The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Apr 2005
Comparative StudyThe early effects of code 405 work rules on attitudes of orthopaedic residents and attending surgeons.
The impact of strict enforcement of Section 405 of the New York State Public Health Code to restrict resident work to eighty hours per week and the adoption of a similar policy by the Accreditation Council on Graduate Medical Education in 2002 for orthopaedic residency training have not been evaluated. Adoption of these rules has created accreditation as well as staffing problems and has generated controversy in the surgical training community. The purposes of this study were (1) to evaluate the attitudes of orthopaedic residents and attending surgeons toward the Code 405 work-hour regulations and the effect of those regulations on the perceived quality of residency training, quality of life, and patient care and (2) to quantify the effect of the work-hour restrictions on the actual number of hours worked. ⋯ On the basis of the survey data, the implementation of the new work-hour restrictions was found to result in a decrease in the number of hours worked per week for PGY-2 and PGY-3 residents and in an increase in work hours for PGY-4 residents. This could explain the definite difference between the attitudes expressed by the senior residents and those of the junior residents. Senior residents felt that their education was negatively impacted by the work rules, while junior residents expressed a more neutral view. However, senior residents did not believe that their operative experience was as negatively impacted as did junior residents. Although junior and senior residents and attending surgeons agreed that resident quality of life had improved, we were not able to determine whether this offset the perceived negative impact on education, continuity of care, and operative experience.
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J Bone Joint Surg Am · Apr 2005
Cross-cultural adaptation and validation of the Brazilian Portuguese version of the short musculoskeletal function assessment questionnaire: the SMFA-BR.
This study was designed to translate, culturally adapt, and validate a Brazilian Portuguese version of the Short Musculoskeletal Function Assessment Questionnaire (SMFA-BR). ⋯ A reliable and valid Brazilian Portuguese version of the SMFA was developed. It will facilitate the examination of functional performance within a large patient population as well as allow cross-cultural comparisons.
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J Bone Joint Surg Am · Apr 2005
A cadaveric model of the throwing shoulder: a possible etiology of superior labrum anterior-to-posterior lesions.
It has been speculated that a shift of the throwing arc commonly develops in athletes who perform overhead activities, resulting in greater external rotation and decreased internal rotation caused by anterior capsular laxity and posterior capsular contracture, respectively. Osseous adaptation in the form of increased humeral and glenoid retroversion may provide a protective function in the asymptomatic athlete but cannot explain the pathological changes seen in the shoulder of the throwing athlete. Therefore, the objective of the present study was to examine the biomechanical effects of capsular changes in a cadaveric model. ⋯ A posterior capsular contracture with decreased internal rotation does not allow the humerus to externally rotate into its normal posteroinferior position in the cocking phase of throwing. Instead, the humeral head is forced posterosuperiorly, which may explain the etiology of Type-II superior labrum anterior-to-posterior lesions in overhead athletes.
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J Bone Joint Surg Am · Apr 2005
The relationship between activity and ions in patients with metal-on-metal bearing hip prostheses.
Total hip replacements with metal-on-metal bearings are frequently implanted in young, active patients. The relationship between patient activity and cobalt and chromium ion levels has not been investigated, to our knowledge. ⋯ For these patients, serum cobalt and chromium ion levels were not acutely affected by patient activity. Periodic measurements of serum ion levels could be used to monitor the tribologic (lubrication, friction, and wear) performance of a metal-on-metal bearing without adjusting for patient activity. Additional research is needed into the kinetics of ion production, transport, and excretion.