The Development of Self-Efficacy to Work with Suicidal Clients

Suicide is a public health crisis which counselors must be prepared to address. In this grounded theory study, the researchers advance a model to show how counselors develop self-efficacy to work with suicidal clients. Counselor educators may use this model to improve programmatic training and supervision of students

Recurrent hemarthrosis after total knee arthroplasty

This report describes a case of spontaneous recurrent hemarthrosis of the knee that presented 4 weeks after total knee arthroplasty. Femoral arteriography showed a false aneurysm of a branch of the inferior lateral geniculate artery. Therapeutic embolization of the arterial branch was performed using three platinum coils with good clinical result and good knee joint function. Hemarthrosis has not recurred since embolization

Arthroscopic observation was useful to detect loosening of the femoral component of unicompartmental knee arthroplasty in a recurrent hemoarthrosis

A case of recurrent hemarthrosis of the knee after a mobile-bearing unicompartmental knee arthroplasty (UKA; Oxford UKA) is described. A 58-year-old man met with a road traffic accident 10 months after UKA. He developed anteromedial pain and hemarthrosis of the knee joint 1 month after the accident, which required multiple aspirations. Physical examination showed no instability. Plain radiograph revealed no signs of loosening. All laboratory data, including bleeding and coagulation times, were within normal limits. Diagnostic arthroscopy demonstrated loosening of the femoral component. Any intraarticular pathology other than nonspecific synovitis was ruled out. The loose femoral component and polyethylene meniscal bearing were revised. Since then, hemarthrosis has not recurred

HALT (Hernia Active Living Trial): protocol for a feasibility study of a randomised controlled trial of a physical activity intervention to improve quality of life in people with bowel stoma with a bulge/parastomal hernia

Background Parastomal hernia (PSH) can be repaired surgically, but results to date have been disappointing, with reported recurrence rates of 30 to 76%. Other types of intervention are therefore needed to improve the quality of life of people with PSH. One potential intervention is physical activity. We hypothesise that the intervention will increase core activation and control across the abdominal wall at a site of potential weakness and thus reduce the risk of PSH progression. Increases in physical activity will improve body image and quality of life (QoL). Methods Subjects and sample There were approximately 20 adults with a bowel stoma and PSH. People with previous PSH repair will be excluded as well as people who already do core training. Study design This is a feasibility study of a randomised controlled trial with 2 months follow-up, in 2 sites using mixed methods. Stage 1 involves intervention development and in stage 2, intervention and trial parameters will be assessed. Intervention A theoretically informed physical activity intervention was done, targeting people with PSH. Main outcome of feasibility study The main outcome is the decision by an independent Study Steering Committee whether to proceed to a full randomised controlled trial of the intervention. Other outcomes We will evaluate 4 intervention parameters—fidelity, adherence, acceptability and safety and 3 trial parameters (eligible patients’ consent rate, acceptability of study design and data availability rates for following endpoints): I. Diagnosis and classification of PSH II. Muscle activation III. Body composition (BMI, waist circumference) IV. Patient reported outcomes: QoL, body image and physical functioning V. Physical activity; VI. Psychological determinants of physical activity Other data Included are other data such as interviews with all participants about the intervention and trial procedures. Data analysis and statistical power As this is a feasibility study, the quantitative data will be analysed using descriptive statistics. Audio-recorded qualitative data from interviews will be transcribed verbatim and analysed thematically. Discussion The feasibility and acceptability of key intervention and trial parameters will be used to decide whether to proceed to a full trial of the intervention, which aims to improve body image, quality of life and PSH progression. Trial registration ISRCTN1520759

Late recovery of atrioventricular conduction after pacemaker implantation for complete heart block in congenital heart disease: fact or fluke?

OBJECTIVES: Pacemaker implantation is a standard recommendation for patients with persistent complete heart block with congenital heart disease. This study was performed to determine the incidence and clinical significance of late recovery of atrioventricular (AV) conduction following pacemaker implantation. METHODS: A retrospective study of patients with congenital heart disease needing pacemaker implantation was performed between 1977 and 2008 at our institution. The postoperative course of all patients with complete heart block, in whom a permanent pacemaker was implanted, was followed on a semi-annual basis by clinical follow-up. RESULTS: A total of 56 patients with complete heart block underwent pacemaker implantation. Indications for pacemaker implantation could be categorized in primary AV conduction block (n = 28 ; 50%) and surgically-induced AV conduction block (n = 28 ; 50%). After pacemaker insertion, recovery of AV conduction was recognized in two patients. The first patient was operated for atrial septal defect type ostium secundum with complete heart block preoperatively. AV block resolved 2 days after pacemaker implantation. The second patient underwent mitral valve replacement. Postoperatively, the patient developed second degree heart block, which progressed 3 years later into complete heart block. A recovery of AV conduction was seen 7.5 years later. In these patients, no late recurrence of complete heart block was found during follow-up after 8 and 4 months, respectively. CONCLUSIONS: Recovery of AV conduction was observed in one patient with primary AV conduction block and in one patient with complete heart block after congenital heart surgery. Lifelong cardiac pacing in these specific subsets of patients may not be necessary.status: publishe

The development of self-efficacy to work with suicidal clients

Suicide is a public health crisis which counselors must be prepared to address. In this grounded theory study, the researchers advance a model to show how counselors develop self-efficacy to work with suicidal clients. Counselor educators may use this model to improve programmatic training and supervision of students. Keywords: Counselor Education, Suicide, Self-Efficacy, Supervision, Grounded Theory

The development of self-efficacy to work with suicidal clients

Suicide is a public health crisis which counselors must be prepared to address. In this grounded theory study, the researchers advance a model to show how counselors develop self-efficacy to work with suicidal clients. Counselor educators may use this model to improve programmatic training and supervision of students