The influence of the posterior cruciate ligament in the maintenance of joint line in primary total knee arthroplasty: a radiologic study

The aim of this study was to compare 2 total knee arthroplasty (TKA) designs radiologically to determine if a posterior cruciate ligament (PCL)-substituting design led to a built-in error of elevation of the joint line postoperatively. The restoration of the true joint line is a goal in primary TKA, although its effect on outcome has not been established fully. A total of 47 patients had 56 TKAs performed by 2 surgeons using either the Howmedica Kinemax Plus (Rutherford, NJ) PCL-retaining or PCL-substituting TKAs. The patients were randomized to receive one of these designs, and the height of the joint line was assessed radiographically preoperatively and postoperatively. The joint line position preoperatively averaged 2.2 cm from the tibial tuberosity and postoperatively averaged 2.4 cm (PCL substituting) and 2.5 cm (PCL sparing). No difference in the thickness of the polyethylene insert used was seen with either design. The theoretical elevation of the joint line that occurs with the sacrifice of the PCL was not found to occur radiologically.

Nurses on-line: career mobility for registered nurses

The demands of a dynamic health care environment have altered the roles and responsibilities of nurses, creating employment situations where distinctions across educational levels are becoming increasingly important. The 1995 Pew Foundation Report projected that, in the next decade, there would exist a shortage of registered nurses with baccalaureate and higher degree preparation. This deficit creates a unique opportunity to provide innovative approaches to career mobility for registered nurses. Constraints related to juggling the demands of home life, child rearing, and employment have been obstacles for diploma and associate degree nurses wishing to continue their education. Web-based instruction offers exciting possibilities for a new paradigm in nursing education that takes advantage of both the interactivity and substantial resources of the internet. On-line registered nurse completion programs offer flexible, cost-effective, and easily accessible alternatives to traditional education. This article describes the application of adult learning theory for use in re-engineering courses for on-line instruction. Hardware and software needs, technical support, development of an instructional model, teaching-learning considerations, and program evaluation also are discussed.

Wired for thought. Electronic meetings in nursing education

Expanded application of electronic meeting software (EMS) in the business world is attributable to its discovery as a time saving and cost effective strategy for team building and group process. Group process and team building are equally important functions within the higher education environment but frequently consume hours of attention with limited productivity. Enhancements in EMS programs promise exciting solutions for completing crucial activities including strategic planning, negotiating, problem solving, consensus building, faculty/staff evaluation, multidisciplinary research and classroom instruction. The College of Nursing and Health at Wright State University in Dayton, Ohio has been "wired for thought." This article presents applications of GroupSystems electronic meeting software from Ventana Corporation, Tucson, Arizona, for solving problems encountered in administration, research collaboration, and classroom teaching within the College.

Opening minds. Values clarification via electronic meetings

Values clarification for nursing practice is one of the most challenging aspects of nursing education. Use of electronic meeting software has been demonstrated to be effective in overcoming typical barriers to student growth. Inhibitions related to fear of censorship are overcome by anonymity of the system. Monopolizing by dominant members is controlled when the ability to speak in parallel exists. Overall, this application of electronic meeting software in the classroom demonstrated involvement of all students in an innovative approach to understand the effect of personal values on health policy development in a graduate nursing course.

Reward dominance: associations with anxiety, conduct problems, and psychopathy in children

The associations between children's behavior and their performance on a task with a steadily increasing ratio of punished to rewarded responses was investigated in a group of clinic-referred (n = 92) and normal control (n = 40) children between the ages of 6 and 13. Clinic-referred children with an anxiety disorder played significantly fewer trials than clinic-referred children without an anxiety disorder but the response style of the anxious children did not differ from that of a normal control group. Children with severe conduct problems who had no anxiety disorder played more trials than (a) children with severe conduct problems and a comorbid anxiety disorder, (b) nonanxious children with attention-deficit hyperactivity disorder, and (c) children in the normal control group. The strongest evidence for the reward dominant response style was for nonanxious subjects with elevations on a measure of psychopathic features, irrespective of whether they also had conduct problems and irrespective of whether they were clinic-referred.

Psychopathy and conduct problems in children

Factor analysis of a measure of psychopathy was conducted in a sample of 95 clinic-referred children between the ages of 6 and 13 years. These analyses revealed 2 dimensions of behavior, one associated with impulsivity and conduct problems (I/CP) and one associated with the interpersonal and motivational aspects of psychopathy (callous/unemotional: CU). In a subset of this sample (n = 64), analyses indicated that scores on the I/CP factor were highly associated with traditional measures of conduct problems. In contrast, scores derived from the CU factor were only moderately associated with measures of conduct problems and exhibited a different pattern of associations on several criteria that have been associated with psychopathy (e.g., sensation seeking) or childhood antisocial behavior (e.g., low intelligence, poor school achievement, and anxiety). These analyses suggest that psychopathic personality features and conduct problems are independent, yet interacting, constructs in children, analogous to findings in the adult literature.