...Knee Surg Sports Traumatol Arthrosc (2013) 21:1510–1515 DOI 10.1007/s00167-012-2149-5 KNEE Patient recall of surgical information after day case knee arthroscopy R. E. da Assuncao • J. Neely • J. Lochab • ¸˜ N. Mizumi-Richards • A. Barnett • H. Pandit Received: 29 November 2011 / Accepted: 19 July 2012 / Published online: 2 August 2012 Ó Springer-Verlag 2012 Abstract Purpose Day case knee arthroscopy is frequently performed on dedicated lists designed to optimise the throughput of patients. This could affect patient recall of clinical information with clinical, ethical and medicolegal consequences. The purpose of this study was to assess patient recall after knee arthroscopy and identify potential contributory factors. Methods Seventy-two patients undergoing day case knee arthroscopy were provided with information about their surgery post-operatively and tested for recall of the information prior to discharge. All patients underwent cognitive assessment when information was delivered and again when tested. Patient recall was correlated with demographic and anaesthetic factors and a multivariate regression model was used to identify risk factors for reduced recall. Results Recall overall was poor. Significant independent risk factors for reduced recall were reduced cognitive state at the time of information delivery and a shorter time between surgery and information delivery. Duration of R. E. da Assuncao (&) Á J. Lochab Á N. Mizumi-Richards ...
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...technique for evaluation of a CT based navigation system for total knee replacement (TKR) Praemer et al30reported that in 1996, 245,000 total knee replacements (TKRs) were done in the United States. They estimated that the projected increase in TKRs in the United States will be 209,000 between 1996 and 2030. Most of the early failures of TKRs are related to technical flaws. Experimental and clinical data indicate that to achieve optimal midterm and long-term results of a TKR, good alignment in /the frontal plane of the lower limb is mandatory. In an experimental study, Hsu et al 14showed that a femoral component in 7° valgus, with the tibial component placed at 90° to the long axis of the tibia, was the best position for the total condylar knee and produced equal force distribution between the medial and lateral plateaus. For the Kinematic knee, the best position was 9° valgus for the femoral component with 2° varus of the tibial component. A clinical association between failure of TKR and malalignment seems likely. Ritter et al 32 reported that varus knees had a lower survival at 10 years than aligned or valgus knees. Jeffery et al,16 with the first design of the Denham prosthesis, reported that at 12 years the incidence of loosening was 3% when, on long-leg standing radio-graphs, the line joining the center of the femoral head to the center of the body of the talus passed through themiddle1⁄3of the knee prosthesis. The incidence of loosening was 24% when the line was...
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...Urinary and Bowel Elimination Case Studies Urinary Elimination Bob Clark is a 70-year-old patient who had a total hip replacement today; he is now on the orthopedic unit in stable condition. Mr. Clark had been having pain in his hip for the past 6 months and took NSAIDs for pain. He has a history of hypertension that is treated with a combination antihypertensive and diuretic drug. He also takes a multivitamin daily. He has been using a walker for the last 2 months to help him ambulate. Mr. Clark has an order for morphine 2 mg IV q4h prn. He had a dose 30 minutes ago. Jared Carr is a student nurse who has been assigned to Mr. Clark. Jared works as a nursing assistant at the organization. Jared assesses Mr. Clark and finds that his pain is now rated a 3 on a scale of 1 to 10. He has an IV running at 100 ml/hr. Jared asks Mr. Clark if he has urinated since he returned from surgery, and Mr. Clark tells him that he has not. Jared asks him if he feels the need to urinate. Mr. Clark tells Jared that he does not. 1. What assessment should Jared do to determine whether Mr. Clark has a full bladder? Palpate the abdomen over the bladder and feel for distention Rationale: Immobility, supine position, anesthesia, and surgery can all lead to urinary retention. The bladder can be palpated. If it feels distended, then there is a large amount of urine in the bladder. 2. Jared finds that Mr. Clark does have a distended bladder and wants to help Mr. Clark urinate. What interventions...
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...joints) or erosive (David & Lloyd, 1998). Osteoarthritis may also be divided into primary idiopathic or secondary. In primary OA there are no preceding injuries or trauma which could have caused it. The main cause is repetitive stress on the joint and cumulative changes to the joint surfaces. It is typically found in women over the age of forty five which repeatedly stress the same joints such as the knees and hips. Secondary OA, on the other hand, is caused by a previous condition, injury or disease. Injury to the joint, gout, rheumatoid arthritis and even obesity may eventually lead to the development of secondary OA (Koopman, 2000) Osteoarthritis Affecting the Knee Joint The knee is the most susceptible joint for development of osteoarthritis. As previously mentioned in the section discussing knee anatomy, the knee is formed by three combined compartments: the lateral tibiofemoral compartment, the medial tibiofemoral compartment and the patellofemoral compartment. As osteoarthritis very rarely affects the joint uniformly, degeneration may be occurring in any one of the different...
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...There are divided into different parts, for example you can apply for the loss of earnings from the date of negligent act up until the trial, this is for the claimant who is prevented from working in the long or short term, then lost earning can be claimed whether they are employed or self employed, in this case as we are not sure about the trial date, I will assume it as two months later so you can claim for at least two months earnings. Secondly, there is medical expense which can also cover private medical treatment, prescriptions, transport or care costs and if the claimant stay off work, so you can also apply for this as you had been to other doctors for medical advises. Lastly there is Expenses to cover special requirements, this will cover expenses such as a wheelchair, adapting a car or home etc… As you are suffering in pain caused by your knee, you required crutches and a mobility scooter to get about it you can apply in this catalogue. General Damages cover losses in the future and are both pecuniary and non pecuniary. There are Future loss of earnings which you will be applying because of the surgery from Dr Padella, from the information you gave us, after the surgery you have never regained a good level of mobility and continued to have pain and stiffness in both knees which cause...
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...An Atlas of Surgical Anatomy An Atlas of Surgical Anatomy Surgical commentary by Alain C Masquelet, MD Illustrations by Léon Dorn © 2005 Taylor & Francis, an imprint of the Taylor & Francis Group First published in the United Kingdom in 2005 by Taylor & Francis, an imprint of the Taylor & Francis Group, 2 Park Square, Milton Park, Abingdon, Oxon OX14 4RN Tel.: +44 (0) 1235 828600 Fax.: +44 (0) 1235 829000 E-mail: info@dunitz.co.uk Website: http://www.dunitz.co.uk All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior permission of the publisher or in accordance with the provisions of the Copyright, Designs and Patents Act 1988 or under the terms of any licence permitting limited copying issued by the Copyright Licensing Agency, 90 Tottenham Court Road, London W1P 0LP. Although every effort has been made to ensure that all owners of copyright material have been acknowledged in this publication, we would be glad to acknowledge in subsequent reprints or editions any omissions brought to our attention. Although every effort has been made to ensure that drug doses and other information are presented accurately in this publication, the ultimate responsibility rests with the prescribing physician. Neither the publishers nor the authors can be held responsible for errors or for any consequences arising...
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...of Maxcis Insurance Company referred this file for medical case management. Instructions were given to meet with Craig Westenburg and assist with coordination of appropriate and related medical care, and identify needs to facilitate recovery. INTERVIEW SETTING On 3/3/17 I met Mr. Westenburg at the office of orthopedic surgeon Dr. Cherwin. Mr. Westenburg arrived alone. He is alert and oriented and willing to work with a nurse case manager. MEDICAL FACTORS Mr. Westenburg said he was cleaning off cars in the auto dealership lot when he slipped between two cars. He hit his right shoulder. Mr. Westenburg reported the injury and was sent for examination. Mr. Westenburg was sent for an MRI and referred to orthopedic surgery Dr. Cherwin....
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...A CLINICAL CASE STUDY: CHEMICAL ERIC ERIC: Age 15, 6’ tall, 150 lbs, size 13 shoes. Swelling presents on right knee and ulcerated sores on his lower left leg with prolonged healing. Doctor’s test results reveal lowered levels of thyroid hormone and low levels of cortisone and testosterone but high growth hormone. Treatment is administered to remove fluid from knee. Shortly after Doctor visit, Eric breaks left hip. PROBLEM: What hormonal problem could be causing these symptoms? A: Hypopituitarism. Based on the symptoms the patient presented it appears there was a deficiency in FSH/LH due the decreased muscle mass (skinny), increase osteoporosis (bone fragility), ACTH deficiency due to the low cortisol in the adrenal glands which reveals symptoms of fatigue, weight loss, can have delayed puberty in children, affects in the immune system. CQ1: What hormonal problem could be causing these symptoms? A: Pituitary gland has problems. CQ2: Based on the diagram in Slide 10 (pituitary gland) choose the correct answer. A: The posterior pituitary probably collects hormones made by the hypothalamus, and the anterior pituitary probably makes hormones under the direction of the hypothalamus. ERIC: Upon test results, it appears a benign pituitary tumor has placed pressure on the pituitary gland and disrupted functions. TREATMENT: Irradiation to kill the pituitary and tumor associated with it. Post irradiation...
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...A lot of people suffer or used to suffer by knee injuries and generally knee pain nowadays. It’s not something rare, otherwise knee problems are found in everyday life. If you ask your family while you have dinner all together at night at least you will be told about one incident minimum. Studies showed that 47% of people will have knee pain and about 19% have or will have ACL injury. That’s the point I want to focus on today, 19% ACL injury?! That’s quite a lot of people but if you compare it with the number of athletes that had or will had ACL injury in their whole career it’s not that spectacular if I can say, because the athletes have a number of 32% in ACL injury. An injury to the Anterior Cruciate Ligament can be a debilitating musculoskeletal injury to the knee, seen most often in athletes. Non-contact tears and ruptures are the most common causes of ACL injury. The anterior cruciate ligament (ACL) is an important ligament for proper movement. ACL injury more commonly causes knee instability that does injury to other knee ligaments. Injuries of the ACL range from mild such as small tears to severe when the ligament is completely torn. Symptoms of an ACL injury include hearing a sudden popping sound, swelling, and anterior instability of the knee (i.e. a "wobbly" feeling). Pain is also a major symptom in an ACL injury and can range from moderate to severe. Continued athletic activity on a knee with an ACL injury can have devastating consequences, resulting in massive cartilage...
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...And he began to grow. Soon he began to notice girls, but after an initial girlfriend or two, he retreated. Too shy, probably. They moved, and moved again, and his grades slipped. He became more introverted. Troubled teen? Doing drugs? She found no evidence, but worried. And he grew. He turned , and he grew. He was getting close to six feet tall now, and was wearing size shoes. He was skinny, weighing only lbs. His right knee began to swell, and he developed mysterious ulcerated sores on his lower left leg that refused to heal. He began to complain often of feeling sick, and came home from school frequently. Never anything seriously wrong, but he just didn’t feel good. They revisited the doctor, who picked up on the description of large hands and feet and decided to check blood levels of some hormones. His thyroid was down, his cortisone levels low, his testosterone levels low, and his growth hormone levels high. Taps of his right knee removed up to cc of fluid, but no evidence of anything specifically wrong inside his knee, just that...
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...Enteropexy 7. artificial opening in the colon Colostomy 8. incision into the abdomen Laparotomy 9. absence of one or both testes Anarchism 10. rupture of the uterus Hysterorrhexis 11. excision of the prostate gland Prostatectomy 12. visual examination of the vagina Colposcopy 13. surgical repair of a testicle Orchiopexy 14. discharge of milk Galactorrhea 15. difficult labour or delivery Dystocia 16. suture of the tongue Glossorrhaphy 17. surgical puncture of the abdomen Abdominocentesis 18. pus in the urine Pyuria 19. pertaining to above the kidney Suprarenal 20. narrowing of the urethra Urethral Stricture Question 2 Give the meaning of each of the abbreviations below. Abbreviation Medical Meaning 1. LUQ Left upper quadrant 2. GI Gastrointestinal 3. OGD Oesophago-gastro duedenoscopy 4. CVS Chorionic villus sampling 5. STD Sexually transmitted disease 6. IUD Intrauterine device 7. TURP Transurethral resection of the prostate 8. DRE Digital rectal exam 9. UTI Urinary Tract Infection 10. C&S Culture and sensitivity Question 3 Using your learning resources, give a brief definition of each of the following medical terms. Medical Term Definition 1. chronic Describing a disease of long duration involving very slow changes. 2. sign An indication of a particular disorder that is detected by a physician while examining a...
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...Negligence Paper HCS478 September 22, 2014 Amputation Mishap The article of the "Amputation Mishap," located in (Pearson Health Science, 2014) Neighborhood News, season 3 episode 7 is about a 62-year-old gentleman who went into the hospital to have his right leg amputated, but instead the wrong leg was amputated. He received a below the knee amputation of his left leg. The reason that he was having his right leg amputated was because he is diabetic and has poor circulation in his right leg. The surgery did not correct his problem but instead created bigger problems, because he still has the leg with the poor circulation and will most likely still need his right leg amputated. This was a huge mistake that the hospital staff has made. The incident of the wrong leg being amputated is a result gross negligence. This paper will be discussing the difference between negligence, gross negligence, and malpractice. It will also cover my opinion about the situation, deciding whether it was a mishap or negligence, the importance of documentation, the ethical principles that serve as a guide in the nursing practice in this situation, and how documentation should be done to satisfy ethical and legal requirements. For negligence or malpractice to be present there is a couple of things that needs to be proven such as a duty owed to the patient, breach of duty to the patient, foreseeability, causation, injury and damage. In order for there to be negligence, it has to be an injury...
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...Sleep Deprivation The OR is a silent room. My surgical scrubs feel warm, like a pair of comfy pajamas. I sit, holding tools, while the surgeon meticulously dissects the patient's. It's a surgery I've assisted on dozens of times before. I blink and try to remember how long I have been in here. It seems like it has been forever since I have arrived at the hospital. In fact, it's been more than thirty hours since my shift started. During this past day and a half, I've logged more than fifteen hours in the OR and had no sleep in-between. My eyelids feel heavy, as if being pulled down by an invisible force. I begin shaking my knee up and down, an attempt to keep myself awake. My knee stops, and the Heaviness returns to my eyelids. Five minutes...
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...D.A.C.N.B. ABSTRACT Objective: This study investigates the clinical utility of testing functional systems within the central nervous system, compared to testing individual motor nerves with manual muscle testing. Design: Private practice. Study Subjects: Patients were examined by the treating chiropractor from his existing patient pool. Methods: Chiropractic management was decided on by the treating chiropractor. A series of twelve tests were designed to discover disorders of functional systems within the CNS. The tests described were to evaluate the function of 12 systems: 1) spinal cord, 2) myelencephalon/reticular formation, 3) vagal system, 4) trigeminal motor system-muscles of mastication, 5) vestibulospinal system, and bulbo reticular area, 6) reticular formation, 7) diencephalons and gait locomotion system, 8) mesencephalon, 9) cardiac sympathetic autonomic system, 10) pyramidal system, 11) limbic system, 12) sensory system. Results: This chiropractic approach tests the nervous system after provocation of functional systems instead of sensory challenges to more discreet portions of the body. Conclusion: For chiropractic patients who are not responding to discreet treatment programs, this method of evaluation may be valuable as it tests underlying system problems within the CNS. Nearly all the functional systems have a related motor activity that results in inhibition and facilitation patterns. Case series...
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...Student Susan Kaculis Neuromuscular Therapy 19 September 2015 Case Study I. The Client My client is my big sister, ______. She is a wife and also a mother of two girls; her youngest was born rather recently, on July 4th. She is currently on maternity leave, but when she is working she does so for a company that recruits special needs educators, spending most of her time at her desk. She rowed crew for four years at The Ohio State University, is a marathon runner, a triathlete, a yogi, and a lifter. She has had only one surgery: an ACL repair on her right knee back in 2008, but has had no trouble with it since. She also has a very slight case of scoliosis, almost unnoticeable until palpated. She sees a chiropractor, a massage therapist, and her little sister–me–for treatment when her busy schedule allows. ________ had no pain complaints before we began her assessment, putting her at a 0 on the pain scale. As a new mother, she is breastfeeding, which means that she has a substantial amount of relaxin in her system that will take another several months to work out. This relaxin makes my already super flexible sister–again she’s a yogi–a walking rubber band, so I didn’t push her range of motion assessments any further than what we would otherwise deem as “normal.” Her goals were to decrease tension, break up and release trigger points, and become more aware of her structural and muscular imbalances. II. The Observations A) Standing: _________ had even weight...
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