1/3. palliative care: a challenge for orthopaedic nursing care.patients who face chronic, incurable, or life-ending musculoskeletal conditions often receive inadequate care either due to a lack of caregiver awareness or inattention to maintaining the highest quality at the end of life. palliative care focuses on the comprehensive physical, psychological, social, spiritual, and existential needs of patients with life-threatening or debilitating illness. Orthopaedic nurses and all nurses in general are challenged to incorporate palliative care principles into care planned with patients and families facing end-of-life issues. This article addresses the leadership role the National association of Orthopaedic nurses (NAON) has taken to develop a consensus document which endorses the Last Acts Precepts of palliative care and affirms the need for palliative care with patients who experience life-threatening illness. A case study is used to illustrate the opportunity a multidisciplinary team has to center care on the individual, while remaining sensitive to the holistic needs of the patient for self-determination at the end of life.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/3. Sacral insufficiency fractures in rheumatoid arthritis.methods. All patients with rheumatoid arthritis (RA) attending an outpatient rheumatology clinic at a major military medical center over 6 years were included in follow-up for the development and subsequent course of sacral insufficiency fractures. RESULTS. Sacral insufficiency fractures developed in 4 of 386 patients. Consistent with the literature, patients were female, elderly, and/or postmenopausal, had severe or long-standing disease, and were taking corticosteroids. The correct diagnosis was initially delayed because radiographs were normal but was later established with bone scan and sacral computerized tomography. Each patient improved with calcitonin and/or physical therapy over time. CONCLUSIONS. patients with RA represent a unique subgroup predisposed to insufficiency fractures because of multiple osteoporotic risk factors. patients who have RA and acute low back or buttock pain should be evaluated aggressively for sacral insufficiency fractures with bone and/or computed tomography scans regardless of normal plain radiographs.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
3/3. Painful transient tibial edema.PURPOSE: To report four cases of leg pain resembling transient bone marrow edema (TBME). MATERIALS AND methods: Four women aged 51-71 years had lower leg pain that regressed over 3-13 months. All patients underwent physical examination, clinical testing, radiography, scintigraphy, and magnetic resonance (MR) imaging. One patient underwent computed tomography; two underwent biopsy. RESULTS: All patients had tenderness at physical examination, and one had erythema and mild swelling over part of the leg. No laboratory results suggested systemic illness or infection. All had normal radiographs and abnormal bone scans, with increased radiopharmaceutical uptake in the tibial diaphyses. MR imaging showed decreased signal intensity with T1-weighting and increased signal intensity with inversion recovery. There were also signal intensity changes consistent with edema in the surrounding soft tissues. Biopsies showed focal marrow fibrosis and new bone formation with foci of devitalized bone. CONCLUSION: These cases resemble TBME but are unusual in their distribution. Whether they represent a previously undescribed clinical syndrome or a variant of TBME remains to be clarified.- - - - - - - - - - ranking = 24.372626004383keywords = physical examination, physical (Clic here for more details about this article) |