Benefits of multidisciplinary case conferencing using audiovisual compared with telephone communication: a randomized controlled trial

Multidisciplinary case conferencing using a video-link was compared with multidisciplinary case conferencing by telephone. One hundred patients were randomized to either videoconferencing (intervention group, 50 patients) or audioconferencing (control group, 50 patients). The effectiveness of the intervention compared with the control was evaluated in terms of: the number of conferences per patient, average length of conference, length of treatment, number of occasions of service, degree of multidisciplinary team involvement, recorded level of communication, quality of the management plan (in terms of the number of points contained in it) and staff satisfaction. The intervention and control groups showed significant differences on only two of the outcome measures: the mean number of case conferences per patient was less for the intervention group, and the intervention group had a shorter length of treatment (6 days) than the control group (10 days). The study did not demonstrate any significant differences in occasions of service or time commitment, which might have resulted in lower costs. However, the introduction of case conferencing by video-link was accompanied by a high level of satisfaction on the part of the 14 team members who were interviewed.

Severe cervical spinal cord injuries related to rugby union and league football in New South Wales, 1984-1996

OBJECTIVE

To determine the frequency and circumstances of serious cervical cord injuries associated with rugby union and league football in New South Wales.

DESIGN

Retrospective review of patients with rugby football-related cervical spinal cord injuries.

SETTING

The two central spinal units in NSW, from January 1984 to July 1996.

OUTCOME MEASURES

Admission to spinal units; injury resulting in permanent tetraplegia.

RESULTS

During the review period, 115 rugby football players (56 union and 59 league) were admitted to the spinal units because of cervical spinal cord injuries. 49 patients had resultant permanent neurological deficits (complete tetraplegia [quadriplegia])--26 associated with rugby union and 23 with rugby league. Two patients died of injury sequelae within two weeks of admission. There was no significant change in the rate of football-related admissions to spinal units for either code. There was a small decline in the number (from 15 in 1984 to 1987 to 7 in 1992 to 1996) and incidence (from 1.2 to 0.5 per 10,000 participants) of patients with tetraplegia associated with rugby union. When this decline was tested as a trend over the years, it was found to be statistically significant (P = 0.06). No significant trend was found in the tetraplegia data associated with rugby league. Cervical spinal cord injuries leading to complete tetraplegia were most commonly associated with scrum-like plays in union and with tackles in league.

CONCLUSION

Serious cervical spinal injuries associated with both codes of rugby continue to occur in NSW. Rugby football in its various forms is still an inherently dangerous game.

Seated-popliteal weight bearing prosthesis for a bilateral amputee

Bilateral lower limb amputees suffer from a lack of stability when seated without prostheses due to lack of ground reaction forces through the stumps. In patients for whom ambulation is not a realistic goal, the seated-popliteal weight bearing prosthesis provides a solution for stability when seated in a wheelchair, without the problem of tibial pressure experienced with patellar-tendon-bearing prostheses.

Catastrophic injuries to the eyes and testicles in footballers

OBJECTIVE

To report the occurrence of uncommon but catastrophic eye and testicle injuries to rugby league and rugby union footballers in New South Wales.

METHODS

A retrospective review of players who had permanent football-related injuries and who claimed financial compensation from a voluntary sports injury insurance scheme from 1978-1994.

RESULTS

An average of 100 000 rugby league and rugby union players per year were registered with the insurance scheme in NSW. As a consequence of playing football, 15 players lost 90%-100% vision in one eye, five lost 75% vision in one eye, four lost 50% of vision in one eye and two lost 75% vision in both eyes. Eye injuries were caused by "gouging" with fingers, kicks, or blows from fists, elbows and knees; five cases appeared to be intentional. Fourteen players had testicular injuries: in 11 players this resulted in complete loss of one testicle, and in three partial loss of one or both testicles. The immediate cause of the injuries to the testicles was kicking and kneeing, usually during tackles; at least three of the injuries appeared to be intentional.

RECOMMENDATIONS

Rules relating to tackles, kicks and other assaults to the head or groin should be strengthened and policed. Officials, players, parents and the public should be educated to support this.

Finite element analysis in the design and characterization of an absorbable cement restrictor

The benefit of using a cement restrictor to achieve cement pressurization during total hip arthroplasty is well established. An absorbable cement restrictor design has been developed with the use of a finite element model. The non-linear axisymmetric model was used to optimize specific parameters so as to perform within acceptable limits when tested over a specified range of medullary canal sizes. The results achieved from a hybrid experimental/analytical design methodology allowed for a shorter development cycle for the initial size and each additional size in the design family thereafter. The resulting cement restrictor design was compared to and exceeded the performance of currently clinically accepted devices in resisting migration.

Should a ventilator be removed at a patient's request? An ethical analysis

The request of a ventilator-dependent quadriplegic person to be removed from the ventilator presents the health care team with an ethical dilemma. Application of ethical principles to case facts guides the decision maker. The ethical principle of autonomy requires that persons be respected and free to determine their course in life. The ethical principle of beneficence requires the health care team to actively benefit or do good for the patient. The ethical principle of nonmaleficence requires the health care team to refrain from harming a patient. The ethical duty of fidelity requires the nurse to be faithful to commitments made to patients. Ethical principles and duties are clear and straightforward. The decision of how they apply to a given case is not. However, applying them to a case, while not providing definitive answers, will provide the certainty that the decision was the best possible in a particular set of circumstances. An increasing number of cases similar to Joe's is being resolved in favor of discontinuing the ventilator. Emotional havoc could be the result to nurses who care for these patients. Individuals and institutions must begin planning strategies to deal with these and similar ethical dilemmas. Strategies might include anticipatory counseling, ethical decision making education programs and utilization of a nurse trained in ethics as a staff resource person. Nurses should attend and be involved in discussions of institutional ethics committees.(ABSTRACT TRUNCATED AT 250 WORDS)

Personality factors of critical care nurses

Two hundred members of the American Association of Critical-Care Nurses responded to a mail-out survey done to determine the psychologic profile of critical care nurses in terms of self-esteem, gender identity, and selected personality characteristics. The instruments used were Cattell's 16 PR, the Personal Attributes Questionnaire (PAQ), and the Texas Social Behavior Inventory (TSBI). Their personality factors tended to be aggressive, assertive, competitive, persevering, moralistic, resourceful, and mechanical. The nurses who enjoyed the field most were of the androgynous or masculine type and had high levels of self-esteem. On the basis of these findings, the nurse recruiter or faculty member doing career counseling could assess the personality characteristics, gender identity, and self-esteem levels of interested nurses. The goal would be to identify nurses who would both enjoy the field and remain active in critical care nursing after orientation. The goal could also be to help nurses dissatisfied with critical care nursing to seek means of improving their self-esteem.