Role of Nutrition in Heart Disease

Role of Nutrition in Heart Diseas

Medicine and Ethics

A new world has probably emerged through the progression of technology which has led to significant debates on social, cultural, legal, and ethical issues, especially in the biomedical field in this century. Application of physician-patient relationship, principles of pluralism, autonomy, democracy, human dignity, and human rights is being challenged within the medicine and health-care system of today. Development of technology-based remedies has fostered greater degrees of medicalization. Hence, the automatic application of such technologies risks distorting the nature of medicine. To be sure, there is a cultural shift that is affecting the society that is increasingly unable to adapt to traditional legal systems. This cultural shift, perhaps, demands new ethics. This entry aims to evaluate the gap between traditional deontological nature of medicine and the emerging new ethics and assess why bioethical reflection is needed

Two stage fracture of a polyethylene post in a 9-year-old posterior-stabilized knee prosthesis: a case report

<p>Abstract</p> <p>Introduction</p> <p>Several cases of tibial post breakage are reported in the literature. To the best of our knowledge, only three cases of NexGen knee prosthesis (Zimmer, Warsaw, Indiana, USA) tibial post failure have been reported.</p> <p>Case presentation</p> <p>In November 1999, a 63-year-old Caucasian woman from Italy with a history of symptomatic left knee osteoarthritis underwent a total knee arthroplasty. In March 2008, while rising from a chair, she felt a sudden pain and instability in her left knee. She reported a fracture of the polyethylene post of the tibial insert. No malposition or malalignment of either the femoral or tibial components were identified. The polyethylene tibial insert was studied under light microscopy and scanning electron microscopy. The fracture was also noted to have occurred without any notable polyethylene wear.</p> <p>Conclusion</p> <p>Scanning electron microscopy revealed two different damage patterns that could be explained with a two-stage rupture of our patient's polyethylene post. This could have been caused by a non-optimal ligamentous balancing during first implant surgery. Her knee probably developed a varus instability that weakened the post, and then a posterior anterior stress finally broke the polyethylene.</p

Optimization of wear loss in silicon nitride (Si3N4)–hexagonal boron nitride (hBN) composite using DoE–Taguchi method

Introduction The contacting surfaces subjected to progressive loss of material known as ‘wear,’ which is unavoidable between contacting surfaces. Similar kind of phenomenon observed in the human body in various joints where sliding/rolling contact takes place in contacting parts, leading to loss of material. This is a serious issue related to replaced joint or artificial joint. Case description Out of the various material combinations proposed for artificial joint or joint replacement Si3N4 against Al2O3 is one of in ceramic on ceramic category. Minimizing the wear loss of Si3N4 is a prime requirement to avoid aseptic loosening of artificial joint and extending life of joint. Discussion and evaluation In this paper, an attempt has been made to investigate the wear loss behavior of Si3N4–hBN composite and evaluate the effect of hBN addition in Si3N4 to minimize the wear loss. DoE–Taguchi technique is used to plan and analyze experiments. Conclusion Analysis of experimental results proposes 15 N load and 8 % of hBN addition in Si3N4 is optimum to minimize wear loss against alumina

Damages of the tibial post in constrained total knee prostheses in the early postoperative course – a scanning electron microscopic study of polyethylene inlays

<p>Abstract</p> <p>Background</p> <p>Investigation of the risk of fracture of the polyethylene (PE) inlay in constrained total knee prostheses.</p> <p>Methods</p> <p>Three unused and seven polyethylene inlays that had been implanted in a patient's knee for an average of 25.4 months (min 1.1 months, max 50.2 months) were investigated using scanning electron microscopy (SEM). All inlays were of the same type and size (Genesis II constrained, Smith & Nephew). The PE surface at the transition from the plateau to the post was analyzed.</p> <p>Results</p> <p>The unused inlays had fissure-free surfaces. All inlays that had been implanted in a patient's knee already had distinct fissures at the front and backside of the post.</p> <p>Conclusion</p> <p>The fissures of the transition from the plateau to the post indicated a loading-induced irreversible mechanical deformation and possibly cause the fracture of the inlay.</p

Quantitative data management in quality improvement collaboratives

<p>Abstract</p> <p>Background</p> <p>Collaborative approaches in quality improvement have been promoted since the introduction of the Breakthrough method. The effectiveness of this method is inconclusive and further independent evaluation of the method has been called for. For any evaluation to succeed, data collection on interventions performed within the collaborative and outcomes of those interventions is crucial. Getting enough data from Quality Improvement Collaboratives (QICs) for evaluation purposes, however, has proved to be difficult. This paper provides a retrospective analysis on the process of data management in a Dutch Quality Improvement Collaborative. From this analysis general failure and success factors are identified.</p> <p>Discussion</p> <p>This paper discusses complications and dilemma's observed in the set-up of data management for QICs. An overview is presented of signals that were picked up by the data management team. These signals were used to improve the strategies for data management during the program and have, as far as possible, been translated into practical solutions that have been successfully implemented.</p> <p>The recommendations coming from this study are:</p> <p>From our experience it is clear that quality improvement programs deviate from experimental research in many ways. It is not only impossible, but also undesirable to control processes and standardize data streams. QIC's need to be clear of data protocols that do not allow for change. It is therefore minimally important that when quantitative results are gathered, these results are accompanied by qualitative results that can be used to correctly interpret them.</p> <p>Monitoring and data acquisition interfere with routine. This makes a database collecting data in a QIC an intervention in itself. It is very important to be aware of this in reporting the results. Using existing databases when possible can overcome some of these problems but is often not possible given the change objective of QICs.</p> <p>Introducing a standardized spreadsheet to the teams is a very practical and helpful tool in collecting standardized data within a QIC. It is vital that the spreadsheets are handed out before baseline measurements start.</p

Opening the black box of quality improvement collaboratives: an Actor-Network theory approach

<p>Abstract</p> <p>Background</p> <p>Quality improvement collaboratives are often labeled as black boxes because effect studies usually do not describe exactly how the results were obtained. In this article we propose a way of opening such a black box, by taking up a dynamic perspective based on Actor-Network Theory. We thereby analyze how the problematisation process and the measurement practices are constructed. Findings from this analysis may have consequences for future evaluation studies of collaboratives.</p> <p>Methods</p> <p>In an ethnographic design we probed two projects within a larger quality improvement collaborative on long term mental health care and care for the intellectually disabled. Ethnographic observations were made at nine national conferences. Furthermore we conducted six case studies involving participating teams. Additionally, we interviewed the two program leaders of the overall projects.</p> <p>Results</p> <p>In one project the problematisation seemed to undergo a shift of focus away from the one suggested by the project leaders. In the other we observed multiple roles of the measurement instrument used. The instrument did not only measure effects of the improvement actions but also changed these actions and affected the actors involved.</p> <p>Conclusions</p> <p>Effectiveness statistics ideally should be complemented with an analysis of the construction of the collaborative and the improvement practices. Effect studies of collaboratives could benefit from a mixed methods research design that combines quantitative and qualitative methods.</p