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Gates M, Hartling L, Shulhan-Kilroy J, MacGregor T, Guitard S, Wingert A, Featherstone R, Vandermeer B, Poonai N, Kircher J, Perry S, Graham TAD, Scott SD, Ali S. Digital Technology Distraction for Acute Pain in Children: A Meta-analysis. Pediatrics 2020; 145:peds.2019-1139. [PMID: 31969473 DOI: 10.1542/peds.2019-1139] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/04/2019] [Indexed: 12/14/2022] Open
Abstract
CONTEXT Digital distraction is being integrated into pediatric pain care, but its efficacy is currently unknown. OBJECTIVE To determine the effect of digital technology distraction on pain and distress in children experiencing acutely painful conditions or procedures. DATA SOURCES Medline, Embase, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Institute of Electrical and Electronics Engineers Xplore, Ei Compendex, Web of Science, and gray literature sources. STUDY SELECTION Quantitative studies of digital technology distraction for acutely painful conditions or procedures in children. DATA EXTRACTION Performed by 1 reviewer with verification. Outcomes were child pain and distress. RESULTS There were 106 studies (n = 7820) that reported on digital technology distractors (eg, virtual reality and video games) used during common procedures (eg, venipuncture, dental, and burn treatments). No studies reported on painful conditions. For painful procedures, digital distraction resulted in a modest but clinically important reduction in self-reported pain (standardized mean difference [SMD] -0.48; 95% confidence interval [CI] -0.66 to -0.29; 46 randomized controlled trials [RCTs]; n = 3200), observer-reported pain (SMD -0.68; 95% CI -0.91 to -0.45; 17 RCTs; n = 1199), behavioral pain (SMD -0.57; 95% CI -0.94 to -0.19; 19 RCTs; n = 1173), self-reported distress (SMD -0.49; 95% CI -0.70 to -0.27; 19 RCTs; n = 1818), observer-reported distress (SMD -0.47; 95% CI -0.77 to -0.17; 10 RCTs; n = 826), and behavioral distress (SMD -0.35; 95% CI -0.59 to -0.12; 17 RCTs; n = 1264) compared with usual care. LIMITATIONS Few studies directly compared different distractors or provided subgroup data to inform applicability. CONCLUSIONS Digital distraction provides modest pain and distress reduction for children undergoing painful procedures; its superiority over nondigital distractors is not established. Context, preferences, and availability should inform the choice of distractor.
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Affiliation(s)
- Michelle Gates
- Department of Pediatrics and.,Alberta Research Centre for Health Evidence, and
| | - Lisa Hartling
- Department of Pediatrics and .,Alberta Research Centre for Health Evidence, and
| | | | - Tara MacGregor
- Department of Pediatrics and.,Alberta Research Centre for Health Evidence, and
| | - Samantha Guitard
- Department of Pediatrics and.,Alberta Research Centre for Health Evidence, and
| | - Aireen Wingert
- Department of Pediatrics and.,Alberta Research Centre for Health Evidence, and
| | - Robin Featherstone
- Department of Pediatrics and.,Alberta Research Centre for Health Evidence, and
| | - Ben Vandermeer
- Department of Pediatrics and.,Alberta Research Centre for Health Evidence, and
| | - Naveen Poonai
- Department of Pediatrics and Internal Medicine, Schulieh School of Medicine and Dentistry, Western University, London, Canada
| | - Janeva Kircher
- Department of Pediatrics and.,Emergency Medicine, Faculty of Medicine and Dentistry
| | - Shirley Perry
- Women and Children's Health Research Institute, University of Albert, Edmonton, Canada
| | - Timothy A D Graham
- Emergency Medicine, Faculty of Medicine and Dentistry.,Alberta Health Services Edmonton Zone, Edmonton, Canada; and
| | | | - Samina Ali
- Department of Pediatrics and.,Emergency Medicine, Faculty of Medicine and Dentistry.,Women and Children's Health Research Institute, University of Albert, Edmonton, Canada
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2
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Tran UE, Kircher J, Jaggi P, Lai H, Hillier T, Ali S. Medical students' perspectives of their clinical comfort and curriculum for acute pain management. J Pain Res 2018; 11:1479-1488. [PMID: 30122978 PMCID: PMC6080666 DOI: 10.2147/jpr.s159422] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objectives Acute pain is a common presenting complaint in health care. Yet, undertreatment of pain remains a prevailing issue that often results in poor short- and long-term patient outcomes. To address this problem, initiatives to improve teaching on pain management need to begin in medical school. In this study, we aimed to describe medical students' perspectives of their curriculum, comfort levels, and most effective pain teaching modalities. Materials and methods A cross-sectional, online survey was distributed to medical students at the University of Alberta (Edmonton, Canada) from late May to early July 2015. Data were collected from pre-clerkship (year 1 and 2) and clerkship (year 3 and 4) medical students for demographic characteristics, knowledge, comfort, and attitudes regarding acute pain management. Results A total of 124/670 (19.6%) surveys were returned. Students recalled a median of 2 (interquartile range [IQR]=4), 5 (IQR=3.75), 4 (IQR=8), and 3 (IQR=3.75) hours of formal pain education from first to forth year, respectively. Clerkship students were more comfortable than pre-clerks with treating adult pain (52.1% of pre-clerks "uncomfortable" versus 22.9% of clerks, p<0.001), and overall, the majority of students were uncomfortable with managing pediatric pain (87.6% [64/73] pre-clerks and 75.0% [36/48] clerks were "uncomfortable"). For delivery of pain-related education, the majority of pre-clerks reported lectures as most effective (51.7%), whereas clerks chose bedside instruction (43.7%) and small group sessions (23.9%). Notably, 54.2%, 39.6%, and 56.2% of clerks reported incorrect doses of acetaminophen, ibuprofen, and morphine, respectively, for adults. For children, 54.2%, 54.2%, and 78.7% of clerks reported incorrect doses for these same medications. Conclusion Medical students recall few hours of training in pain management and report discomfort in treating and assessing both adult and (more so) pediatric pain. Strategies are needed to improve education for future physicians regarding pain management.
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Affiliation(s)
- Uyen Evelyn Tran
- Undergraduate Medical Education, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Janeva Kircher
- Department of Emergency Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.,Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada,
| | - Priya Jaggi
- Department of Emergency Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Hollis Lai
- Undergraduate Medical Education, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Tracey Hillier
- Undergraduate Medical Education, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.,Department of Radiology & Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada
| | - Samina Ali
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada, .,Women and Children's Health Research Institute, Edmonton, Alberta, Canada,
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Farkhondeh Fal M, Kircher J. [Treatment after anatomical and inverse shoulder TEP]. Orthopade 2018; 47:420-427. [PMID: 29470592 DOI: 10.1007/s00132-018-3545-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Shoulder arthroplasties in specialized centers are routine procedures with an increasing number of operations in the developed countries. Restoration of pain free shoulder function requires an intensive, specific and individual rehabilitation program for each patient. There is a phase-like course with different specific demands and measures that extends over a period of several weeks. Return to sport and a pain free function for activities of daily living resulting in a high patient satisfaction can routinely be expected. This excellent perspective, extent and intensity of the rehabilitation program shall be part of the preoperative decision making.
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Affiliation(s)
- M Farkhondeh Fal
- Schulter- und Ellenbogenchirurgie, ATOS Klinik Fleetinsel Hamburg, Admiralitätstraße 3-4, 20459, Hamburg, Deutschland
| | - J Kircher
- Schulter- und Ellenbogenchirurgie, ATOS Klinik Fleetinsel Hamburg, Admiralitätstraße 3-4, 20459, Hamburg, Deutschland. .,Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Moorenstr. 5, 40255, Düsseldorf, Deutschland.
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Zettel-Watson L, Tessler J, Kircher J, Islas L, Aquino J, Fisher K, Cortez F, Cherry B. ACCELERATED PHYSICAL AND COGNITIVE AGING IN A CHRONIC PAIN CONDITION VS. NORMAL AGING. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- L.A. Zettel-Watson
- Gerontology, California State University, Fullerton, California,
- Psychology, California State University, Fullerton, California,
| | - J. Tessler
- Psychology, California State University, Fullerton, California,
| | - J. Kircher
- Psychology, California State University, Fullerton, California,
| | - L. Islas
- Psychology, California State University, Fullerton, California,
| | - J. Aquino
- Health Science, California State University, Fullerton, California,
| | - K.L. Fisher
- Kinesiology, California State University, Fullerton, California
| | - F. Cortez
- North Dakota State University, Fargo, North Dakota,
| | - B.J. Cherry
- Gerontology, California State University, Fullerton, California,
- Psychology, California State University, Fullerton, California,
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Abstract
Implantation of reverse shoulder endoprostheses is becoming more popular for elderly patients besides the well-established standard anatomic endoprostheses. The reasons for this are the increased life expectancy, age-dependent degeneration of the rotator cuff leading to cuff tear arthropathy, posttraumatic disability after failed osteosynthesis and primary reverse fracture arthroplasty. Stemless implants are more frequently used for primary osteoarthritis with the bone quality being the limiting factor. Modern implant systems allow the stepwise extension from bone preserving primary implants to modular and convertible revision implants that allow a partial exchange of components. Revision surgery, especially that of reverse arthroplasty, has limited potential for secondary treatment options and therefore implantation and revision should be performed in specialized treatment facilities.
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Affiliation(s)
- J Kircher
- Schulter- und Ellenbogenchirurgie, Klinik Fleetinsel Hamburg, Admiralitätstr. 3-4, 20459, Hamburg, Deutschland.
- Orthopädische Klinik, Universitätsklinikum, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Moorenstr. 5, 40255, Düsseldorf, Deutschland.
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Kircher J, Stauffer B, Kessler BD, Su M. In Response to ‘Intravenous Lipid Emulsion Given to Volunteers Does Not Affect Symptoms of Lidocaine Brain Toxicity’. Basic Clin Pharmacol Toxicol 2015; 117:361. [DOI: 10.1111/bcpt.12450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Janeva Kircher
- Department of Emergency Medicine; University of Alberta; Edmonton AB Canada
| | - Brandy Stauffer
- Department of Emergency Medicine; University of Alberta; Edmonton AB Canada
| | - Benjamin D. Kessler
- Department of Emergency Medicine; North Shore University Hospital; Manhasset NY USA
| | - Mark Su
- Department of Health and Mental Hygiene; New York City Poison Control Center; New York NY USA
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Thomas D, Kircher J, Plint AC, Fitzpatrick E, Newton AS, Rosychuk RJ, Grewal S, Ali S. Pediatric Pain Management in the Emergency Department: The Triage Nurses' Perspective. J Emerg Nurs 2015; 41:407-13. [PMID: 25837698 DOI: 10.1016/j.jen.2015.02.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 02/21/2015] [Accepted: 02/23/2015] [Indexed: 11/17/2022]
Abstract
UNLABELLED Understanding triage nurses' perspectives of pain management is essential for timely pain care for children in the emergency department. Objectives of this study were to describe the triage pain treatment protocols used, knowledge of pain management modalities, and barriers and attitudes towards implementation of pain treatment protocols. METHODS A paper-based survey was administered to all triage nurses at three Canadian pediatric emergency departments, between December 2011 and January 2012. RESULTS The response rate was 86% (n=126/147). The mean respondent age was 40 years (standard deviation [SD] 9.3) with 8.6 years (SD 7.7) of triage experience. General triage emergency department (GTED) nurses rated adequacy of triage pain treatment lower than pediatric-only triage emergency department (PTED) nurses (P < .001). GTED nurses reported a longer acceptable delay between triage time and administration of analgesia than PTED nurses (P < .002). Most nurses rated more comfort with a protocol involving administration of acetaminophen (97 mm, interquartile range [IQR] 92, 99) or ibuprofen (97 mm, IQR 93, 100) than for oral morphine (67 mm, IQR 35, 94) or oxycodone (57 mm, IQR 15, 81). The top three reported barriers to triage-initiated pain protocols were monitoring capability, time, and access to medications. Willingness to implement a triage-initiated pain protocol was rated as 81 mm (IQR 71, 96). DISCUSSION Triage nurses are willing to implement pain protocols for children in the emergency department, but differences in comfort and experience exist between PTED and GTED nurses. Provision of triage initiated pain protocols and associated education may empower nurses to improve care for children in pain in the emergency department.
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Affiliation(s)
- Daina Thomas
- Edmonton, Alberta, Ottawa, Ontario, Halifax, Nova Scotia, and Vancouver, British Columbia, Canada
| | - Janeva Kircher
- Edmonton, Alberta, Ottawa, Ontario, Halifax, Nova Scotia, and Vancouver, British Columbia, Canada
| | - Amy C Plint
- Edmonton, Alberta, Ottawa, Ontario, Halifax, Nova Scotia, and Vancouver, British Columbia, Canada
| | - Eleanor Fitzpatrick
- Edmonton, Alberta, Ottawa, Ontario, Halifax, Nova Scotia, and Vancouver, British Columbia, Canada
| | - Amanda S Newton
- Edmonton, Alberta, Ottawa, Ontario, Halifax, Nova Scotia, and Vancouver, British Columbia, Canada
| | - Rhonda J Rosychuk
- Edmonton, Alberta, Ottawa, Ontario, Halifax, Nova Scotia, and Vancouver, British Columbia, Canada
| | - Simran Grewal
- Edmonton, Alberta, Ottawa, Ontario, Halifax, Nova Scotia, and Vancouver, British Columbia, Canada
| | - Samina Ali
- Edmonton, Alberta, Ottawa, Ontario, Halifax, Nova Scotia, and Vancouver, British Columbia, Canada.
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Djogovic D, MacDonald S, Wensel A, Green R, Loubani O, Archambault P, Bordeleau S, Messenger D, Szulewski A, Davidow J, Kircher J, Gray S, Smith K, Lee J, Benoit JM, Howes D. Vasopressor and inotrope use in Canadian emergency departments: evidence based consensus guidelines. CAN J EMERG MED 2015; 17:1-2. [PMID: 25961083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Kircher J, Drendel AL, Newton AS, Plint AC, Vandermeer B, Dulai S, Ali S. Acute pediatric musculoskeletal pain management in North America: a practice variation survey. Clin Pediatr (Phila) 2014; 53:1326-35. [PMID: 25381329 DOI: 10.1177/0009922814555972] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Children's musculoskeletal (MSK) injury pain remains poorly managed. This survey of pediatric emergency physicians and orthopedic surgeons assessed analgesia administration practices and discharge advice for children with acute MSK pain; 683 responses were received. Ibuprofen was the most commonly reported analgesic used in the emergency department (52%) and at discharge (68%). Most (85%) reported using oral opioids in the previous 6 months. Codeine use was the most commonly reported opioid used in the emergency department (38%) and at home (51%). For equal levels of pain, younger children received less opioids than older children. Younger physicians and recent graduates chose acetaminophen and codeine more than older and more experienced colleagues, who preferred ibuprofen and non-codeine containing opioid compounds (P < .001 and .006, respectively). Orthopedic surgeons reported less ibuprofen use than pediatric emergency physicians (P < .001). Choice of analgesic agents is heterogeneous among physicians and is influenced by pain severity, child's age, and physician characteristics.
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Affiliation(s)
| | - Amy L Drendel
- Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, WI, USA
| | - Amanda S Newton
- University of Alberta, Edmonton, Alberta, Canada Women and Children's Health Research Institute, Edmonton, Alberta, Canada
| | - Amy C Plint
- University of Ottawa, Ottawa, Ontario, Canada
| | | | | | - Samina Ali
- University of Alberta, Edmonton, Alberta, Canada Women and Children's Health Research Institute, Edmonton, Alberta, Canada
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10
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Weingarten L, Kircher J, Drendel AL, Newton AS, Ali S. A Survey of Children's Perspectives on Pain Management in the Emergency Department. J Emerg Med 2014; 47:268-76. [DOI: 10.1016/j.jemermed.2014.01.038] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2013] [Revised: 11/18/2013] [Accepted: 01/31/2014] [Indexed: 11/24/2022]
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11
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Ali H, Meyers C, Kircher J, MacLellan J, Ali S. 191: Pediatric Pain Management: the Emergency Medicine Residents' Perspectives. Paediatr Child Health 2014. [DOI: 10.1093/pch/19.6.e35-187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Ziskoven C, Patzer T, Ritsch M, Krauspe R, Kircher J. [Current treatment options for complete ruptures of the pectoralis major tendon]. Sportverletz Sportschaden 2011; 25:147-52. [PMID: 21922436 DOI: 10.1055/s-0031-1273369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The rupture of the pectoralis major tendon is an uncommon pathological condition that is reported in literature to prevail among athletes, although also case reports and case series of nursing home residents or workers can be found, as well as traumatic lesions. Among athletes, pectoralis major tendon ruptures have shown a significant increase in incidence over the last years. This may be due to the higher number of individuals taking part in high-impact sports and weight-lifting. In the recent literature, there are only few recommendations to rely on conservative treatment alone. Especially in athletes, numerous case reports and series give the recommendation for an early surgical intervention. Comparing the results of the two treatment plans, there is some evidence for a superior outcome after surgical repair with better cosmesis, better functional results, better recovery of muscle power and return to sports compared to the conservative treatment. In summary, anatomic surgical repair is the treatment of choice for complete acute ruptures of the pectoralis major tendon or muscle in athletes. In all other cases, especially in the elderly, conservative treatment remains an important option.
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Affiliation(s)
- C Ziskoven
- Orthopädische Klinik, Universitätsklinikum Düsseldorf
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13
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Kircher J, Patzer T, Magosch P, Lichtenberg S, Habermeyer P. Osteochondral autologous transplantation for the treatment of full-thickness cartilage defects of the shoulder. ACTA ACUST UNITED AC 2009; 91:499-503. [DOI: 10.1302/0301-620x.91b4.21838] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We describe the outcome at a mean follow-up of 8.75 years (7.6 to 9.8) of seven patients who had undergone osteochondral autologous transplantation for full-thickness cartilage defects of the shoulder between 1998 and 2000. These patients have been described previously at a mean of 32.6 months when eight were included. One patient has been lost to follow-up. The outcome was assessed by the Constant shoulder score and the Lysholm knee score to assess any donor-site morbidity. Standard radiographs and MR scores were obtained and compared with the pre-operative findings and the results from the previous review. No patient required any further surgery on the shoulder. The mean Constant score improved significantly until the final follow-up (p = 0.018). The Lysholm score remained excellent throughout. There was a significant progression of osteoarthritic changes from the initial surgery to the first and final follow-up but this did not appear to be related to the size of the defect, the number of cylinders required or the Constant score (p = 0.016). MRI showed that all except one patient had a congruent joint surface at the defect with full bony integration of all osteochondral cylinders. The results have remained satisfactory over a longer period with very good objective and subjective findings.
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Affiliation(s)
- J. Kircher
- Heidelberg Shoulder and Elbow Surgery, ATOS Clinic, Bismarckstrasse 9-15, D-69115, Heidelberg, Germany
| | - T. Patzer
- Heidelberg Shoulder and Elbow Surgery, ATOS Clinic, Bismarckstrasse 9-15, D-69115, Heidelberg, Germany
| | - P. Magosch
- Heidelberg Shoulder and Elbow Surgery, ATOS Clinic, Bismarckstrasse 9-15, D-69115, Heidelberg, Germany
| | - S. Lichtenberg
- Heidelberg Shoulder and Elbow Surgery, ATOS Clinic, Bismarckstrasse 9-15, D-69115, Heidelberg, Germany
| | - P. Habermeyer
- Heidelberg Shoulder and Elbow Surgery, ATOS Clinic, Bismarckstrasse 9-15, D-69115, Heidelberg, Germany
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Mazoochian F, Schrimpf FM, Kircher J, Mayer W, Hauptmann S, Fottner A, Müller PE, Pellengahr C, Jansson V. Proximal loading of the femur leads to low subsidence rates: first clinical results of the CR-stem. Arch Orthop Trauma Surg 2007; 127:397-401. [PMID: 17602233 DOI: 10.1007/s00402-007-0384-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2005] [Indexed: 02/09/2023]
Abstract
INTRODUCTION A new femoral stem was developed with a design that leads to compression of cancellous bone in the calcar region which results in proximal loading. The cross-sectional design of the implant provides rotational stability. MATERIALS AND METHODS In the first clinical investigation ten patients underwent uncemented total hip arthroplasty between January 1999 and May 1999 using the CR-stem((R)) (Implantcast GmbH, Buxtehude, Germany). Results were investigated using the Harris-hip-score (HHS) and antero-posterior and lateral radiographs. Migration was evaluated with the EBRA-FCA-method with a follow-up of 7 years. RESULTS We demonstrated a mean subsidence rate of 2.23 +/- 1.13 mm 7 years after implantation thus providing basic data for extensive testing in a clinical environment. DISCUSSION As small subsidence rates are regarded as predictor for superior long-term results in uncemented total hip arthroplasty according to the literature, the CR-stem shows promise for excellent long-term results.
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Affiliation(s)
- F Mazoochian
- Department of Orthopaedics, Universitätsklinikum Grosshadern, Ludwig-Maximilians-University of Munich, Marchioninistr. 15, 81377 Munich, Germany.
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15
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Kircher J, Bergschmidt P, Bader R, Kluess D, Besser-Mahuzir E, Leder A, Mittelmeier W. Die Bedeutung der Gleitpaarung beim jüngeren Endoprothesenpatienten. Orthopäde 2007; 36:337-46. [PMID: 17387448 DOI: 10.1007/s00132-007-1069-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The success and long-term survival rates of modern joint arthroplasty leads to a high patient satisfaction and, together with its technical improvements, has broadened the indications to an increasingly younger population. Limitations to the established systems are the long-term survival rates, which are mainly influenced by wear of the articulating parts and the resulting problems. Beside "classic" long-stemmed cemented shafts articulating with metal against polyethylene, short-stemmed or cup designs with a hard-hard self pairing are increasingly used in total hip arthroplasty. This paper reflects the current state of the art in joint arthroplasty for younger patients with the focus on wear couples and discusses future perspectives. Special interest is focused on the advantages and disadvantages of ceramic bearings, problems with allergies to implant components and the design of endoprostheses with regard to avoidance of impingement.
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Affiliation(s)
- J Kircher
- Orthopädische Klinik und Poliklinik, Universität Rostock, Doberaner Strasse 142, 18057 Rostock, Deutschland.
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16
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Abstract
Increasing age and a higher level of mobility lead to an increasing incidence in revision arthroplasty after total knee replacement and tumor surgery. So far, the reconstruction of large defects in bony and soft tissue environments can be accomplished by the modern modular components of revision implants. The consecutive reconstruction of the extensor mechanism in extended revision has its own drawbacks and is often associated with significant functional limitations for the patient. Specially designed implants and methods are required to generate good functional results. The modular knee revision system MML provides specific modifications of the tibial component for reconstruction of the extensor mechanism. Combined with artificial strips, an excellent functional outcome could be achieved. In this study, 70 patients were operated with the MML endoprosthesis in knee revision or tumor surgery. An excellent functional outcome could be determined. At 7 years after surgery, an average of 32+/-13 points was achieved on the Oxford Knee Score. The outcome measurement using the functional scoring system of the American Knee Society (AKS score) showed similarly good results with 71+/-25 points out of 100. A minor deficit of only 2 degrees in active extension could be observed after reconstruction of the extensor mechanism. In conclusion, we have demonstrated that the MML modular revision system is appropriate for reconstruction of segmental bone defects.
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Affiliation(s)
- L Gerdesmeyer
- Department Endoprothetik und Wirbelsäulenchirurgie der Klinik für Orthopädie und Unfallchirurgie, Mare-Klinikum, Eckernförder Strasse 219, 24119, Kiel-Kronshagen.
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17
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Henn R, Kircher J, Cardona M, Wittlin A, Duijn VH, Menovsky AA. Far-infrared c-axis response of La1.87Sr0.13CuO4 determined by ellipsometry. Phys Rev B Condens Matter 1996; 53:9353-9358. [PMID: 9982438 DOI: 10.1103/physrevb.53.9353] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
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Kircher J, Cardona M, Zibold A, Widder K, Geserich HP. Optical investigation of room-temperature chain ordering in YBa2Cu3O7- delta. Phys Rev B Condens Matter 1993; 48:9684-9688. [PMID: 10007216 DOI: 10.1103/physrevb.48.9684] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Zollner S, Garriga M, Kircher J, Humlicek J, Cardona M, Neuhold G. Temperature dependence of the dielectric function and the interband critical-point parameters of GaP. Phys Rev B Condens Matter 1993; 48:7915-7929. [PMID: 10006977 DOI: 10.1103/physrevb.48.7915] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
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Kircher J, Cardona M, Zibold A, Geserich H, Kaldis E, Karpinski J, Rusiecki S. Dielectric tensor of YBa2Cu4O8: Experiment and theory. Phys Rev B Condens Matter 1993; 48:3993-4001. [PMID: 10008849 DOI: 10.1103/physrevb.48.3993] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
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Hadjiev VG, Thomsen C, Kircher J, Cardona M. Raman-scattering probe of oxygen ordering during room-temperature annealing of YBa2Cu3O7- delta. Phys Rev B Condens Matter 1993; 47:9148-9150. [PMID: 10004976 DOI: 10.1103/physrevb.47.9148] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
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23
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Kircher J, Brücher E, Schönherr E, Kremer RK, Cardona M. Room-temperature annealing of YBa2Cu3O7- delta observed by optical measurements. Phys Rev B Condens Matter 1992; 46:588-590. [PMID: 10002265 DOI: 10.1103/physrevb.46.588] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
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Etchegoin P, Kircher J, Cardona M, Grein C. Piezo-optical response of Ge in the visible-uv range. Phys Rev B Condens Matter 1992; 45:11721-11735. [PMID: 10001187 DOI: 10.1103/physrevb.45.11721] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
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Heyen ET, Kircher J, Cardona M. Resonant Raman scattering in insulating YBa2Cu3O6 as a probe of its electronic structure. Phys Rev B Condens Matter 1992; 45:3037-3047. [PMID: 10001855 DOI: 10.1103/physrevb.45.3037] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
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27
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Kircher J, Cardona M, Gopalan S, Habermeier H, Fuchs D. Optical investigation of the valency of Pr in Y1-xPrxBa2Cu3O7- delta. Phys Rev B Condens Matter 1991; 44:2410-2413. [PMID: 9999806 DOI: 10.1103/physrevb.44.2410] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Kircher J, Kelly MK, Rashkeev S, Alouani M, Fuchs D, Cardona M. Anisotropy and oxygen-stoichiometry dependence of the dielectric tensor of YBa2Cu3O7- delta (0 <= delta <= 1). Phys Rev B Condens Matter 1991; 44:217-224. [PMID: 9998237 DOI: 10.1103/physrevb.44.217] [Citation(s) in RCA: 30] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
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Kircher J, Alouani M, Garriga M, Murugaraj P, Maier J, Thomsen C, Cardona M, Andersen OK, Jepsen O. Anisotropy of the dielectric function in YBa2Cu3O6. Phys Rev B Condens Matter 1989; 40:7368-7371. [PMID: 9991147 DOI: 10.1103/physrevb.40.7368] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
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Kircher J. Legal doctrines associated with medical malpractice. Physician Assist 1986; 10:52-7. [PMID: 10314631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
Malpractice is the legal charge against a professional accused of a private wrong. Claims must be filed under tort (or civil) law; specific statutes can vary from state to state. Legal doctrines associated with malpractice include respondeat superior, which places ultimate liability with a superior or employer; proximate cause, which states that the professional's negligence resulted in injury; and res ipsa loquitur, which allows malpractice to be proved without expert testimony. Traditionally, PAs have been protected by respondeat superior; however, while some legal precedents have assigned liability to the physician entirely, others have distributed it proportionately between the supervised nonphysician provider and the physician. Consequently, no clear guidelines exist for PAs regarding malpractice, since the degree of liability has not yet been definitely decided by the courts. However, in the current legal climate, more and more PAs assume malpractice liability, and are providing for personal coverage.
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Cohn NB, Kircher J, Emmerson RY, Dustman RE. Pattern reversal evoked potentials: age, sex and hemispheric asymmetry. Electroencephalogr Clin Neurophysiol 1985; 62:399-405. [PMID: 2415335 DOI: 10.1016/0168-5597(85)90049-8] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Binocular pattern reversal evoked potentials (PREPs) and EEG power were recorded bilaterally from occipital scalp of 50 boys and 50 girls aged 5-14. PREP latency was unaffected by either age or gender. Amplitudes, however, were consistently larger for girls than boys, with differences diminishing by adolescence. Significant electrophysiological asymmetries were also found; larger PREP amplitudes were measured at the right occipital electrode than the left for the two waves investigated. These asymmetries were apparent in both girls and boys across all ages, although they tended to diminish with maturation. EEG alpha asymmetry did not correlate with PREP amplitude asymmetry. PREPs elicited by half-field stimulation of 8 girls aged 9-10 years determined that 'paradoxical lateralization' of the half-field response was the same for both left and right half-fields, thus failing to account for the asymmetry of the full-field binocular response.
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