionado ou a solução de imersão para enxágue da prótese; sabão na água, onde foi realizada a imersão do pé (recomendação do podólogo); parafuso bioabsorvível utilizado na cirurgia; injeções intra-articulares de dexametasona; no entanto, nenhuma delas pode ser confirmada. Quando feito o teste de senbilidade observou-se que as cepas apresentavam em torno de 80% de sensibilidade à amicacina, claritromicina e ciprofloxacina. / The mycobacteriosis is a disease caused by nontuberculous mycobacteria belonged to the Mycobacterium genus. Infections due to rapidly growing mycobacteria (RGM) are strongly related to failures in the processes of cleaning, disinfection and sterilization of medical products. The objective is to analyze the occurrence of surgical site infections by RGM in patients undergoing orthopedic procedures through integrative review; to characterize the surgical site infections (SSI) by RGM; and to verify the presence of factors that may explain the surgical site infections by RGM. The method was the integrative review, which includes the following steps: elaboration of the research question; establishment of inclusion and exclusion criteria; definition of information to be extracted from the study; assessment of the included studies; interpretation of results; and presentation of the review. 21 articles were found, mostly published in English and two in French, varying considering the continent and country of the origin of the article. The time between surgery and onset of symptoms was reported by 34 (100%) patients, but the analysis was performed for 33 patients because it was considered only the first episode of infection by RGM. The average time to diagnosis of SSI was 653.6 days (93 weeks), standard deviation ± 1343 days (192 weeks), median of 80 days (11.4 weeks) and mode of 90 days (three months). The most prevalent signs and symptoms reported by patients were: pain (61.8%), secretion (50.0%), edema (41.2%), fever (41.2%), erythema (26.5%), fistula (20.6%), heat (14.7%), tremor (5.9%), abscess (5.9%) and hematoma (3.0%). Regarding surgical interventions performed in patients after diagnosis of SSI, the most frequent was antibiotic therapy (100%), removal of dentures (50.0%), drainage (41.2%), surgical debridement (41.2%), irrigation (23.5%), surgical revision (17.6%), replacement of dentures (8.8%), removal of the prosthetic components (8.8%), and reimplantation of the prosthesis (2.9%). The identification of etiological agent(s) of SSI did not follow a routine methodology, which can influence the reliability of the results, especially regarding the kind of etiologic agent. Related to the kind of isolated RGM of the infection sites, it was found that M.fortuitum was the most prevalent; being also isolated the M.chelonae, M.abscessus, M.goodii, M.smegmatis, M.farcinogenes and M.wolinskyi. Regarding the sources investigated: probably from iatrogenic origin, it is habits of residents in orthopedics during surgeries to use hydromassage before operating; liquid components or cement powder of methylmethacrylate or metal prosthesis; cortisone injections for chronic synovitis during 5 years before surgery; air conditioning system or soaking solution to rinse the denture; soap in the water, where it was accomplished the immersion foot (podiatrist\'s recommendation); bioabsorbable screws used in surgery; intraarticular injections of dexamethasone; however, none of them can be confirmed. When the sensitivity test was done, it was observed that the strains had approximately 80% of sensitivity to amikacin, clarithromycin, ciprofloxacin. Quando feito o teste de senbilidade observou-se que as cepas apresentavam em torno de 80% de sensibilidade à amicacina, claritromicina e ciprofloxacina.

Lai, Wai Yin. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2013. / Includes bibliographical references (leaves 106-108). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstracts also in Chinese.