An Extended Epistemology for Fostering Transformative Learning in Holistic Nursing Education and Practice

The transformation from traditional nursing practice to holistic nursing is one that requires recognition of multiple ways of knowing. Transformative learning theory reflects a strong bias toward cognitive epistemology and propositional knowing. This epistemology, labeled here as truncated, rests on an understanding of experience derived from pragmatism. This article describes an extended epistemology derived from the work of John Heron that better reflects the full range of knowing utilized by holistic nurses. This epistemology provides a foundation for innovative approaches for the development of holistic awareness in the training and continuing professional development of nurses. One such approach, collaborative inquiry, is described.

Effect of Zoledronic Acid and Alendronate on Bone Edema and Pain in Spontaneous Osteonecrosis of the Knee: A New Paradigm in the Medical Management

Objective  The aim of the present study was to determine the effect of combined zoledronic acid and alendronate therapy on bone edema and knee pain in cases of spontaneous osteonecrosis of the knee. We report our experience with this treatment.

Methods  A retrospective case series of 11 patients with spontaneous osteonecrosis of the knee confirmed by magnetic resonance image (MRI). The patients were treated with a single dose of 5 mg of intravenous zoledronic acid combined with 35 mg twice a week of oral alendronate, for 16 weeks. The visual analogue scale scores were noted before the beginning of the therapy, at 8 weeks, and at 16 weeks of follow-up. The size of the bone marrow edema adjacent to the lesion was measured on T2-weighted MRI coronal images at the beginning of the therapy and at 16 weeks.

Results  The average visual analogue scale score at 0 weeks was of 7.72, and of 0.81 at 16 weeks of therapy; the difference was statistically significant ( p  = 0.03). The mean bone marrow involvement at 0 weeks was of 80%, which reduced to 11.81% at 16 weeks of therapy. This change was statistically significant ( p  = 0.03).

Conclusion  Our data shows that the combination therapy causes early pain relief and reduction of the bone edema, and it is safe, effective and well-tolerated for a painful disease entity like spontaneous osteonecrosis of the knee.

1170 Outcome of Various Fixation Techniques for Talo-Navicular Arthrodesis

Aim

The talonavicular (TN) forms part of the medial joint complex, which is involved in maintaining stability during the gait cycle Arthrodesis can be used to manage a range of deformities and to treat degenerative and inflammatory changes of the joint. The most significant complication is non-union, but chronic pain due to complex regional pain syndrome, or progressive arthritic changes can also occur. The aim was to evaluate the outcome of different methods of fixation used for TN arthrodesis in adults within the trust.

Method

This was a quality improvement project, looking retrospectively at inpatient surgeries over a 6-year period. Inpatient notes, operative notes, clinic letters and imaging were analysed. Treatment methods included IOFIX devices, cannulated screws, staples, plates and screws, and combined staples and screws. The sample included a total of 57 patients (42 females and 15 males).

Results

IOFIX had a 93% fusion rate, and a 27% complication rate. Cannulated screws had a 79% fusion rate, and a 46% complication rate. Screws and staples had a 75% union rate, and a 13% complication rate. Only one sample used plates and screws, which resulted in union and no complications. Using staples alone had a 78% union rate and a 11% complication rate.

Conclusions

The greatest union rate was achieved with IOFIX devices, followed by cannulated screws. Greatest complication rate was with cannulated screws, and lowest with the combined use of staples and screws. Highest rate of revision surgery was with cannulated screws. Recommendations included a switch to IOFIX devices for TN arthrodesis.

Management of septic arthritis and prosthetic joint infection

Management of joint infection is an evolving topic. This article reviews the literature on the management of native and prosthetic joint infection and suggests some areas of improvement in short- and long-term management which could lead to better patient outcomes. Surgical management is the mainstay of treatment for native or prosthetic knee infection and aspiration should only be used for diagnostic purposes. A multidisciplinary team approach and compliance with national guidelines, alongside referral networks and pooling of expertise, should be mandatory to improve patient outcomes.