Journal of long-term effects of medical implants
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J Long Term Eff Med Implants · Jan 2005
A biomechanical study of unilateral posterior atlantoaxial transarticular screw fixation.
The purpose of this study was to investigate the fixation of C1-C2 instability with the use of a unilateral screw. Transarticular screw placement across C1-C2 may be contra-indicated in up to 20% of specimens on at least one side because of anatomic variations or other pathological processes. Hence the current study looks into unilateral screw fixation of C1- C2 instability. ⋯ The stiffness value in flexion was 0.813 +/- 0.189 N-m/mm and in translation 67.1 +/- 25.1 N/m. It was found that stability after unilateral transarticular screw fixation was less than that previously reported after bilateral transarticular screw fixation, but similar to that found with modified Brooks posterior wiring, which has been shown to provide better stability than other posterior wiring methods, and fusion rates of 96% have been reported. We concluded that C1-C2 unilateral posterior transarticular screw fixation with supplemental posterior graft and wiring would confer adequate stability in cases where bilateral screw placement is contraindicated.
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J Long Term Eff Med Implants · Jan 2004
Comparison of total body tissue interface pressure of specialized pressure-relieving mattresses.
The pressure-relieving ability of three specialized support surface mattresses was investigated and compared to a standard hospital mattress by measuring total body tissue interface pressure in a laboratory experiment designed to simulate clinical conditions predisposing to formation of pressure ulcers. ⋯ The Pegasus Airwave mattress outperforms the other tested support surfaces by decreasing overall pressure. Therefore, the Pegasus Airwave mattress is an excellent addition to augment nursing care in the prevention and treatment of pressure sores.
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J Long Term Eff Med Implants · Jan 2004
Maryland State Police Aviation Division. A model emergency medical system for our nation.
This collective review has the following purposes. First we will describe each of the components of the Maryland State Police Aviation Division. We will then provide detailed information about the Atlas and Database of Air Medical Services (ADAMS) compiled by the center for transportation and injury research (Buffalo, New York) in alliance with the Association of Air Medical Services (Alexandria, Virginia) that provides a unique opportunity for each state to evaluate the comprehensive nature of their air medical services. ⋯ Regardless of population density, Maryland provides air medical transport throughout the entire state, with the exception of only three small geographic areas. Maryland's 15 helicopter bases provide quick access for the seriously injured patient to either a Level I or pediatric trauma center within the "golden hour." In contrast, the air medical transportation system in Oregon is restricted to only three small geographic regions, making it an invitation to death for many seriously injured patients. It should be a federal mandate that the injured patient should gain access either by air transport or ambulance service to a Level I trauma center within that "golden hour." This federal legislation should include new criteria to initiate the dispatch of a helicopter to the scene of an accident or injury.
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The purpose of this collective review is to outline the predisposing factors in the development of pressure ulcers and to identify a pressure ulcer prevention program. The most frequent sites for pressure ulcers are areas of skin overlying bony prominences. There are four critical factors contributing to the development of pressure ulcers: pressure, shearing forces, friction, and moisture. ⋯ Because there is not sufficient staff to provide pressure relief to rotate the patient every 2 hours in a hospital setting, with the exception of the intensive care unit, the immobile patient is prone to develop pressure ulcers. The cost of caring for these preventable pressure ulcers may now be as high as 60,000 dollars per patient. The occupational physical strain sustained by nursing personnel in rotating their patients has led to occupational back pain in nurses, a major source of morbidity in the healthcare environment.
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J Long Term Eff Med Implants · Jan 2004
Review Biography Historical ArticleAn organized approach to trauma care: legacy of R Adams Cowley.
The organized approach to caring for trauma patients was introduced into the civilian setting by the innovative pioneer, R Adams Cowley. His system in Maryland has the following 11 components: (1) a State Police Aviation Division that transports patients throughout the State; (2) trained paramedics at the scene of the accident as well as on the helicopter, who will stabilize the patients en route to the Shock Trauma Center; (3) one central dispatch communication center in Baltimore that coordinates information between paramedics and the Trauma Center; (4) a Shock Trauma Center with a helicopter landing zone near the building; (5) trained trauma nurses and trauma technicians to transfer the patient from the helicopter by stretcher to the resuscitation area; if there is a special complication, such as an airway problem, the anesthesiologist and or trauma surgeon may meet the helicopter on the roof as well; (6) trauma surgeons, board-certified in surgery, with a certificate of added qualification in surgical critical care, to treat the critically ill trauma patients in the resuscitation area; (7) a CT scan and portable X-ray units in the admission area that aid in the diagnosis of the injury; (8) operating rooms adjacent to the admission area for repair of trauma injuries; (9) a surgical intensive unit to care for the trauma patient; (10) a team of specialty physicians trained in a wide variety of specialties who work as a multidisciplinary unit caring for the hospitalized patient; and (11) an ambulatory outpatient unit that allows the patient to be followed in the center after discharge. Dr. ⋯ Emergency communication systems remain fragmented, and adequate training programs and protective equipment for health personnel remains notably absent. The threat of inadequate funding for the state manifests itself in the consistent uneasiness regarding the recruitment and continued retention of trauma care providers. Federal authorities must devise national emergency medical and organized trauma programs to save the lives of injured Americans.